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					                                                                                   Opening Remarks
                 Founded 1982
                                                                                   Dear Friends,
Blue Ridge Orthopaedics Associates, PA                                            It is with great pleasure that the physicians and staff of Blue

10630 Clemson Blvd., Ste. 100                                                     Ridge Orthopaedics introduce you to our second issue of Blue
Seneca, SC 29678
                                                                                  Ridge Orthopaedics. Our opening issue was met with consid-
Phone: (864) 482-6000
Fax: (864) 482-7000
                                                           erable praise and approval from our audience of wonderful patients and the local
                                                           medical community, and it goes without saying that your support is integral in our
Blue Ridge Surgery Center                                  continued success in providing quality orthopaedic care in the region.
10630 Clemson Blvd., Ste. 200
Seneca, SC 29678
                                                           In this issue, we continue to produce articles of interest. We also take this opportuni-
Phone: (864) 482-5100
Fax: (864) 482-9100                                        ty to introduce you to some very important members of our team, our physician assis-
                                                           tants, as well a new addition to our orthopaedic surgery staff.
Blue Ridge Orthopaedics Associates, PA
AnMed Cardiology &                                         Thank you again for your continued support and generous praise of our efforts with
Orthopaedic Center
                                                           this magazine. We remain dedicated to providing the highest standard of care for our
100 Healthy Way, Ste. 1200
Anderson, SC 29621                                         patients. We hope you enjoy this issue of Blue Ridge Orthopaedics.
Phone: (864) 260-9910
Fax: (864) 328-1451                                        Sincerely,

            Larry S. Bowman, MD
                                                           P. Sean McCallum, MD
             Sean McCallum, MD
             Secretary/ Treasurer
             John H. Murray, MD

Blue Ridge Orthopaedics is an education-
al and informative resource for physicians,
health care professionals, employer
groups, and the general public. Blue
Ridge Orthopaedics’ goal for this publica-
tion is to introduce its staff and facilities
and provide a forum for communicating
news and trends involving orthopaedic-
related injuries and treatments, as well as
other health-related topics of interest.

The information contained in this publi-
cation is not intended to replace a
physician’s professional consultation
                                                                    In This Issue
and assessment. Please consult your
physician on matters related to your                           4        Down to the Bone
                                                                        Arthritis treatments aim to relieve pain
personal health.
                                                                        Anesthesia Today
                                                               6        Training, techniques, and monitoring reduce complications

Blue Ridge Orthopaedics is published by QuestCorp
Media Group, Inc., 885 E. Collins Blvd., Ste. 102,
                                                               8        A Biologic Method of Cartilage Repair
                                                                        New therapies help heal damaged knees
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                                                             11         ‘ReSTORing’ Vision
                                                                        Breakthrough technology provides clarity without glasses Editorial comments: Brandi
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                                                                        Physician assistants improve many medical services
Single copies: $5.95. This publication may not be repro-
duced in part or in whole without the express written
permission of QuestCorp Media Group, Inc.

                                                                                                                             Blue Ridge Orthopaedics   3
Down to the Bone                                                                                              By W. Bruce Richmond II, MD

Arthritis treatments aim to relieve pain
        Arthritis simply means painful joint.        the United States and is a leading cause        such as those in the knees, hips, and spine

        There are many known and suspected
        causes of arthritis, but the most common
        type is osteoarthritis, also known as
        degenerative joint disease. Osteoarthritis
        affects more than 40 million people in
                                                     of physical disability. In the next 15
                                                     years, the number of people affected
                                                     by osteoarthritis is expected to increase
                                                     to more than 60 million people. Osteo-
                                                     arthritis mainly affects load-bearing joints,
                                                                                                     but can affect any joint in the body.

                                                                                                     The exact cause, or causes, of osteo-
                                                                                                     arthritis is unknown. In the past, many
                                                                                                     physicians regarded it as an inevitable
                                                                                                     result of aging. Little could be done
                                                                                                     except for using a cane and taking aspirin
                                                                                                     or acetaminophen. The results of recent
                                                                                                     research provide physicians with many
                                                                                                     new therapies and options for treating
                                                                                                     osteoarthritis. When a painful joint fails
                                                                                                     to respond to simple over-the-counter
                                                                                                     remedies such as acetaminophen, topical
                                                                                                     creams, glucosamine, or nonsteroidal
                                                                                                     anti-inflammatory drugs, it is time to
                                                                                                     seek professional help.

