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MICHIGAN MEDICAL REPORT
FromthephYSicianSatSt.JoSephmercYoaKland
Summer2010
FOCUS : ORTHOPEDICS
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anklejointreplacement
relieffromhippain
treatingfragilebones
healingarotatorcufftear
otherneWS
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overcomingurinaryincontinence
Summersafetyforkids
tiFrelieveschronicheartburn
Shingles:apainfulrash
managingyourweight
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Helping restore quality of life
A message from Christopher
L. Tisdel, MD, Chair, Division of
Orthopedics
CHRISTOPHER L.
TISDEL, MD
The St. Joseph Mercy Oakland
(SJMO) orthopedics division has a
special mission: to give hope, new
life and new function to patients
seeking relief from bone and joint
pain or injury.
In performing our mission, we treat not only a specific
medical problem but also the whole patient—body, mind
and spirit. We do this by being dedicated to personal,
compassionate care; making patient safety our No. 1 priority; achieving successful outcomes; and recruiting skilled,
experienced physicians.
Most of our orthopedic surgeons have completed fellowships in such specialties as hand, shoulder, foot, ankle and
spine care; joint replacement; and sports medicine. The
orthopedic care at SJMO is equal to what patients experience in large university and hospital health systems, but it
is delivered, we believe, at a more personal level.
In addition to traditional surgery, we treat patients with orthopedic problems with physical therapy and minimally invasive,
outpatient surgery. We are constantly improving upon these
techniques so that patients will have shorter hospital stays, less
pain, fewer complications and faster recovery times.
Another technique introduced
this year is ankle joint replacement. This improved implant
technique will help patients
with chronic ankle ar thritis
pain. SJMO is also using a new
type of shoulder replacement
implant that helps patients gain
improved range of motion. A
third advancement is tissue engineering, which involves
the use of platelet-rich plasma to treat muscle, ligament
and tendon injuries.
The availability of new technologies, larger operating suites
and our new Surgical Pavilion allow our orthopedic surgeons to improve care and increase patient safety. Technologically advanced, ceiling-mounted, mobile equipment
allows physicians to view sharper digital images of x-rays
and CT and MRI scans without ever leaving the patient’s
side during surgery.
Meanwhile, our orthopedic unit has been updated and made
more user-friendly. Designed specifically for the orthopedic
patient’s needs, the unit has private rooms, enlarged doorways to accommodate walkers, a new non-slip floor that
helps prevent falls, and aesthetically pleasing rooms and
hallways conducive to comfort and healing.
Our skilled nursing staff helps the healing process by ensuring that patients have a memorable experience with
Overcoming urinary incontinence
Women, you know the feeling. You laugh a little too hard.
You cough or sneeze, and—uh
oh—leakage. What you’ve experienced is urinary incontinence.
having urinary incontinence during perimenopause or
menopause. Other causes are engaging in high-impact
physical activity, having a history of surgery involving the
pelvic organs, or consuming a lot of caffeine or alcohol.
Obesity can make the issue worse.
BACKGROUND According
to St. Joseph Mercy Oakland
Lisa Helmick, DO
obstetrician/gynecologist Lisa
Helmick, DO, urinary incontinence refers to an involuntary loss of urine. Women
are more likely to experience incontinence, Dr. Helmick
says, because of childbirth, decreasing hormone levels, a
genetic predisposition or an overactive bladder. Age is
a factor as well, and women have a greater chance of
When you urinate, the muscles in the wall of the bladder
contract, pushing urine out of the bladder and into the
urethra, which is controlled by the sphincter muscle. This
muscle relaxes, and urine passes from the body. Incontinence most often occurs when the bladder muscles suddenly contract and the sphincter muscle cannot hold back
urine, such as with an overactive bladder, or when there is
a sudden increase in abdominal pressure that overcomes
the sphincter muscle, like when you cough or sneeze.
Overactive bladder and urinary tract infections (UTI) are
related to urinary incontinence.
“Patients with an overactive bladder can present with
the same symptoms as with a bladder infection,” such as
a frequent urge to urinate, Dr. Helmick says. However,
there’s a difference. The UTI is an inflammation, whereas
overactive bladder is “a problem with the nerve responses
involving the bladder. The bladder muscle contracts when
it shouldn’t.”
TYPES OF INCONTINENCE There are four types of
incontinence:
●● Stress: A leakage of urine because of increased abdominal pressure, usually caused by coughing, sneezing or laughing
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personal care—from the time they are admitted through
discharge.
It’s no wonder that SJMO’s orthopedic program wins so
many awards for orthopedic and joint replacement excellence. Our newly renovated Joint Care Center is the standard
for such centers around the country, especially in the areas
of patient outcomes and efficiency. SJMO’s Foot and Ankle
Center is recognized nationwide for the skill and expertise
of its orthopedic surgeons. Recently, SJMO was named a
Blue Cross Blue Shield of Michigan Blue Distinction® Center
for Knee and Hip Replacement.
