Good Health Magazine, a monthly publication from Scripps Howard, serves as the medical crossroads where top local physicians  bring patients the latest news  about  treatment, technology, and medicine.

• Associate Publisher – Elizabeth Williams
• Editor – Ginger H. Porter
• Feature Editor – Holli W. Haynie
• Creative Director – Jada Thompson
• Account Executive - Mary Newman

For more information on how to advertise your medical practice in Good Health, please contact Elizabeth Williams at 901.529.6502 or e-mail williamse@goodhealthmemphis.com

Take a brief survey about orthopaedic health and you could win tickets to a Memphis Redbird game!

Role model? An African proverb says, “It takes a whole village to raise a child.” – I have modeled my life after many in my village! While growing up, I had an opportunity to work for many successful people. They each excelled at some aspect in their lives. One in particular was an orthopaedic surgeon who actually was the son of my employer. I followed his journey through medical school and residency. While being a terrific surgeon, he never lost sight of his family’s needs. Others who inspired me were everyday people who diligently sought to excel in their work. Each stood out in their particular field as a result of their determination.

What motivates you? Owing to the fact my father died at a young age, academic opportunities were heavily dependent on my resourcefulness. Faced with my mother’s challenges raising five children, I realized the need to be self-reliant. This motivated me to strive for success through hard work. I am blessed with sufficient health and energy to continue that today!

If you were not a doctor? I would have a career that involved affecting people’s health and life choices – maybe in the form of education or developing a company aimed at life coaching.

What is the most exciting medical breakthrough you’ve witnessed in your career? The advent of more sophisticated instruments has allowed surgeons to accomplish reconstructive surgery through smaller incisions.  This has resulted in less surgical trauma to the normal structures that stand between the outside world and the structure affected by the condition.

What is your favorite quote? Don’t aim for success if you want it; just do what you love and believe in, and it will come naturally. - David Frost

Where do you see your specialty in 10 years? In ten years, more choices will be available for arthritis conditions that currently affect millions of Americans. These will include products we inject or implant that will restore the damaged cartilage to a more consistent living cellular outcome.

My patients… Inspire me to maintain my humanity and knowledge to resolve health challenges they bring to me.

Good health advice? If you don’t use it, you will lose it! Our bodies LOVE variety and moderation in all things we do!

The life of Kevin Merigian, M.D., is an amalgamation of science and art. A modern-day Renaissance man skilled in both the creative and the analytical, he has a broad base of knowledge in multiple disciplines. As an artist, he works in a broad variety of media. As a doctor, he merges training in emergency medicine, toxicology and pharmacology for the benefit of his patients.

His practice, The Stone Institute, seeks to streamline the care path of the patient.

“The Institute was originally established for wellness promotion,” Merigian said. “however, the patients who came were in a disjointed model where a number of specialists see them independently of each other. They were saying, ‘Can you integrate this? We’re having side effects. Can you help us?’”

Dr. Merigian also integrates medicine into his art – and art into his medicine. He has been known to melt down X-rays into shapes and forms and pour plaster into them to make cloudlike shapes. The ink washes in his conference room were actually done with a syringe, created by ink pulsing through a needle onto paper. Dr. Merigian’s patients are given paper and a bowl of crayons and markers as they wait in an exam room. Their creations not only occupy them as he prepares for their appointment, but they also give him a peek into their psyche as he takes their history.

“You can tell a lot from their art as you greet them. If they are drawing in the corner of the paper and the whole sheet is not utilized, then it is a self-esteem issue,” he said. “There was a woman who drew a stick figure with red lines around the wrists, ankles and neck…now you know that person is not in a great emotional place.”

A trip to his office revealed a lobby filled with sculpture, photos and sketches. The hallways were lined with Dr. Merigian’s prismatic paintings, rich in bright, beautiful hues. There were some paintings and pottery works given to him by his patients. He showed one earthy, glazed bowl in particular.

“I would never sell it. It is a prized possession. That’s a piece of her (the patient’s) soul sitting there,” he said.