                                                                                                     Causes, Symptoms, and Diagnosis

                                                                                                     Normal healthy joints are composed of
                                                                                                     smooth surfaces on the ends of bones
                                                                                                     called articular cartilage, joint fluid
                                                                                                     called synovial fluid, and the joint cap-
                                                                                                     sule lined by synovial cells. The articular
                                                                                                     cartilage lacks a blood supply and gets its
                                                                                                     nourishment from the synovial fluid
                                                                                                     secreted by the synovial cells of the joint
                                                                                                     capsule. In joints affected by osteoarthri-
                                                                                                     tis, the articular cartilage begins to
                                                                                                     degrade and break down. The joint fluid
                                                                                                     becomes less oily due to the decrease in
                                                                                                     hyaluronic acid (more on this later), and
                                                                                                     the joint capsule becomes inflamed.

                                                                                                     The patient may experience joint pain
                                                                                                     described as a dull ache with sharp pain
                                                                                                     on sudden movements, swelling, and/or
                                                                                                     stiffness, especially after a period of
                                                                                                     immobilization such as riding in a car,
                                                                                                     sitting in a movie theater, or getting out
                                                                                                     of bed.

                                                                                                     Arthritis symptoms usually come on
                                                                                                     gradually over several weeks or months.
                                                                                                     Sometimes the pain may be brought on
                                                                                                     by a recent fall or twisting.

                                                                                                     The physician’s first priority is to make
                                                                                                     an accurate diagnosis because not all

4 Blue Ridge Orthopaedics
joint pains are caused by osteoarthritis.                                                       minimally invasive techniques for joint
Tendinitis, bursitis, infection, stress frac-                                                   replacement, tendon repair, and fracture
tures, avascular necrosis, meniscus tears,                                                      care. We welcome the opportunity to dis-
herniated disc in the spine, and cancer                                                         cuss these treatment options with you at
(rarely) can also cause joint pain. Your                                                        our Seneca and Anderson offices. BR
physician will need to take a detailed
history, perform a physical exam, and                                                           W. Bruce Richmond II, MD, earned his medical
possibly order diagnostic tests (x-rays,                                                        degree from the Medical University of South
lab tests, CT scans, or MRI scans) to                                                           Carolina. He completed medical training at
form a diagnosis.                                                                               Erlanger Medical Center of the University of
                                                                                                Tennessee College of Medicine, Chattanooga
Treatment Options                                                                               Unit, with an orthopaedic surgery residency and
                                                                                                an orthopaedic trauma fellowship. He is board
In reality, there is no cure for osteoarthri-                                                   certified by the American Board of Orthopaedic