Our reputation for orthopedic excellence is known throughout Michigan, and patients from around the state come to
St. Joe for treatment. Since the Joint Care Center’s opening in
1998, more than 6,700 patients have had their quality of life
restored thanks to the expert care of SJMO’s orthopedics
department. When you need relief from bone or joint pain
or injury, you can feel confident that our dedicated, experienced physicians will provide extraordinary care.
●● Urge: An inability to get to the restroom in time, which
often coincides with overactive bladder
●● Functional: A person has impaired mobility or cognition, such as a spinal cord injury or dementia, or doesn’t
realize he or she needs to use the restroom
●● Transient: Occurs when there’s an underlying condition affecting the bladder, such as medication, bladder
infection or irritation of the bladder, but is resolved after
treatment
TREATMENT To treat incontinence, the physician will
do a thorough medical history review and physical exam
and assess the patient’s symptoms, including the impact
incontinence has on her quality of life. The physician will
obtain a urine sample to determine if there’s an underlying infection or measure the amount of urine remaining in
the bladder after urination. He or she may order further
testing—complex urodynamic studies—to better evaluate
the exact cause of incontinence.
“The first line of treatment is behavior modification,” such
as weight loss, diet changes, reducing fluid intake and bladder training, Dr. Helmick says.
Other treatments include Kegel exercises to strengthen
the muscles of the pelvic floor, and surgery and medication to decrease the amount of bladder spasms. The
correct treatment option depends on the cause of the
incontinence.
REFERRAL For a referral to a St. Joe obstetrician/
gynecologist or urologist near you, call the referral line at
800-372-6094.
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w e l l n e ss
Make sure summertime is a safe time for kids
When you send the kids outside
to have some summer fun, how
do you keep them safe?
Kingsley A.
Thomas, MD
guards and not ride or skateboard in the street.
Lawn mower safety. When mowing the lawn, keep children
a safe distance away to prevent injury. “A child should never
be in front of a lawn mower, nor should he be allowed to
ride a lawn mower by himself,” Dr. Thomas says.
St. Joseph Mercy Oakland (SJMO)
pediatrician Kingsley A. Thomas,
MD, says there are a lot of ways
to protect your kids from injuries
and other hazards this summer.
Having access to an urgent care center or first aid kit is
always wise, he adds.
Stranger danger. The most important information a parent can give a child is a warning about strangers. Parents
should be familiar with the local playground and advise
their children to stay away from bushes and shrubbery
where strangers can hide. Children should also be advised
to stay away from unfamiliar animals, who might have rabies.
Physical exam. Summertime is also a good time to get
your child a back-to-school physical. “It’s the best time to
catch up on immunizations” and check the child’s overall
health, Dr. Thomas says. The physician also can talk to an
older child about drug abuse, sexually transmitted diseases
and eating disorders. The exam also is a good opportunity
to discuss preventing obesity.
Sun safety. “Parents should protect their children from extensive exposure to sunlight,” Dr. Thomas says. “Children’s
bodies should be covered—and include a hat.”
The annual physical also is an opportune time for the
physician to address changes in young patients’ bodies. The
physician also can do a sports physical to ensure that the
young athlete—male or female—is in shape for sports.
Protective lotion with a minimum 30 SPF (sun protection
factor) should be applied.
Helmets protect kids when riding bikes.
Hydration. Children should be well-hydrated. Dr. Thomas
says if they’ve gone more than four hours without urinating,
“that indicates they’re not getting enough fluid.” Children
should drink only water or liquids with electrolytes.
Water safety. At the pool or lake, “kids should always have
a life vest,” Dr. Thomas says. Parents should never leave a
child unattended, and there should always be a lifeguard
or someone able to swim on-site.
Insect repellent. Prevent bug bites with insect repellent,
but, Dr. Thomas cautions, “test the spray on the back of
the hand first to see if there’s a reaction, and never use
the spray on a child under 4 years of age.” If a bug bite is
red, swollen or burning or there’s persistent itching, take
your child to his or her physician.
Bikes and skateboards. Bikes and skateboards can be a
lot of fun, but using them in an unsafe manner and without
proper protection can be harmful. Dr. Thomas recommends
that kids wear helmets, knee and elbow pads, and wrist
Another aspect to the physical is an emotional inventory
of the child. A physician can look at the child’s emotional
makeup during the exam and make referrals if the child
needs help.
“We have been entrusted with the joys of having children,”
Dr. Thomas says. “We have an opportunity for our child
to get the best education and the best health information a child can have.”
To find an SJMO pediatrician, call the referral line at
800-372-6094.