When The Stone Institute opened in 2000, he spent hours making handmade cards for his patients. When the caseload grew, he began printing reprints of his original cards and supplying various poems for them. He estimated he has written hundreds of poems. One called “Clouds of Terror,” sits framed in the lobby as a memorial to the victims of 9/11. Dr. Merigian was sent to the Pentagon in the aftermath to render treatment and received a Distinguished Services Award from the Tennessee Medical Association for his efforts. The doctor also has written between 20 and 30 songs, co-authored a novel and is working on another. He has six other books outlined to write. In addition, he is currently taking scraps from a metal roof installation on his home and welding it into sculptures for his backyard. When asked how he accomplishes so much, he has an easy answer.

“As Americans, we multitask and we can never complete anything, but we’re doing lots of stuff. I have more of a European consciousness, where I feel you ought to pick out a project and take it to its end. Then, go to the next thing. I get more done that way,” he explained.

The mosaic of this physician/artist’s history has been a series of unlikely juxtapositions. Poverty was overshadowed by opportunity through Cranbrook High School in Bloomfield Hills, Mich. The boarding school had an art center in the middle of the campus, a planetarium, a theater and science and computer labs—and this was in the 1970s. It was a unique education experience for this boy from the wrong side of the tracks in Detroit. He applied, tested and went on a full scholarship.

“Cranbrook is like nothing else imaginable. It was the number one thing that changed me as a person,” Dr. Merigian said.

From Cranbrook, it was off to Kalamazoo College and then medical school at Michigan State University. He completed an internship and residency in emergency medicine at University of Cincinnati Hospital as well as postgraduate education in toxicology/pharmacology.

Although he came from a family of artists, he was not encouraged to go in that direction. His uncle, his aunt, brother, sister, father and grandfather were all artists, but his father was worried about his kids not being able to make a living.

“I became a physician to impress my father, but my true passion is the arts,” he said. “Art is something I am driven to do. People will tell me maybe it’s my therapy, but even if it is, that in and of itself is enough to do it.”

by Ginger H. Porter

Allows surgeons to provide a more customized and precise implant fit for knee replacement surgery.

As our “baby-boomers” grow older, the number of knee replacements will dramatically increase over the next 20 years. In fact, the total number of knee replacements performed annually in the U.S. will jump 525 percent by the year 2030. This trend is being driven by patients leading more active lifestyles which put them at a higher risk for joint complications and arthritis at an earlier age. In addition, as the population ages, a greater need for these surgeries among the baby boomer generation will arise. The advancements in knee replacement technology have also made an impact in the number of people opting to undergo this type of elective surgery.

One of these latest advancements in knee replacement is now being offered by Timothy Krahn, M.D. of orthomemphis p.c. This brand new pre-operative scanning technology allows surgeons to envision the results of surgery before it actually occurs. Developed by Wright Medical, PROPHECY™ Pre-Operative Navigation enables surgeons to utilize basic CT and MRI technology to plan precise implant placement and alignment before they even enter the operating room.

Before, surgeons relied on traditional instruments to shape the bone and align the implant during surgery. By utilizing PROPHECY™ Pre-Operative Navigation prior to surgery, surgeons can enter the operating room with a well-defined plan, which eliminates the need for some of the decision-making that has to be made during a typical knee surgery. This allows patients to receive a more precise and customized procedure that allows the knee implant to fit the patient’s own unique knee anatomy.

PROPHECY™ Pre-Operative Navigation guides are much less invasive than traditional instruments used during knee surgery and are designed to provide a surgical placement that is matched more closely to each individual.

“The end result is to improve accuracy to allow for greater function and long-term survival of the implant,” said Dr. Krahn. “Placing the implant in the exact place eliminates the chance for misalignment of the implant. When an implant is not properly aligned, you put the patient at a greater risk for early implant failure. This new technique ensures that the implant is positioned to match the patient’s own anatomical shape in order to provide the patient with a customized fit.”

