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Letter to Our Patients

Oct. 20, 2014

Dear Patient:

As 2014 nears the end and healthcare reform continues to make headlines daily, I wanted to let you know where your Tri Rivers Surgical providers fit into the bigger picture.

I am pleased to share that our practice has decided to align as part of a joint venture with two strong, strategic partners — UPMC and Butler Health System. For those of you who don’t know, we have had decades-long histories with both of these fine organizations, so it makes perfect sense for us to formalize these relationships.

Beginning Jan. 1, 2015, our name will change to Tri Rivers Musculoskeletal Centers, which more appropriately reflects the specialties we offer and services we provide. From there, this change will only allow us to serve you better: Our physicians and staff on whom you rely and trust will remain the same. The offices conveniently located near your home or work will remain the same. The services we provide will remain the same. In fact, if anything, our services may expand, with the added economic strength of these two healthcare institutions backing us. And ultimately, that’s what led us to this decision.

But in our region, what everyone wants to know is. . . what insurance plans can we accept? And that’s where I can share the very best news. We can continue to accept Highmark plans, UPMC plans and all of the insurance plans we have always accepted, because we will be owned as a joint venture by both of these healthcare organizations.

For our Highmark patients: You can continue to see all of your Tri Rivers physicians at any of our offices, including the UPMC Passavant location. However, the contract lapse between UPMC and Highmark means that for any Highmark subscribers (excluding Medicare patients), elective orthopedic surgeries cannot be performed at UPMC Passavant or any UPMC facility. Our staff will assist in scheduling procedures for patients with Highmark commercial at an alternate location such as Butler Memorial Hospital, where our physicians are able to operate. Prior to Jan. 1, there is no change in where patients can be seen or scheduled for surgery.

We recognize that clear communication is very important at this time. Visit our website, www.TriRiversOrtho.com, for regular updates. We are always committed to providing exceptional care for you, our patient.

We wish you good health.

Best regards,

D. Kelly Agnew, M.D.

Managing Partner

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Frequently Asked Questions about Tri Rivers Surgical Joint Venture

Tri Rivers Surgical Associates has decided to align with two strong, strategic partners . . . UPMC and Butler Health System, as part of a joint venture. We have formalized our decades-long histories with both of these fine organizations into a permanent partnership.

Q: Why was the Tri Rivers — UPMC — Butler Health System joint venture formed?

A: Because the dynamics of health care are rapidly changing both nationally and regionally, the physicians of Tri Rivers entered this joint venture so we can continue to expand our services for patients while solidifying the practice’s long-term stability in this ever-changing landscape. The joint venture allows our practice to ensure access to exceptional musculoskeletal care for the greatest number of patients in both Allegheny and Butler counties well into the future.

Q: Will Tri Rivers keep the same name, physicians, locations and hospital affiliations?

A: Beginning Jan. 1, 2015, Tri Rivers Surgical Associates will be renamed Tri Rivers Musculoskeletal Centers, as it more appropriately reflects our multispecialty practice and the scope of services we offer. Our same physicians will continue practicing in our same six primary office locations — Butler-BHS East, Butler-Clearview, Cranberry/Mars, North Hills, Saxonburg and Slippery Rock — and they will maintain their same hospital affiliations — Butler Memorial Hospital, UPMC Passavant, UPMC Passavant Cranberry and Butler’s outpatient surgery center, Benbrook Surgery Center. Patients can continue scheduling appointments by calling 1-866-874-7483 or on our website, www.TriRiversOrtho.com.

Q: Will my relationship with my doctor remain the same?

A: Absolutely, because a commitment to quality patient care remains our top priority.

Q: I have an appointment scheduled with Tri Rivers before Dec. 31, 2014. Do I need to do anything differently before my appointment?

A: No, everything will remain the same through the end of this year.

Q: I have an appointment scheduled with Tri Rivers after Jan. 1, 2015. Do I need to do anything differently before my appointment?

A: Not at this time, other than remembering that our name changes on Jan. 1 to Tri Rivers Musculoskeletal Centers. We will communicate any other changes with our patients as they become available. Visit our website at www.TriRiversOrtho.com for regular updates.

Q: Which insurance companies will Tri Rivers Musculoskeletal Centers accept in 2015?

A: Just as we always have, Tri Rivers will continue to accept most major insurance carriers.

Q: I have a Medicare plan. What does this mean for me?

A: Most Medicare-covered patients, including those with Highmark plans, will have in-network access to all of our physicians for office visits as well as surgical and non-emergency care at any UPMC facility, including UPMC Passavant McCandless or UPMC Passavant Cranberry.