tis because the exact cause or causes are                                                       Surgery and is a member of the South Carolina
unknown. The focus of treatment is on                                                           Medical Association, the South Carolina
relieving pain and stress and reducing                                                          Orthopaedic Association, and the American
damage to the articular cartilage.              Note the gradual loss of space between the      Academy of Orthopaedic Surgeons.
                                                bones in the images above. This loss of joint
Weight reduction of as little as 20 lb can      space occurs when the articular cartilage
                                                wears away.                                       Prosthesis Materials
significantly relieve arthritis pain. Low-
impact exercises such as water aerobics,        Steroid injections (cortisone) combined
                                                                                                  Over the past 50 years, there have
walking, and swimming help keep the             with a local anesthetic can provide dra-
joint fluid healthy to provide needed           matic pain relief due to their powerful           been many advances in total joint
nutrients to the articular cartilage. Some      anti-inflammatory properties. However,            arthroplasty. Orthopaedic surgeons
patients are candidates for special             the duration of relief varies tremen-             can replace painful, stiff hips with
unloading braces to shift weight to less        dously from patient to patient.                   durable prostheses made of metal
involved areas of the joint.                                                                      alloys, high-grade plastics, and poly-
                                                Viscosupplementation is the weekly
                                                                                                  meric materials. All materials used in
                                                injection of hyaluronic acid (the sub-
                                                                                                  total hip replacements have four
    New surgical techniques                     stance that makes joint fluid more oily)
                                                in the knee joint for a total of up to five       characteristics in common:
      and refined implants
                                                injections. Hyaluronic acid helps lubri-
    are improving the quality                   cate the joint, and a physician can repeat
                                                                                                  1. They are biocompatible, meaning
     of life of patients with                   the injections every six months if needed.        they won’t create a local or a systemic
          osteoarthritis.                       This treatment is effective in up to 75%          rejection response.
                                                of patients.
                                                                                                  2. They are durable, meaning they are
Medial management ranges from                   Surgical Alternatives                             resistant to corrosion, degradation,
acetaminophen for mild osteo-                                                                     and wear and will retain their strength
arthritis to nonsteroidal anti-inflamma-        When nonoperative treatment fails, sur-           and shape for a long time.
tory drugs (NSAIDs) for moderate to             gery may be indicated. An orthopaedic
severe osteoarthritis.                          surgeon is a physician specializing in            3. They are functional, meaning they
                                                surgical treatment of bone and joint dis-         have mechanical properties that
The effectiveness of the over-the-counter       ease and injury. Surgical options include         duplicate the replaced structures,
supplements (neutraceuticals) glu-              many minimally invasive or less invasive          such as the strength to handle
cosamine and chondroitin sulfate are            surgeries such as arthroscopy and
                                                                                                  weight-bearing loads, the flexibility to
controversial. Some medical studies             joint replacement. New surgical tech-
clearly showed improvements in pain             niques and refined implants are                   bear stress, and the ability to glide
and stopped cartilage breakdown.                improving the quality of life of patients         against each other.
Others studies were either inconclusive         with osteoarthritis.
                                                                                                  4. They are high quality, meaning
or showed no benefit. In another study,
vitamin C (150 mg/day) reduced                  The physicians and staff at Blue Ridge            they meet the highest fabrication
osteoarthritis progression more than            Orthopaedics are committed to providing           standards at a reasonable cost.
three-fold compared to a placebo.               proven, top-quality care for pain due to
Topical agents such as capsaicin creams         osteoarthritis and many other painful or          Source: American Academy of
                                                                                                          Orthopaedic Surgeons
and Aspercreme can reduce pain but do           debilitating conditions of the bones and
not affect the progression of arthritis.        joints. Blue Ridge surgeons emphasize