The process for the PROPHECY™ program begins several weeks in advance of the procedure. The patient undergoes a CT or MRI scan which follows a strict protocol in order to obtain information of the full leg. Then, a virtual pre-operative alignment is performed according to the surgeon’s preferences. The surgeon will then receive a presentation of the surgical plan detailing the accuracy of the alignment, sizing, and placement. After the surgical plan is approved by the surgeon via the PROPHECY™ program website, patient-specific PROPHECY™ guides are manufactured using a rapid prototype machine. Once this process is complete, the surgeon can perform the knee replacement.

Dr. Krahn recently had great success with the PROPHECY™ program for one of his young patient’s second knee replacement. Craig struggled his entire life with painful and debilitating juvenile rheumatoid arthritis. His pain was so severe that he was forced to rely on a wheelchair to get around. Throughout high school, he could not attend social gatherings or play sports; leaving him feeling trapped in his own body.

“Going into Craig’s second replacement, I felt more confident in my technique,” said Dr. Krahn. “Because of Craig’s arthritis, his knees were severely deformed which increased the difficulty of his first surgery. The biggest advantage in using PROPHECY™ navigation is in cases where traditional instrumentation cannot be properly used, such as Craig’s case. The customized guides allow me to place the implant in the exact orientation I want. As a surgeon, it gives you more confidence which, in turn, ensures that my patients are receiving the best care.”

Since having his double knee replacement, Craig’s quality of life has vastly improved. Instead of listening to his brother and friends talk about their weekend plans, he participates in an active social life. He attends concerts, football games and church and no longer needs help getting dressed. He even assumed responsibility for walking the family dog.

“Stories like this reinforce why I became a surgeon,” said Dr. Krahn. “Knowing you can help improve a person’s quality of life; nothing beats that feeling. Thanks to companies, such as Wright Medical, who have taken tremendous strides forward in providing medical advancements for orthopedic surgery, more people can benefit from joint replacement than ever before.”

PROPHECY™ Pre-Operative Navigation was developed by Arlington, Tenn. based Wright Medical Technology, Inc.. Wright Medical Group, Inc. is a global orthopaedic medical device company specializing in the design, manufacture and marketing of reconstructive joint devices and biologics. The company has been in business for more than 50 years and markets its products in over 60 countries worldwide. For more information about Wright Medical, visit our website at www.wmt.com/prophecy.

A rotator cuff tear is a common cause of pain and disability among adults. The cuff can be torn from a single traumatic injury triggering onset of pain lasting for several months. A cuff tear may also happen at the same time as another injury to the shoulder, such as a fracture or dislocation. Even so, most tears are the result of overuse of these muscles and tendons over a period of years. People who are especially at risk for overuse are those who engage in repetitive overhead motions. These include participants in sports such as baseball, tennis, weightlifting, and rowing. Symptoms usually include:

1. Pain when lifting the arm

2. Pain when lowering the arm from a fully raised position

3. Weakness when lifting or rotating the arm

4. A crackling sensation upon certain shoulder positions

5. Inability or difficulty in removing and wearing clothing

6. Thinning of  the muscles about the shoulder

Cuff tear diagnosis is based on symptoms and physical examination. X-rays and MRI are also helpful. In many instances, nonsurgical treatments such as these can provide pain relief and improve function:

– Rest and limited overhead activity

– Use of a sling

– Medications

– Steroid injection

– Strengthening exercises

– Physical therapy

Surgery may be recommended if nonsurgical treatment does not relieve symptoms. It is also indicated if the tear has just occurred and is very painful, it is a full-thickness tear, or the tear is in the dominant shoulder of an active person. In the event maximum strength in the arm is needed for overhead work or sports, surgery can also be considered.

Many surgical repairs can be done on an outpatient basis. After surgery, the arm is immobilized to allow the tear to heal. An exercise program will help regain motion and strength in the shoulder. Of course, a strong commitment to rehabilitation is important to achieve a good outcome.