SJMO COMMUNITY EVENTS
Community Orthopedic
Seminars
Metabolic Nutrition and Weight Management Program
One Tuesday a month
6 to 7 p.m.
St. Joseph Mercy Oakland
Franco Communications Center
44405 Woodward Ave.
Pontiac
Free
Learn about St. Joseph Mercy Oakland’s (SJMO) comprehensive team
approach to orthopedics and joint
replacement:
●● “Shoulder,” Matt Bahu, MD, July 27
●● “Knee,” Jignesh Patel, DO, Aug. 24
●● “Minimally Invasive Shoulder,”
Richard Bartholomew, DO, Sept. 28
●● “Foot and Ankle,” Christopher
Tisdel, MD, Oct. 26
●● “Total Joint Replacement,” Safa
Kassab, MD, Nov. 16
Registration is required; call 800372-6094. Light refreshments will
be provided.
Second and fourth Tuesdays
6:30 p.m.
St. Joseph Mercy Oakland
Franco Communications Center
44405 Woodward Ave.
Pontiac
Free informational seminar
Conducted by Tom Rifai, MD, Medical
Director, SJMO Metabolic Nutrition and
Weight Management Program. These seminars provide information about the serious
medical complications of being overweight
and how SJMO’s program can help you.
For information, call 248-858-2475.
Diabetes Health Seminars
Thursdays, July 15, Aug. 5 and 19, Sept. 2 and 16, Oct. 7 and 21, Nov. 4 and 18, Dec. 2 and 16, Jan. 6 and 20
Mercy Place
55 Clinton St.
Pontiac
S u m m e r
Free
Topics include a description of diabetes,
the importance of blood glucose monitoring, diabetes and nutrition, diabetic
foot care, exercise, and medical management. Includes support sessions and
community forums. For information, call
248-333-0840, ext. 231.
Michigan Bariatric Institute Seminars
Mondays, July 19, Aug. 23, Sept. 20, Oct. 18, Nov. 15, Dec. 20
6 to 7:30 p.m.
St. Joseph Mercy Oakland
Franco Communications Center
44405 Woodward Ave.
Pontiac
Free
Learn about minimally invasive bariatric
surgery options from Jacob Roberts, DO,
bariatric and general surgeon. Registration required; call 877-WHY-WEIGHT
(877-949-9344).
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MICHIGAN MEDICAL REPORT SPEAKERS
BUREAU
The Michigan Medical Repor t
Speakers Bureau has qualified health care professionals
who speak on a wide range
of topics to community
organizations.
If your group would like
to have a speaker on a
particular topic, please call
St. Joseph Mercy Oakland Public Relations Specialist Heidi
Press at 248-858-6662.
Speaker appearances are free
of charge.
Orthopedics
Excellent care for your bones and joints
Ankle joint replacement
don’t work, ankle joint replacement may be necessary.
Total ankle joint replacement removes and then replaces
both sides of the ankle joint with specially designed prostheses. The tibial prosthesis consists of a polyethylene and
titanium base plate tray that is inserted into the tibia and
fibula, giving the implant a wide base for support.The upper
portion of the talus, the bone that moves up and down, is
replaced with a prosthetic made of cobalt chromium alloy,
a metal commonly used in joint replacement prostheses.
Take the first step
Your ankle really hurts. Maybe it
was that broken ankle you had
as a child that’s causing you pain
today. Perhaps it’s those extra
pounds. Now that arthritis has
set in, you need to do something
about it.
Each artificial ankle prosthesis is made up of two parts:
●● The tibial component is the metal and polyethylene
portion of the joint replacement that replaces the socket
of the ankle (the top portion).
●● A metal component replaces the talus—the bone of
the foot that forms the lower part of the ankle joint.
CHRISTOPHER L.
TISDEL, MD
St. Joseph Mercy Oakland’s
(SJMO) skilled orthopedic surgeons are using a proven technique to restore arthritic
ankles—ankle joint replacement.
BACKGROUND Christopher Tisdel, MD, Chair of the
SJMO Division of Orthopedics and a pioneer in joint
replacement, offers the latest advancements in ankle
joint replacement, an effective and viable alternative to
traditional ankle fusion. The result is greater mobility for
patients who wish to gain range of motion and resume
an active lifestyle.
CAUSES Ankle pain can be caused by arthritis—which
can occur after a previous ankle injury—rheumatoid
arthritis, infection, a genetic tendency to wear out joints and
Hip replacement surgery
Don’t let hip pain
keep you down
Safa Kassab, MD
As the population ages and continues to enjoy physical activity
throughout life, older adults may
experience hip pain or fractures.
St. Joseph Mercy Oakland’s
(SJMO) award-winning, experienced orthopedic team stands
ready to care for you when you
need treatment.