                                                                                                                      Blue Ridge Orthopaedics     5
        Anesthesia                                                                                            By Henry H. Salzarulo, MD

            Today                                                   Training, techniques, and monitoring
                                                                    reduce complications

        How safe is your anesthetic? In the early     determinations, continuous ECG screen-        more intuitive and less established.

       H20th century, one in 1,000 surgical
        patients was expected to die. When I
        began residency training in 1970, the
        generally accepted figure was between
        one in 4,000 and one in 5,000. Today,
        however, we expect less than one fatality
        per quarter million uses of anesthetic.
                                                      ing, and oxygen and carbon dioxide
                                                      observation. Most patients who receive
                                                      general anesthesia have their inhaled gas
                                                      mixtures constantly measured. If the oxy-
                                                      gen falls too low or the carbon dioxide or
                                                      anesthetic gas rises too high, alarms sound
                                                      and lights flash. Today’s anesthetic envi-
                                                                                                    Regional anesthesia clearly reduces the
                                                                                                    risk of postoperative complications in
                                                                                                    major orthopaedic and general surgical
                                                                                                    procedures. There is no evidence that it
                                                                                                    reduces major preoperative compli-
                                                                                                    cations in the healthy, outpatient
                                                                                                    population — the group we treat at
                                                      ronment is a far cry from the “seat-of-       Blue Ridge Orthopaedics.
        Many changes have taken place to              the-pants” experience of years past.
        account for this startling difference.                                                      To be sure, patients experience less
        Improved training and credential-             Dramatic Improvements                         postoperative pain and are much less
        ing requirements have gone a long                                                           likely to suffer nausea and vomiting
        way toward making anesthetic safer.           New drugs are introduced frequently,          with regional anesthesia. The recovery
        Board-eligible or board-certified anes-       and older agents that caused renal or         period is shorter, the discharge is usual-
        thesiologists or certified registered         hepatic damage were eliminated. Greater       ly quicker, and the first 24 hours are
        nurse anesthetists now attend all             understanding of the lingering effects of     more pleasant. For these reasons, we
        anesthetic uses, as well as many proce-       muscle relaxants has reduced the inci-        advocate the use of regional anesthesia
        dures requiring sedation.                     dence of silent death in the postanes-        at our surgery center.
                                                      thetic unit. Explosive anesthetics were
        The introduction of continuous oxygen         removed decades ago.                          We must weigh these benefits against
        measurement in both the inhaled gas                                                         the serious, potentially lethal outcome if
        mixture and the patient’s blood, as well                                                    the local anesthetic is incorrectly inject-
        as continuous carbon dioxide monitor-                                                       ed — an outcome no less catastrophic
                                                           Improved training and                    than that of a poorly administered
        ing in the patient’s exhaled breath, have
        reduced death and neuralgic damage                  credentialing require-                  general anesthetic.
        from esophageal intubations to near                ments have gone a long
        zero. The elimination of this complica-              way toward making                      In the hands of well-trained, skilled pro-
        tion is an attainable goal. No advances                                                     fessionals using modern anesthetic tech-
                                                               anesthetic safer.
        have proven as important as these tech-                                                     niques and state-of-the-art monitors, the
        nologies in reducing preventable mor-                                                       risk of life-threatening complications
        bidity associated with surgery.               Equipment has improved dramatically.          approaches zero. It is difficult to get
                                                      Anesthetic machines can no longer             much better than that, but we keep try-
        The Changing                                  deliver a gas mixture without oxygen.         ing. And we will continue trying until
        Anesthetic Environment                        When an oxygen tank went empty and            every preventable death and major com-
                                                      the anesthesiologist failed to notice,        plication is eliminated in every hospital
        When I was a resident at the University of    renowned pop artist Andy Warhol died.         and surgery center in America. BR
        Pennsylvania, a top training center, elec-    A few years earlier, the lead singer of a
        trocardiogram (ECG) monitoring was            popular rock group died during a rela-        Henry H. Salzarulo, MD, earned his medical
        available only for open heart surgery,        tively simple ear procedure. Disposable       degree from the Indiana University School of
        and blood pressure monitoring was con-        tubes and breathing tubes have replaced       Medicine. Upon completion of an internship at
        sidered unnecessary for pediatric             reusable ones, reducing the spread            Letterman General Hospital, Dr. Salzarulo
        patients. We have come a long way since       of infection.                                 trained in anesthesiology while serving in the
        then in assuring patient survival by sim-                                                   U.S. Army in Yokohama and Camp Zama,
        ply requiring observation of the effects of   Regional Anesthesia                           Japan. He then completed his residency in
        the surgical and anesthetic trespass.                                                       anesthesiology at the University of Pennsylvania.
                                                      The contribution of the increasing use        Dr. Salzarulo is board certified by the American
        Every surgical patient is now moni-           of regional anesthetic is controversial.      Society of Anesthesiology and is a member of
        tored with frequent blood pressure            Some benefits are clear, while others are     the South Carolina State Medical Society.

6 Blue Ridge Orthopaedics
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                                                                                      Blue Ridge Orthopaedics            7
                                                                                                                    By Brian J. Redmond, MD

A Biologic Method
                                                                             New therapies help heal
of Cartilage Repair                                                          damaged knees

        Each year, more than two million

       EAmericans injure their knee cartilage.
        Blue Ridge Orthopaedics’ surgeons per-
        formed 2,000 knee surgeries last year
        and more than 6,000 during the past
        three years. Whatever the cause, the
        result is the same — pain that can hinder
        an active life. Many people live with knee
        pain for years. Simple activities like play-
        ing with children or grandchildren and
        getting in and out of a car are often chal-
        lenging obstacles.