Apurva Dalal, M.D., is a board-certified orthopaedic surgeon specializing in arthroscopic surgeries of the knee and shoulder joints. He completed his residency in orthopaedic surgery at the Albert Einstein School of Medicine, Bronx-Lebanon Hospital, New York, and his fellowship training in total joint replacement surgery at the Center for Hip and Knee Surgery, Mooresville, Ind.

On May 19, CFI hosted an educational event geared toward informing and training patients and health care professionals on the latest developments in “bionic” lower limb prosthetics.  The event, titled “C-Leg Roadshow” featured nine patients, ranging in age from six to 60 years old.  In addition to CFI clinical personnel, representatives from Otto Bock Healthcare, local physical therapists and other medical practitioners were on site.

“The Roadshow allowed us to give patients a chance to really see what the technology is all about, and an opportunity for them to test out and feel the difference between their current prostheses and one that is microprocessor controlled. Patients who were interested in making the shift from a conventional prosthesis also had occasion to talk with one of our experienced C-Leg wearers who attended the show in order to provide first-hand information,” said Ted Snell, C.P., L.P., and president of CFI.

“We are going to be conducting these types of forums on a regular basis,” said Sean Snell, vice president of operations and marketing.  “There is just a tremendous amount of innovation going on in both orthotics and prosthetics right now.  Much of this is to the point that we can now introduce it to the patients and healthcare professionals.  Our next educational event will surround new myo-electric applications for lower extremity orthotics, followed by a workshop on upper extremity ‘bionic’ prosthetics.”

The practice has also recently expanded and renovated their facility at 1665 Shelby Oaks Drive. Before the changes, patient care was in one building and the lab and some administrative offices were in another. Having everyone in the same building has increased efficiency and more importantly, has allowed the company to provide even more effective patient care through its innovative lab.

“Now, we have been able to design and construct the ideal laboratory,” said Mike Smith, vice president of Corporate Contracting.

The Snell family, which owns and operates CFI Prosthetics Orthotics has been in the orthotics and prosthetics field in Memphis and surrounding area since 1911.  Company president Ted Snell is the 4th generation in the family to head the business and Sean Snell represents the 5th generation of Snells in the practice.

CFI has three locations: one at 1665 Shelby Oaks Drive, one in Southaven, Mississippi, and one in Campbell Clinic.

For more information regarding microprocessor prosthetics and orthotics as well as diabetic shoes and custom inserts, CFI can be contacted at 901-725-0060 or through their website at www.cfipando.com.

Elbow injuries are common but increase in the springtime as people increase their outside activities such as racquet sports, golf, and yardwork. Two very common sources of elbow pain are tennis elbow (lateral epicondylitis) and less commonly golfer’s elbow (medial epicondylits)

Lateral epicondylitis is much more common than medial epicondylitis, It is known as tennis elbow because if affects 25 to 50 percent of tennis players at some point in their career. However, most patients with tennis elbow are not involved in racquet sports. Anyone using repetitive movement at least two hours a day is at greater risk. People who smoke also have a higher risk of developing tennis elbow. Tennis elbow can result in chronic pain — especially when lifting or gripping objects. The dominant arm is most often involved, and sufferers are usually aged 30 to 50.

The cause of both is repetitive forearm motion causing stress over the outside (lateral epicondylits) or inside (medial epicondylits) of the elbow. Eventually inflammation develops from small “microtears” in the tendon insertions around the elbow, causing pain on the outside or inside of the elbow which worsens over weeks to months. The conditions are diagnosed through a complete medical history and physical exam. The physician will apply pressure to the bony prominences on each side of the elbow to test for pain. He or she will also test for elbow pain with finger, wrist and elbow motion. Usually, imaging tests such as X-ray, CT, or MRI are not necessary for diagnosis.

Nonsurgical treatment is usually very successful. Activity modification, ice, anti-inflammatory medication, cortisone injections and counterforce bracing can all play a role in treatment. Physical therapy consisting of stretching, range of motion exercises and strengthening is sometimes required.