Q: Will Tri Rivers continue seeing patients with Highmark insurance after the UPMC-Highmark contract expires?

A: We are pleased to share that, as a result of aligning through this joint venture, Tri Rivers physicians will still be able to see Highmark-insured patients at any of our offices, including our UPMC Passavant location. However, the contract lapse between UPMC and Highmark means that for any Highmark subscribers (again, excluding Medicare patients), elective orthopedic surgeries cannot be performed at UPMC Passavant or any UPMC facility. This is true for ANY surgeons who operate at UPMC Passavant and not just Tri Rivers physicians because of our new affiliation with UPMC.

Q: How can I stay informed about any future changes?

A: As always, we are committed to providing exceptional care for you, our patients. One part of that care is clearly communicating any changes that directly affect your relationship with our practice. Another part is working through various issues that result during these challenging times in health care. We will provide regular updates on our website at www.TriRiversOrtho.com. Should you still have questions after reading the information we have provided, please call our dedicated communications line at 412-367-5814 and dial extension 222. We will return your call in a timely manner to answer your questions.

Thank you for choosing Tri Rivers as your musculoskeletal care providers.

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Dr. Richmond Wants to Save Your Shoulder

What many people don’t know is that the shoulder is the most complex joint of the body. It offers 360 degrees of mobility and requires bones, muscles, tendons and ligaments to work together. But such a complex joint is bound to have some aches and pains.

Recently, John M. Richmond, M.D., a sports medicine and shoulder specialist with Tri Rivers Surgical Associates, addressed more than 80 seniors at UPMC-Passavant Cumberland Woods Village about shoulder care. While shoulder pain is very common and can affect patients of all ages, incidences do increase in older patients.

Dr. Richmond, who also sees general orthopedic patients at Tri Rivers’ North Hills and Slippery Rock offices, said that the most common diagnoses for those 60 years or older are rotator cuff injuries and arthritis. The causes of such problems are simple: life.

“Maybe you had a physical job where you reached over your head a lot, maybe it is genetic, but it’s like how everyone gets gray hair: It just happens,” Dr. Richmond said.

The good news is that there are steps you can take to restore your shoulder and avoid surgery.

“The end stage is surgery, but there are a lot of things to do to prevent that,” Dr. Richmond said. “[Doctors] don’t usually recommend surgery as soon as a patient shows up with a shoulder injury.”

To start, the best way to preserve your shoulder is by maintaining its strength and range of motion. In some cases, pain can be alleviated by simple physical therapy exercises that retrain you, your shoulder and the surrounding muscles to function properly. The next step would be consistently performing those exercises at home.

Dr. Richmond also suggests modifying your activity if you are experiencing shoulder pain, taking anti-inflammatory medicine such as ibuprofen or Celebrex or asking your doctor about cortisone injections.

“Cortisone can last you years or last you weeks,” Dr. Richmond explained. “Relate it to how big the fire is. A small fire may be put out by one bucket of water, or one shot, but a larger fire may need two injections.”

Another explanation for shoulder pain, according to Dr. Richmond, is that the problem may not even be your shoulder. Pain can originate from a back or neck condition or from a nerve or tendon condition such as carpal tunnel or cubital tunnel syndromes.

For the conditions that do require shoulder surgery, such as a full rotator cuff tear or degenerative arthritis, complete recovery can take up to a year. Patients should expect postoperative care to include six weeks in a sling to stabilize the shoulder followed by four to six months of physical therapy to regain strength and range of motion.

Shoulder replacement surgery, however, is not for everyone, especially in younger patients, because the materials used in the joint do have a shelf life.

“We haven’t created a joint that can stand the test of time,” Dr. Richmond said.

If you are experiencing chronic shoulder pain, most orthopedic specialists can diagnose shoulder distress during a physical examination to recommend the best course of action.

To request an appointment with Dr. Richmond or another Tri Rivers shoulder specialist, visit www.TriRiversOrtho.com or call 1-866-874-7483.

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Tips and tricks to help you stay vibrant

Think physical exercise is the only thing that can make you healthy? Think again.

Physical exercise, mental stimulation, stress reduction and diet all are vital to staying healthy and vibrant as you grow older.

Tri Rivers Surgical physical medicine and rehabilitation specialist Anna K. Gaines, M.D., discussed how to stay vibrant as we age recently at St. Barnabas retirement community in Gibsonia. And just how much we can control might surprise you.