        There are many different knee problems
        that can cause these symptoms, but
        whatever the diagnosis, without a reme-
        dy, every day may begin and end in pain.
        Fortunately, there are treatment alterna-
        tives — some only available in the last
        several years — that may effectively           The first surgical procedure required for Carticel implantation is an arthroscopic outpatient pro-
                                                       cedure to remove a biopsy for culturing. Often, the biopsy is taken during the initial evaluation
        repair damaged knee cartilage and
                                                       procedure, reducing the number of surgeries from three to two.
        relieve pain.
                                                       surgical repair procedures. Since articular        The knee joint is made of three bones,
        Now a Biologic Treatment Option                cartilage does not repair itself, Carticel         four major ligament groups, and two
                                                       provides orthopaedic surgeons with a               types of cartilage. The bones in the knee
        In March 1995, the field of bio-               “biologic option” to treat appropriate             are the femur, tibia, and patella. The
        orthopaedics was introduced in the             patients. Surgeons at Blue Ridge                   femur has two separated prominences
        United States when the first patient was       Orthopaedics are trained in this highly            called condyles. The inner condyle is the
        treated with a new option, Carticel®           specialized procedure. Blue Ridge                  medial femoral condyle, and the outer is
        (autologous cultured chondrocytes). In         Orthopaedics is one of only a few prac-            the lateral femoral condyle. The tibia
        August 1997, the Food and Drug                 tices in South Carolina to offer Carticel          meets the femur at the knee with two
        Administration (FDA) issued a biologics        as one of the many options for treatment           areas on which the two femoral condyles
        license that approved Carticel for the         of cartilage damage in select individuals.         “ride.” These are the medial and lateral
        repair of articular cartilage defects in the                                                      tibial plateaus. The patella, or kneecap,
        medial and lateral femoral condyle and         Knee Anatomy                                       rides in a shallow groove (sulcus) over
        trochlea regions of the knee.                                                                     the front part of the femur called
                                                       The knee has the difficult task of trans-          the trochlea.
        Carticel was the first product approved        ferring the weight-bearing load of the
        under the FDA’s proposed approach to           body while allowing rapid change in                Ligaments are tough, fibrous bundles
        regulating human tissue and cell therapy       direction and speed. This necessary twist-         that are strong but only slightly elastic.
        products. In January 2000, the Carticel        ing and rotating adds to the stress the            Each ligament connects the femur to the
        indications were modified to include use       joint endures. With certain activities, the        tibia or fibula at a different point. The
        in patients who have had inadequate            knee is subjected to nearly 10 times the           ligaments in the knee are the medial and
        responses to prior arthroscopic or other       body’s weight.                                     lateral collateral ligaments (MCL and

8 Blue Ridge Orthopaedics
LCL) and the anterior and posterior cru-         around them healthy. Think of the cells              approach to locate the damaged
ciate ligaments (ACL and PCL).                   as a few marshmallows suspended in a                 chondral tissue and trim away or
                                                 Jell-O mold. As with most body tissues,              stabilize the area. Chondroplasty
The two types of cartilage in the knee are       there is constant wearing out and                    may relieve pain for a short period
meniscal and articular. Meniscal cartilage       replacement activity of this matrix.                 of time, but it does not repair the
is best described as C-shaped pads found         Unfortunately, the cells do not replicate.           cartilage defect.
between the femur and tibia, one at each         Once they are damaged or lost, the sur-
side. They are attached to the top of the        rounding matrix gradually degenerates.             • Microfracture or marrow stimula-
tibia or tibial plateaus and serve to cush-      Without help, the body is unable to                  tion. This procedure is used as an
ion and transfer joint force by distribut-       repair these articular cartilage defects,            attempt to repair a small cartilage
ing joint forces over a larger area of the       which can lead to a more serious condi-              defect using the body’s own marrow
joint, transferring force from the curved        tion known as osteoarthritis.                        stem cells. These cells enter through
femoral condylar margins to the flatter                                                               small holes made through the bone
tibial plateaus.                                 Cartilage Damage                                     by abrasion, drilling, or using a
                                                                                                      small pick to create microfractures.
Articular cartilage is the glistening white      Articular cartilage is often damaged by              Think of this process as repairing a
tissue that covers the ends of the bones         sports, traumatic injuries, work injuries,           pothole in the road — filling in the
at the knee joint. It is both tough and          and daily wear and tear. This damage                 hole prevents it from widening and
resilient. It has the consistency of firm        often occurs in conjunction with dam-                involving the entire road. These
rubber but is actually a mixture of colla-       age to another area of the knee, such as             techniques are successful in address-
gen and special, large, sponge-like mole-        injury to the ACL or meniscus. It is                 ing symptoms in some patients.
cules, all maintained by living cartilage        important to note that early interven-
cells (chondrocytes). With normal joint          tion may help prevent damage from                  • Osteochondral transfer. With this
fluid, the surface is more slippery than         spreading to surrounding healthy carti-              technique, the surgeon removes a
ice on ice. This cartilage structure allows      lage and further deterioration to the                small section of the patient’s own
for normal, smooth, and easy joint               joint surface. There are various surgical            cartilage and the underlying bone
motion and also “softens” the impact             treatment options to address articular               plug. It is obtained from an area
during loading, much the same as a               cartilage loss, including those for pain             that does not bear a lot of weight.
shock absorber.                                  relief and cartilage replacement. More               The size of the defect treatable with
                                                 common options to treat cartilage injury             this method is usually between 1
Articular cartilage may not appear alive,        include the following:                               and 2 cm, or the size of a thumbnail.
but in fact, it is. The number of chron-
drocytes residing in the tissue is small          • Arthroscopic chondroplasty or                  These are several options for regenera-
(approximately 5%), but chondrocytes                debridement. This procedure                    tion and/or repair of damaged articular
have the job of keeping the matrix                  involves using an arthroscopic                 cartilage. Your physician will determine