CAUSES Many patients endure hip pain for a long time,
and it affects their daily lives. Some of the reasons for
pain include:
●● Osteoarthritis. Over time and with heavy use, parts
of the hip can wear away. This causes severe pain when
bone grinds against bone. New bone that forms around
the joint is called an osteophyte, or bone spur, which makes
walking and other activities difficult and painful.
●● Rheumatoid arthritis. Occasionally the immune system will attack different body parts. When a joint, such
as the hip, is involved, it is called rheumatoid arthritis.
Typically, the linings of the joint are eaten away, leaving
excessive weight. Symptoms include:
●● Ankle stiffness
●● Swelling around the joint
●● Bone spurs
●● Joint deformity
●● Instability of the ankle
“Similar to other joint replacement surgeries, ankle joint
replacement is not for every patient experiencing pain,”
Dr. Tisdel says. “Careful evaluation, coupled with the patient’s health history and desired outcomes, are critical to
opting for replacement surgery.”
TREATMENT Ankle arthritis is diagnosed with an examination and x-rays. Typical treatments include footwear
changes, modifying activities, braces, anti-inflammatory
medications or a cortisone injection. However, when these
Following rehabilitation therapy, most patients can resume
the activities that ankle pain kept them from enjoying.
REFERRAL For a referral to a St. Joe orthopedic specialist,
call the referral line at 800-372-6094.
little or no protection in the hip joint. As with
osteoarthritis, the ability to move is greatly
hindered.
●● Traumatic arthritis. Abnormal wearing
away and inflammation of the hip can occur
when a trauma, such as a fracture, has impacted
the hipbone or tissues around the hip.
“When the tissues of the joints start wearing
away to a point where you dread the thought
of having to walk or move, it is time to think
about joint replacement surgery,” says Safa
Kassab, MD, an orthopedic surgeon at SJMO.
“Hip replacement has proven to be one of the
most successful surgeries in modern medicine.”
TREATMENT Hip replacement surgery involves removing
the arthritic femoral head (the ball of the ball-and-socket
joint), coring out the socket, and replacing it with a titanium
or cobalt chromium joint. As with all joint replacement
surgeries, the new joint is precisely aligned to fit the
patient’s body.
A recent advancement in orthopedic surgery is the use
of a minimally invasive technique in which the surgeon
makes one to two incisions that are two to five inches
long. Compared to open or conventional hip surgery, the
replacement is made with smaller incisions. By using the
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With the minimally invasive
technique, patients experience
less blood loss and pain.
minimally invasive technique, the patient experiences less
blood loss and pain, a shorter hospital stay, reduced scar
appearance, and faster healing.
“When followed by rehabilitation, hip replacement can
significantly relieve pain and restore range of motion and
function of the hip joint,” Dr. Kassab says.
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oSteoporoSiS
treatmentForFragileBoneS
Medical headlines and the media
have helped raise awareness of
osteoporosis. Understanding this
disease, which most often affects
women, is the key to early prevention, diagnosis and effective
treatment.
SHIVAJEE
NALLAMOTHU, DO
BacKgroundShivajee Nallamothu, DO, is part of an expert
team of orthopedic surgeons at St. Joseph Mercy Oakland
(SJMO) that understands osteoporosis—having fragile
bones—and the injuries that can result from it. More than
10 million Americans currently have osteoporosis, with
women representing 8 million of those affected.
“Unfortunately, osteoporosis is one of those diseases
that is often diagnosed only after a patient suffers a bone
fracture,” Dr. Nallamothu says. “Early prevention can make
all the difference and truly proves that an ounce of prevention is worth a pound of cure.”
cauSeSDefined as the thinning of bone tissue and loss
of bone density, osteoporosis rarely becomes apparent
until later in life. As a person ages, bone pain and fractures
are more likely to lead to the diagnosis and treatment
of osteoporosis.
Risk factors for osteoporosis include:
● Age and gender
● Family history
● Diet and exercise
● Taking certain medications
● Certain illnesses
Diagnostic tests for osteoporosis involve measuring a
patient’s bone mineral density. Following a complete
Spinecompressionfractures
medical history and physical examination, a physician
can order skeletal x-rays,
bone densitometr y and
specialized laboratory tests.
Bone densitometry—often
ordered for women during menopause—is a safe,
painless x-ray technique
that compares current
bone density to the peak
bone density that someone
of the same gender and
race should have reached
at 20 to 25 years of age.