Mobility and brain function are among the most important factors for healthy aging. Dr. Gaines said exercise is the key to preserving mobility, but exercise serves a greater overall health purpose. Higher lifetime exercise levels correlate with lower risk of heart and lung disease, chronic pain and brain disorders such as Alzheimer’s or Parkinson’s disease.

“Hundreds of millions of dollars a year go into research on exercise,” Dr. Gaines said. “Exercise in aging is studied a lot. It’s so powerful that researchers commit that much funding to it on an annual basis so we can keep building our knowledge.”

Exercise can improve physical strength and balance, increase your ability to perform daily tasks, improve chronic health conditions, reduce depression and improve brain function.

Dr. Gaines said people of all ages should exercise for 150 minutes per week, whether that is five times per week for 30 minutes or 10 sessions of 15 minutes each. Simply “being active” is not sufficient exercise.

She recommended finding ways to integrate exercise into regular daily activities. For example, walking with friends for 15 minutes after breakfast or lunch or doing 10 minutes of balance training while your coffee brews might afford reasonable opportunities for regular exercise. A complete exercise program includes aerobic activity, strengthening, flexibility and balance training.

Like the body requires a variety of exercise for maximum benefit, part of keeping the brain healthy and expanding it means breaking monotony. Your brain only gets exercised as much as it is challenged. If you find that you are breezing through puzzles or reading similar things on a daily basis, it might be time to challenge yourself by mixing up your selection.

Finding enjoyable activities to do can help counteract another condition that affects brain size and function: stress.

“Stress is a hard thing to treat,” Dr. Gaines said. “We don’t have any medications that take stress away. We don’t have an anti-stress button. But it doesn’t mean we can’t tackle it just because it’s hard. Sometimes, you need specific therapy to help work on stress and lower the impact of it.”

It is vital to address stress because it is a big enough factor to brain function that it can counteract all of the good things you are otherwise doing for your brain and body, Dr. Gaines said.

And among those good things you can do for your brain is maintaining good nutrition.

Dr. Gaines said the traditional Mediterranean Diet probably is among the most balanced and well-studied diets shown to positively affect cognitive health and body health.

People who maintained a high adherence to the Mediterranean Diet had a 28 percent reduction in the risk of mild cognitive impairment, according to a recent study. The positive effect on heart health and cancer risk is also well-documented.

This diet consists primarily of plant-based food such as fruits and vegetables, beans, whole grains and nuts. It replaces butter with healthy fats such as olive oil and replaces salt with flavorful herbs. It limits the consumption of red meat to a few times per month and suggests two servings of fish or poultry per week.

“With all of the choices we can make in our daily life, we most certainly have the capacity to influence our brain and body health as we age,” Dr. Gaines said. “The idea of staying vibrant as we age is something we can and should set as a goal.”

To request an appointment, click here or call 1-866-874-7483.

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Foot and ankle specialist helps seniors put best foot forward

Considering that the average person walks about 100,000 miles during his or her lifetime, it makes sense that many people experience foot problems by the time they reach their golden years.

Tri Rivers orthopedic foot and ankle specialist William E. Saar, D.O., discussed the diagnosis and treatment of common foot problems - including plantar fasciitis, progressive flatfoot deformity, bunions, hammertoe and Morton’s neuroma - during a recent presentation at St. Barnabas Retirement Communities.

One of the most common foot ailments is plantar fasciitis, an inflammation of the tissue that connects the heel bone to the base of the toes, according to Dr. Saar.

“A common sign of this condition is pain in the heel that occurs when a person stands after being in a sitting or lying position, especially first thing in the morning,” he said. “The patient may feel a sharp, stabbing pain in the bottom of the heel.”

Nonsurgical treatments include stretching exercises, rest, ice on the heel, activity modification, splints, heel cups or orthotics, steroid injections, casts and physical therapy.

About 90 percent of plantar fasciitis patients should improve after six to eight weeks using the conservative measures and without surgery, Dr. Saar noted.

Progressive flatfoot deformity mostly affects women older than 50 and those who are obese or have high blood pressure or inflammatory conditions. Signs can include pain and swelling of the ankle, inability to stand on toes and progressive loss of the arch.

“Without treatment, progressive flatfoot can develop into advanced arthritis of the foot and ankle,” he said. “The deformity can become so severe that ulcers may develop and predispose to infections, which may require aggressive surgical procedures.”

The patient can be treated initially with medication, rest, braces and, if necessary, surgery.

Another common condition encountered, particularly in women, is Hallux Valgus (commonly referred to as bunions).