  Five Steps of Carticel

        1                               2                             3                               4                                5

                                                                                                                                                             Images courtesy of Genzyme Corporation

  1. An initial biopsy of normal joint surface is removed from the non–weight-bearing portion of the knee. 2. The biopsy is sent to a Genzyme lab, where
  it is cultured and grown into a solution of the patient’s cartilage cells. 3. During the second procedure, the surgeon makes an incision in the knee and
  removes any damaged cartilage. 4. A piece of lining is then removed from the adjacent upper tibia bone and sewn over the defect. 5. This creates a
  water-tight membrane to contain the cultured cartilage cells. The patient’s cells are then injected into the defect.

                                                                                                                         Blue Ridge Orthopaedics                                                      9
         which option is right for you, based on        the cells to your physician for the second    solid, but full activities and many sports
         the type and extent of your knee injury.       stage — autologous chondrocyte implan-        will have to wait until nine to 12 months
                                                        tation. Your surgeon implants these cul-      after surgery.
         How Carticel Can Help                          tured cells in your knee during a second
                                                        surgery to repair and restore the surface     Although the number of patients who are
         Carticel is a biologic product using your      of your articular cartilage. Carticel has     candidates for Carticel treatment is rela-
         own (autologous) cultured chondrocytes         the advantage of restoring a normal car-      tively small, Blue Ridge Orthopaedics sur-
         to repair the articular cartilage defects in   tilage surface instead of a scar tissue       geons are experts in the latest technologi-
         the knee that are greater than 2 cm.           patch that other techniques, like             cal advances for the knee and all other
         Receiving Carticel is a two-stage process.     microfracture, create.                        major joints. Each person and injury is
         If your surgeon thinks you are a candi-                                                      unique; therefore, treatment for each
         date for Carticel, the first step is to        The recovery time following Carticel          injury is individualized. Our orthopaedic
         obtain a small amount of your cartilage.       goes through many phases, depending on        surgeons can discuss these and other
         Your physician will perform an                 additional procedures needed. Initially,      options with you and help you decide
         arthroscopy on your knee specifically to       you will walk with crutches for six to        which treatment will serve you best. BR
         obtain the biopsy, or he or she may            eight weeks and will use a continuous
         obtain the cartilage biopsy while per-         passive motion machine to gently move         Brian J. Redmond, MD, is board certified by the
         forming another arthroscopic procedure         your knee at home. In three to six            American Board of Orthopaedic Surgery. He is a
         on your knee.                                  months after surgery, you will likely walk    fellow of the American Academy of Orthopaedic
                                                        without crutches and resume most nor-         Surgeons and the American Orthopaedic Society
         The biopsy is shipped to Genzyme               mal daily routines. If light-duty work is     for Sports Medicine. He is also a member of the
         Biosurgery, where the cells are cultured       available, you may return to that, as well.   South Carolina Medical Association and the
         to increase the number of cells from a         You are given specific exercises; however,    American Medical Association. In 1998, Dr.
         few hundred thousand to more than 10           no sports, cutting, or twisting activities    Redmond received the Young Investigators Award
         million. Once the cell-culturing process is    are allowed. During the second six            from the American Orthopaedic Society of Sports
         complete, Genzyme Biosurgery returns           months, the repair will become more           Medicine for best clinical research by a fellow.