Wristfractures
hipfractures
Several types of bone densitometry are used to detect bone loss in different
areas of the body. Dual-energy x-ray absorptiometry,
a technique for measuring
bone mineral density, is one
More than 10 million Americans currently have
of the most accurate methods, but other techniques
osteoporosis—8 million of whom are women.
can also identify osteoporosis, including single photon
absorptiometry, quantitative
computed tomography (which measures bone mineral While treatment cannot reverse existing bone loss, lifecontent), radiographic absorptiometry and ultrasound.
style changes—such as doing weight-bearing exercises
and eating calcium-rich foods—along with medication
treatment“Diagnosing osteoporosis is the first step can effectively prevent additional bone loss and reduce
to treatment and injury prevention,” Dr. Nallamothu the risk of bone fractures.
says. “The goal is to slow down or stop additional bone
loss and prevent fractures so that the patient can enjoy reFerralFor a referral to an SJMO orthopedic specialregular activity.”
ist, call the referral line at 800-372-6094.
aneWWaYtohealrotatorcuFFtearS
RICHARD
BARTHOLOMEW, DO
A promising new therapy offers an
effective solution for treating patients with rotator cuff pain in the
process of healing after surgery,
says Richard Bartholomew, DO,
a member of the award-winning
St. Joseph Mercy Oakland orthopedic team.
BacKground P
latelet-rich
plasma (PRP) therapy is a procedure that may accelerate
the natural healing of tendon injuries and osteoarthritis
without putting the patient at risk. Defined as a sample of
autologous—one’s own rather than donated—blood with
concentrations of platelets above baseline values, PRP plays
an instrumental role in the normal healing response.
“Platelet-rich plasma is an exciting, safe and simple option
for improving tendon repair quality and rate of healing,”
says Dr. Bar tholomew, who specializes in shoulder and
knee pain. “Using the body’s natural response makes
PRP therapy an ideal treatment option for rotator cuff
injuries.”
The rotator cuff is a network of four muscles and several
tendons that forms a covering around the top of the upper arm bone, called the humerus. The rotator cuff holds
the humerus in place in the shoulder joint and enables
the arm to rotate.
SYmptomSA rotator cuff tear is among the most common
causes of pain and disability among adults. The tear can result
from an injury to the shoulder, such as a fracture or dislocation. Most frequently, however, the tear is from overusing the
muscles and tendons over a period of years. Especially at risk
are people who do repetitive overhead motions, such as
those in baseball, tennis, golf, weightlifting and rowing.
“Platelet-rich plasma contains and releases at least seven
unique growth factors, known as cytokines, that stimulate
and accelerate bone and soft tissue healing,” Dr. Bartholomew says. “PRP is a natural, effective therapy that helps
get the patient back to the activities they enjoy sooner.”
Both non-surgical and surgical options can help relieve
rotator cuff pain. In either case, PRP therapy can be an
effective part of treatment.
reFerralTo find an orthopedic specialist near you, call
the St. Joe referral line at 800-372-6094.
treatment PRP therapy involves extracting platelets
from the patient’s own blood supply. The platelets are then
precisely directed to the rotator cuff through an injection.
This new therapy is an ideal
treatment for rotator cuff pain.
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rotator
cufftear—
siteofprp
injection
following
repair
f e e l i n g b e t t e r
treating chronic
heartburn
Chocolate, lemonade, pizza, coffee and tea. They’re your favorite
foods, but ongoing heartburn is
preventing you from enjoying
them. You’ve tried over-thecounter and prescription medications, but nothing brings relief.
Until now.
Bashar G.
Yaldo, MD, FACS
BACKGROUND Gastroesophageal reflux disease (GERD), also known as acid reflux or
chronic heartburn, is a condition in which stomach acid
backs up into the esophagus, causing a burning sensation
in the chest. When the valve at the base of the esophagus
that connects to the stomach fails to close after swallowing food, reflux—the backup—occurs, causing heartburn.
The valve can fail to close because of weak contractions
or abnormal relaxations. Once a patient has GERD, he or
she will have it for life.
Patients with GERD find it tolerable during the day when
they’re upright and gravity pulls the acids back toward the
stomach. But at night, when swallowing stops, acid remains
in the esophagus and causes damage.
SYMPTOMS According to Bashar G. Yaldo, MD, FACS, a
St. Joseph Mercy Oakland (SJMO) general surgeon, there are
many symptoms of GERD besides heartburn.These include:
●● Difficulty or inability to swallow
●● Chest pain
●● Sore throat
●● Hoarseness
●● Laryngitis
●● Pneumonia
●● Persistent cough
●● Regurgitation (sour or bitter taste in the mouth)
●● Asthma-like symptoms
TREATMENT People who have had reflux and are on
medications that aren’t helping are candidates for a transoral incisionless fundoplication (TIF).
“The gold standard for treating GERD is an open or laparoscopic procedure,” Dr. Yaldo says.
But the TIF procedure requires no incisions and is done
through the mouth using a device specially developed for
the procedure and an endoscope.