Although 85 to 90 percent of cases are resolved thorough nonsurgical treatment, surgery is sometimes required. Surgical treatment is reserved for severe cases not responding adequately to at least six months of conservative treatment. An outpatient procedure, surgery involves removing the degenerated tendon tissue and reattaching healthy tendon to bone. This is done under either general or regional anesthesia.

After surgery, a splint is worn for approximately one week. Then physical therapy starts for gradual stretching and increasing range of motion. Strength training is gradually added. Full athletic activity is generally permitted after three to six months.

As with most orthopedic injuries, the best prevention is maintaining a healthy lifestyle through an appropriate diet and regular exercise. Golfers and tennis players need to have a professional review their technique. Sports enthusiasts should prepare for any sport season with appropriate conditioning and strength training. Always be sure to warm up properly before a sports activity. Gently stretch the forearm muscles at your wrist before and after use. After heavy use of your arm, apply an ice pack or use ice massage, which can be accomplished by filling a sturdy paper or plastic foam cup with water and freezing it. Then, roll the ice directly on the outside of your elbow in a circular motion for five to seven minutes.

Before the doctor appointment:

Write down any symptoms including any that may  seem unrelated.

Make a list of all your medications as well as any vitamins or supplements.

Write down questions to ask your doctor.

Questions for your doctor include:

What’s the most likely cause of my symptoms?

Are there any other possible causes for my symptoms?

What kinds of tests do I need?

Is my condition likely temporary or chronic?

What treatments are available, and which do you recommend for me?

Are there any exercise restrictions that I need to follow?

Are there any brochures or other printed material that I can take home with me?

What Web sites do you recommend visiting?

What to expect from your doctor:

Your doctor is likely to ask you a number of questions as well, such as:

Where is your pain located?

When did you first begin experiencing symptoms?

Have your symptoms been continuous, or occasional?

How severe are your symptoms?

What, if anything, seems to improve your symptoms?

What, if anything, appears to worsen your symptoms?

Have you had any medical treatment for this condition previously?

What you can do in the meantime:

While you are waiting to see the doctor, stop doing the exercise or activity that worsens your symptoms, if possible. Ice the area several times a day for about 15 minutes at a time. Wrapping the area with an elastic wrap or bandage also may help keep swelling down. Use of over-the-counter anti-inflammatory medications may help temporarily, but they are not recommended for long-term use due to gastrointestinal problems.

Christopher Ferguson, M.D., earned a medical degree from University of Mississippi School of Medicine, in Jackson, Miss., and he completed his residency in orthopaedic surgery there as well. Dr. Ferguson completed a special trauma fellowship in Chur, Switzerland, and is currently earning his board certification.

“When patients receive knee implants they may lack the confidence to engage in some of the activities of daily life – especially those that require bending,” said  Patrick Treacy, vice president of marketing, Stryker Orthopaedics.

“Movements – especially those that require bending, like tying shoes or putting socks on – can be difficult in many cases,” Treacy said.

However, he said, the Stryker Triathlon Knee System is designed to imitate the natural movement of the knee joint, resulting in a natural feel for the patient. “Not only does this implant bend and rotate, but it is also designed for natural motion,” Treacy said. “The design addresses patients’ concerns, increasing the extent to which they can bend their knees after the implant.”

The design of this knee system takes into account the amount of flexion, which is the bending position that is made possible by the joint angle decreasing. Flexion involves the skeletal and muscular systems working together to move the joint into a flexed position. The Triathlon Knee System allows up to 150 degrees of flexion, “Flexion essential to descending stairs, sitting down, and gardening are taken into consideration,” Treacy said. “Right after the operation, I felt it had been a success. I have my life back again.” said Cindy Goodfellow, who received a Stryker Triathlon Knee in 2005. With any surgery individual results will vary including recovery time and post-operative activity levels.

For more information about Stryker joint replacements, call 1.888.Stryker or visit Memphis.aboutstryker.com.