“A bunion is a deformity at the joint that connects the big toe to the foot, which often appears as a swollen or sore bump,” Dr. Saar explained.

About 90 percent of bunions occur on women and are usually caused by improperly fitting shoes.

Dr. Saar suggests:

• Avoid sharply pointed shoes and heels higher than 2 1/4 inches

• Stretch shoes to ensure a better fit

• Use protective pads and splints if necessary to improve fit

Another common condition, the hammertoe deformity usually affects the second, third and fourth toes.

“The ailment occurs when a toe is bent resembling a hammer,” Dr. Saar explained. “It is usually related to improperly fitted (tight) shoes.”

Conservative treatment options include: toe splints, stretching exercises and good, supportive, well-fitted shoes. If these fail, surgical intervention may become necessary.

Morton’s neuroma occurs when the nerve tissue thickens as it passes under a ligament leading to the toes.

“It can cause burning pain in the ball of the foot that radiates into the toes,” Dr. Saar explained. “The toes involved feel numb, and symptoms usually worsens with activity or wearing shoes.”

About 80 percent of patients get relief with conservative treatments such as medications, shoe modifications and steroid injections.

Most people can avoid problems with their feet by wearing properly fitting shoes and taking conservative steps to address these conditions from becoming more serious health concerns.

To request an appointment, click here or call 1-866-874-7483.

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The woman in the mirror is pain free from arthritis

More than a decade ago, Janet Tempalski, now 63, of Cranberry Township, slowly walked toward the door of a local department store.

She saw a reflection of a woman in the store window and thought, “Who is the lady with bowed legs?” She quickly realized the reflection was hers.

Janet was among the 46 million Americans suffering from arthritis.

She didn’t want to have surgery because it would interrupt her life. So she lived with knee discomfort for more than 10 years. She had trouble with everyday activities, such as climbing stairs and working in the garden.

Finally, she decided to take steps to end the pain. Janet had two knee replacements, performed by William Abraham, M.D., a joint replacement specialist with Tri Rivers Surgical Associates.

In June 2011, Janet had her right knee replaced. Four months later, she had her left knee replaced.

Now, she plays with her grandchild and dog, and gardens without pain.

What is osteoarthritis?

Like Janet, 20 percent of adults in the United States have been diagnosed with arthritis, according to the Centers for Disease Control and Prevention. Three of five Americans ages 65 and older are affected by arthritis.

Janet had osteoarthritis - one of the most common forms of arthritis. It is among the more than 100 forms of the disease.

Osteoarthritis is referred to as the wear-and-tear arthritis and occurs when the protective cartilage on the ends of bone wears down over time. Symptoms may include pain, warmth, swelling or stiffness in the joint.

“Mild joint pain that occurs with activity can generally be controlled with self-help measures,” Dr. Abraham said.

“Rest, topical ointments and use of over-the-counter medications — such as aspirin and ibuprofen - are usually effective in treating mild cases.”

When should a patient consult a medical professional?

Dr. Abraham recommends seeking medical attention when the condition affects an individual’s lifestyle. Individuals should see a physician when stiffness and swelling:

•Cannot be relieved by rest or reduced by home remedies and over-the-counter medications

•Occur even when someone is not involved in activity

•Interfere with the ability to perform many activities, such as climbing stairs and bending over

•Awakens the individual from sleep

Treatments

A variety of nonsurgical treatments, such as exercise, steroid injections and joint fluid therapy, are available.

The final option is surgery, such as arthroscopic (removal of the damaged cartilage) and joint replacement (replacement of the damaged joint with a metal and plastic joint).

Patients with severe arthritis may consider joint replacement if they experience:

•Unbearable pain after conservative treatment

•Symptoms that significantly affect their ability to perform normal activities

•Pain that regularly interferes with sleep

•Pain and loss of mobility that greatly affect the quality of life

Knee replacements have proven to be a very successful way to treat many patients

“A variety of techniques are available for knee surgery. Minimally invasive knee surgery involves the use of a smaller incision to remove and replace a damaged knee,” Dr. Abraham explained. “For many patients, this technique may result in less surgical pain, a shorter hospital stay, accelerated rehabilitation and a faster recovery.

“While arthritis can be very painful, the good news is that with early intervention, symptom control and minor lifestyle modification, many patients can manage the condition and participate in many of their everyday activities with little or no pain,” he said.

Through the years, knee replacement has proven to be a very successful way to treat many patients without serious complications, according to Dr. Abraham.

To request an appointment with Dr. Abraham or another Tri Rivers physician, visit "request an appointment" on tririversortho.com or call 1-866-874-7483.

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