Performed under general anesthesia, the 45-minute TIF
procedure reconstructs the tissue at the junction between
the stomach and esophagus to create a functioning valve,
restoring the patient’s ability to prevent stomach acids
from backing up. The patient typically stays overnight in
the hospital for observation and goes home the next day.
After the procedure, patients have “no pain, no heartburn
and are able to eat their favorite foods without restrictions,” Dr. Yaldo says.
And they no longer need medications. “The first two
weeks after discharge, a patient will be limited to a
mostly liquid diet, but after two weeks the patient can
have solid foods without restriction,” Dr. Yaldo says.
“Hear tburn medications are only treating the symptoms, but the TIF procedure is a permanent resolution
of the problem.”
REFERRAL For a referral to an SJMO physician near you,
call the referral line at 800-372-6094.
SJMO Orthopedic Specialists
Matt Bahu, MD
Shoulder/Elbow/Sports
Medicine
●●44555 Woodward Ave.
Suite 105
Pontiac
248-335-2977
●●6060 Dixie Hwy.
Suite F
Clarkston
248-858-3855
Richard S.
Bartholomew, DO
Shoulder/Hip
4800 Highland Rd.
Waterford
248-673-0500
Andrew P. Ciarlone, DO
General Orthopedics
5701 Bow Pointe Dr.
Suite 300
Clarkston
248-620-2325
Joseph M. Failla, MD
Hand/Wrist
29829 Telegraph Rd.
Suite 201
Southfield
248-352-4263
Michael J. Fugle, DO
Joint Replacement
●●1350 W. Huron
Waterford
248-681-4206
●●940 W. Avon Rd.
Suite 10
Rochester
248-656-0440
Bruce T. Henderson, MD
Spine
44555 Woodward Ave.
Suite 406
Pontiac
248-334-0524
Safa S. Kassab, MD
Knee/Hip
●●44555 Woodward Ave.
Suite 105
Pontiac
248-335-2977
●●6060 Dixie Hwy.
Suite F
Clarkston
248-858-3855
William M. Kohen, MD
Knee/Hip
4800 Highland Rd.
Waterford
248-673-0500
Robert S. Levine, MD
Knee/Spine/Pain/Shoulder
43368 Woodward Ave.
Suite 101
Bloomfield Hills
248-334-4536
Frederick V. Minkow, MD
Hand/Wrist
43700 Woodward Ave.
Suite 205
Bloomfield Hills
248-332-8391
Michael I. Quinn, MD
Hand/Wrist
43700 Woodward Ave.
Suite 205
Bloomfield Hills
248-332-8391
Paul C. Lewis, DO
Sports Medicine
44555 Woodward Ave.
Suite 406
Pontiac
248-858-6951
Shivajee V. Nallamothu, DO
Sports Medicine
5701 Bow Pointe Dr.
Suite 300
Clarkston
248-620-2325
Edward J. Lis Jr., DO
Sports Medicine/Joint
Replacement
5701 Bow Pointe Dr.
Suite 300
Clarkston
248-620-2325
John R. Olenyn, MD
Knee/Hip/Hand
3100 Cross Creek Pkwy.
Suite 200
Auburn Hills
248-377-8000
Louis N. Radden, DO
Spine
●●30055 Northwestern Hwy.
Suite 270
Farmington Hills
248-865-4262
●●14555 Levan Rd.
Suite 116
Livonia
734-464-0400
Arthur Manoli, MD
Foot/Ankle
44555 Woodward Ave.
Suite 503
Pontiac
248-858-6773
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Jignesh N. Patel, DO
Total Joint Reconstruction
1349 Rochester Rd.
Suite 250
Rochester
248-650-2400
John E. Samani, MD
Knee/Shoulder
937 N. Opdyke Rd.
Auburn Hills
248-373-7600
Uzma H. Rehman, DO
Hand
●●45650 Schoenherr
Shelby Township
586-532-0803
●●43940 Woodward Ave.
Suite 100
Bloomfield Hills
248-335-2638
●●2611 Electric Ave.
Suite E
Port Huron
810-987-9871
2 0 1 0 6 M i c h i g a n
m e dic al
Brenda L. Sanford, MD
Foot/Ankle
4800 Highland Rd.
Waterford
248-673-0500
Paul J. Siatczynski, MD
Knee/Shoulder/Elbow
3100 Cross Creek Pkwy.
Suite 200
Auburn Hills
248-377-8000
Miles L. Singer, DO
Orthopedic Surgery
2300 Haggerty Rd.
Suite 2100
West Bloomfield
248-926-1960
Christopher L. Tisdel, MD
Foot/Ankle
44555 Woodward Ave.
Suite 406
Pontiac
248-858-6951
report
William S. Ward, MD
Knee/Hip
●●44555 Woodward Ave.
Suite 406
Pontiac
248-334-0524
●●7210 N. Main St.