10 Blue Ridge Orthopaedics
‘ReSTORing’ Vision                                                                                  By Scott C. Massios, MD, FACS

                  Breakthrough technology provides
                  clarity without glasses
Sight is by far one of our most valuable      lens works like that of a camera. It picks    excessive exposure to sunlight. Cataracts

senses. Without our vision, we would be
unable to experience the beauty of a sun-
set or see the face of a loved one. Without
sight, everyday tasks like driving and
reading would be impossible.

Our eyes are complex machines that
                                              up images and then focuses the lights,
                                              colors, and shapes on the retina, the
                                              transmitter located at the back of your
                                              eye that sends the images to your brain.
                                              In a normal eye, light passes through the
                                              lens and is focused on the retina. To help
                                              produce a sharp image, the lens must
                                                                                            can also develop soon after an eye injury
                                                                                            or even years later. In more than 90% of
                                                                                            cases, however, cataracts are caused by
                                                                                            the aging process[2]. Unfortunately,
                                                                                            cataracts are not preventable, but they

                                                                                                 The ReSTOR IOL allows
deliver a clear picture of the world          remain clear.
around us, communicating the simplest                                                         the patient to read the type
of colors, shapes, and textures. When our     What Cataracts Are Not                           on items such as prescrip-
sight is compromised, it affects not only                                                        tion bottles, magazines,
our lives but also the lives of those close   A cataract is not a “film” over the eye,
                                                                                               and newspapers while also
to us.                                        and neither diet nor lasers will make it go
                                              away. The best way to treat a cataract is         having the ability to drive
Cataract surgery provides the restora-        to remove the old, clouded lens and pro-         or go on a sightseeing tour
tion of this sight and has undergone          vide a replacement.                               — all without depending
tremendous technological advances                                                                 on glasses or bifocals.
since the days of your parents and            In its early stages, a cataract may not
grandparents, resulting in one of the         cause a vision problem. The cloudiness
safest, most effective types of surgery.      may affect only a small part of the lens.     are easily corrected through a simple
It’s also one of the most successful[1].      Over time, the cataract may grow larger       surgical procedure.
This year, millions of patients will          and cloud more of the lens, sometimes
choose to have both their sight and their     causing sharp images to appear blurred        Once the cataract makes an impact on an
lifestyles restored thanks to this life-      or making seeing things at night more         individual’s quality of life, surgery may
changing medical procedure.                   difficult. It may also be why eyeglasses or   be needed to improve vision. This treat-
                                              contact lenses that used to help you see      ment involves removing the cloudy lens
Cataracts                                     or perform other simple tasks no longer       and replacing it with an artificial lens.
                                              seem to help.
A cataract is a “clouding” of the lens in                                                   Each year, approximately 2.7 million
the eye. Located just behind the iris, or     There are several causes of cataracts,        cataract surgeries are performed in the
the colored part of your eye, the eye’s       including aging, smoking, diabetes, and       United States; and globally, 9 million

   ReSTOR IOL Implantation                                                                                                              Images courtesy of Alcon Labs, Inc.

    AqualaseTM lens removal                       Injection of ReSTOR implant                   ReSTOR implant in the capsular bag