Suite 200
Clarkston
248-625-1600
Stephen E. Werner, MD
Hand/Wrist
43700 Woodward Ave.
Suite 205
Bloomfield Hills
248-332-8391
Ira Zaltz, MD
Pediatric Orthopedics
●●2799 W. Grand Blvd.
Suite K-12
Detroit
313-916-2013
●●30575 Woodward Ave.
Suite 100
Royal Oak
248-280-8550
s tay i n g
Shingles
A painful rash
If you had chickenpox as a child,
you may be at risk for shingles.
BACKGROUND Shingles appears as a rash caused by the
varicella zoster virus (VZV) and
is known as herpes zoster or just
zoster. The virus is the same one
Fadi Salloum, MD
that causes chickenpox, but it
doesn’t cause genital herpes. Even after chickenpox heals,
the virus remains dormant in the nerve cells and can
reappear years later as shingles.
SYMPTOMS According to Fadi Salloum, MD, a St. Joseph Mercy Oakland (SJMO) internist, the symptoms of
shingles include a rash, pain, a burning sensation, numbness and itching. The rash can last from 10 to 14 days
with some residual pain and itching. Although people in
their 20s, 30s and 40s can have shingles, it usually appears after age 50.
“The older you are, the higher the risk,” Dr. Salloum says.
People who are immunosuppressed—such as those with
cancer, those undergoing steroid treatment, or those who
Eat well, live well
Managing your weight
There is no reason to live with a
diet mentality—one that stresses
using willpower and a no-pain,
no-gain mantra. Instead, there are
small changes that you can make
to embrace a healthy lifestyle.
“Eating small, frequent meals and
understanding the principles of
calorie and protein density are
two little but impactful steps that you can take to lead a
lifestyle that promotes weight management and wellness,”
says Tom Rifai, MD, Medical Director of St. Joseph Mercy
Oakland’s Metabolic Nutrition and Weight Management
Program.
Tom Rifai, MD
have HIV or diabetes—will experience a severe form of the
disease, and it’s also dangerous
for pregnant women.
Shingles usually starts with pain,
itching or tingling on the face
or torso before turning into a
rash, which then blisters and
becomes crusty. Most often, the
rash appears as a “belt” of blisters
around one side of the waist. It
also occurs on one side of the
face around the eye and on the
forehead, but it can occur elsewhere on the body.
It is not contagious, but the virus that causes it can spread
to someone who comes in contact with the rash. The
exposed person will develop chickenpox, not shingles.
The virus is only contagious when the rash is in the blister stage, not before or after. Once the rash reaches the
crust stage, the patient is no longer contagious.
TREATMENT Children vaccinated with the VZV vaccine
are less likely to get shingles as adults. At the same time,
researchers have found that adults age 60 and older who
have had a VZV vaccine were at lower risk of getting the
disease or experienced fewer and less severe complications if they did have shingles. If not complicated by infection, shingles can be treated with antiviral, antiseizure and
topical pain medications.
But there is an aftereffect. “After the shingles is resolved,
there could be some lingering pain,” Dr. Salloum says.
Called postherpetic neuralgia, this lingering pain can be
mild or severe but is not life-threatening.
“If it’s treated within the first 72 hours, the patient will have
the disease for a shorter time and have fewer complications and decreased risk of contagion,” Dr. Salloum says.
“Don’t miss your window for treatment.”
“Break the fast” with some quality protein and a low caloriedense carbohydrate.
in losing weight without hunger, try this tip: Make sure
that the majority of the low-protein foods you choose
have fewer calories than grams of food per serving. The
gram weight of the serving is found in the serving size
area of a nutrition facts label. Research has shown that
calorie density is the most reliable indicator of how to
feel full on fewer calories after eating a particular food
or meal.
MAKE GOOD FOOD CHOICES In addition to eating
smaller, more regularly scheduled meals and healthy snacks,
understanding calorie and protein density is critical to
achieving satiety, or feeling full, on the lowest amount of
calories as part of a healthy lifestyle change.
Low calorie-dense foods, such as whole fruits and vegetables, are those that have fewer calories per bite and can
help fill you up on less calories, particularly if eaten early
on in the meal. In addition to having low calorie-dense
foods, make sure that the meal or snack also has a quality
source of protein—whether it’s a meal replacement or
lean foods like fish, egg whites, poultry breast or fat-free
Greek yogurt. This will help to sustain fullness longer and
maintain muscle mass during fat loss.
Because calorie density is an important principle to learn
Therefore, you want foods that will give you a generous
portion for as few calories as possible. That is why whole
fruit is much healthier in terms of weight loss than dried
fruit. Also, avoid or limit liquid calories like sugared pop,
fruit juices, sports drinks and alcohol.
REFERRAL As a metabolic and nutrition specialist,
Dr. Rifai partners with each patient’s primary care physician to address weight management and wellness.To learn
more about St. Joe’s Metabolic Nutrition and Weight
Management Program, call 248-858-2475.
More ways to manage weight
CAUTIONS Skipping breakfast can slow metabolism
and lead to overcompensating by eating one or two
high-calorie, larger, later-day meals. This may result in
muscle loss and fat gain over time—both of which are
risk factors for hear t disease and cancer. While there
are exceptions, generally speaking, by eating a lean
breakfast and then smaller amounts of lean, healthy
foods every two to four hours, resulting in two to
three smaller meals and two to three small snacks, you
will follow a lifestyle pattern more consistent with a
healthy weight.
●● SHAPEDOWN: For children and teens ages 6
to 18. SHAPEDOWN involves the entire family in
the child’s journey to a healthier lifestyle. Classes
include nutrition education, exercise and communication techniques. There is a fee.
●● Senior Fit: This free exercise program for
senior adults combines health benefits and social
interaction.
●● Minimally invasive bariatric surgery:
St. Joe offers many bariatric surgery options in an
integrated program that helps people regain their
quality of life. The Michigan Bariatric Institute and
St. Joe’s comprehensive weight-loss surgeons and
physicians work with the patient to find the best
treatment option.
People tend to skip breakfast because they feel they do
not have time or can get away with it. However, based
on medical evidence linking breakfast eating to lower
diabetes risk and leaner bodies, even if you do not feel
hungry, it is important.
h e a lt h y
S u m m e r
2 0 1 0 7 M i c h i g a n
m edic al
report
Welcome,neWdoctorS
St. Joseph Mercy Oakland (SJMO) is constantly searching for physicians to
bring you the best care. Listed below are some of the recent additions to our
medical staff. Please visit our Web site at stjoesoakland.org for the most
up-to-date information about SJMO physicians.You also may call our physician
referral line toll-free at 800-372-6094.
Murali Guthikonda, MD
neurosurgery
4160Johnr
Suite930
detroit
313-831-0777
Uzma H. Rehman, DO
orthopedicSurgery
45650Schoenherr
Shelbytownship
586-532-0803
Kristopher
MacWilliams, MD
emergencymedicine
44405Woodwardave.
pontiac
248-758-7000
Nishant Shah, MD
pediatriccardiology
3901BeaubienBlvd.
detroit
313-745-5481
Stephanie L. Martin, DPM
podiatry
18161W.13milerd.
Suited-2
Southfield
248-258-0001
Vijaya K. Surapaneni, MD
pediatrichospitalist
37595Sevenmilerd.
Suite420
livonia
734-542-0689
Why choose
urgent care?
Because your time
is as impor tant
as your health.
Tanya Wynn, MD
obstetrics/gynecology
1234S.lapeerrd.
lakeorion
248-693-0543
needanurgent
careFacilitY?
St. Joseph Mercy Oakland has two convenient locations
to serve you and your family:
laKeorionurgentcare
1375 S. Lapeer Rd.
Suite 106
Lake Orion
Phone: 248-693-9040
Fax: 248-693-9007
Hours: 24 hours a day, seven days a week
Findadoctorwho’srightforyou.clickon
“St.Josephmercyoakland”then“Findaphysician”
at stjoesoakland.org.
MICHIGAN MEDICAL REPORT
NORtheRN OaklaNd cOUNty’S
hOSpItal Of chOIce.
FromthephYSicianSatSt.JoSephmercYoaKland
To learn more about our top-rated quality services
and programs, visit our Web site at stjoesoakland.org,
or to find a physician nearest you, call our referral line
at 800-372-6094.
President and CEO
tyroneandrews
Chief Marketing Officer
WIDE TRACK
From
Utica
59
heidipress
Public Relations Specialist/Editor
ST. JOSEPH
MERCY OAKLAND
rebeccao’grady
H
SQUARE LAKE
FRANKLIN
W
O
O
Marketing Communication Specialist
CROOKS
Exit 75
AP
GR
LE
We serve together in Trinity Health, in the spirit
of the Gospel, to heal body, mind and spirit, to
improve the health of our communities and to
steward the resources entrusted to us.
JackWeiner
From Flint
TE
OUR MISSION
WaterFordurgentcare
5800 Highland Rd.
Waterford
Phone: 248-673-2474
Fax: 248-618-6951
Hours: Monday through Friday, 5 to 10 p.m.,
Saturday and Sunday, 8 a.m. to 8 p.m.
lauraminor
Marketing Coordinator
75
DW
AR
D
From
Detroit
Information in MICHIgAN MEDICAL REPORT comes
from a wide range of medical experts. If you have any
concerns or questions about specific content that may
affect your health, please contact your health care provider.
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