                                                                                                               Blue Ridge Orthopaedics                                        11
         cataract surgeries are performed. Today,     With the introduction of the ReSTOR               the chief of the Department of Ophthalmology at
         cataract surgery involves removing the       lens, IOL technology has taken a giant            Eglin U.S. Air Force Regional Hospital and was a
         cloudy lens and replacing it with an arti-   leap forward. No longer is the objective          member of the U.S. Air Force’s Mobile
         ficial lens, often a monofocal intraocular   of cataract surgery to simply restore             Ophthalmic Surgical Team. His distinguished
         lens (IOL). A monofocal lens typically       your distance vision while leaving you            and decorated career spanned 13 years in the
         provides patients with only one focal        depending on reading glasses for small            U.S. Air Force from 1988 to 2001. Dr. Massios
         point, most commonly far away, leaving       print. The ReSTOR IOL allows the                  has been in the upstate for the past five years
         patients dependent on glasses for up-        patient to read the type on items                 and is Director of Blue Ridge Eye Center in
         close tasks such as reading or knitting.     such as prescription bottles, magazines,          Seneca, South Carolina. He has been a member
                                                      and newspapers while also having the              of the Blue Ridge Surgery Center Staff since
         New Multifocal Solution                      ability to drive or go on a sightseeing           January 2005, bringing the latest in intraocular
                                                      tour — all without depending on                   (cataract and glaucoma) and eyelid surgery to
         Thanks to new, revolutionary technolo-       glasses or bifocals.                              this state-of-the-art facility.
         gy, the AcrySof® ReSTOR® IOL allows
         patients to see a full range of vision,      In fact, U.S. Food and Drug Admin-                References:
         near through distance, using patented        istration (FDA) clinical studies have
         apodized diffractive technology              demonstrated that 80% of patients                 [1] Facts About Cataract. National Eye
         designed to provide visual freedom for       never needed to wear glasses or bi-                   Institute, National Institutes of
         the patient.                                 focals again with the ReSTOR lens                     Health, Department of Health and
                                                      compared to 8% of patients with regu-                 Human Services. June 2004.
         Simply speaking, the ReSTOR lens is          lar monofocal lenses. BR
         designed to improve vision at all dis-                                                         [2] Lang GK. Ophthalmology. New
         tances and was created for patients who      Scott C. Massios, MD, FACS, is one of the first       York, NY: Thieme New York; 2000.
         wish to have a full range of vision once     surgeons in South Carolina chosen to implant
         their cataract lenses are removed.           the revolutionary AcrySof ReSTOR lens. He was

12 Blue Ridge Orthopaedics
                                                                                          Physician assistants
Helping Hands                                                                             improve many
                                                                                          medical services

Physician assistants (PAs) are highly         phases. The first phase includes class-     Credentialing

skilled, licensed health professionals who
provide medical services that are other-
wise performed by physicians. For exam-
ple, PAs assist in surgery, take medical
histories, perform physical examinations,
diagnose and treat illnesses, order and
interpret laboratory tests, perform minor
                                              room and laboratory instruction in basic
                                              medical sciences, including anatomy,
                                              physiology, pathology, microbiology, and
                                              pharmacology, as well as behavioral sci-
                                              ence and medical ethics.

                                              The second phase consists of structured
                                                                                          Before they can practice, graduates of
                                                                                          accredited PA programs must pass a
                                                                                          single national certification exam de-
                                                                                          veloped by the National Board of
                                                                                          Examiners and administered by the
                                                                                          National Commission on Certification
surgery, and, in South Carolina, prescribe    clinical rotations, providing students      of Physician Assistants. Only those
medications. Patient education and coun-      with direct patient contact. They are       individuals with current certification
seling are also important aspects of a PA’s   teamed with medical students, function      may use the designation “Physician
daily activities. PAs practice virtually      similarly, and are taught by physicians.    Assistant-Certified,” or “PA-C.” They
every medical specialty — from family         The rotations are intensive, hands-on       are licensed by the South Carolina State
medicine to surgery.                          learning experiences in private and         Board of Medical Examiners and team
                                              institutional settings in medical disci-    with their supervising physicians to
Education                                     plines, such as family practice, internal   provide comprehensive medical care.
                                              medicine, obstetrics and gynecology,
Physician assistants graduate from pro-       pediatrics, surgery, and orthopaedic        To maintain certification, PAs must earn
grams accredited by an independent            emergency medicine.                         100 hours of continuing medical educa-
  organization supported by the                                                           tion every two years and sit for a recerti-
   American Medical Association,                                                          fication exam every six years. These
      American Academy of Family                                                          requirements keep them abreast of
        Physicians, American College                                                      medical advances.
          of Surgeons, American Aca-
            demy of Physician Assis-                                                      Meet Our Physician Assistants
              tants, and other national
               organizations.                                                                           C. Stephen Jackson, PA-C,
                                                                                                        received his training at
               Most PAs have a bache-                                                                   Creighton University in
               lor’s degree and more                                                                    Omaha, Nebraska, while
               than four years of                                                                       serving in the U.S. Army.
                health care experience                                                                  He also earned a Medical
                before admission. The                                                     Master’s of Science degree from Saint
                 typical PA program                                                       Francis University in Loretto, Pennsyl-
                  lasts 24 months and                                                     vania. Jackson is board certified by the
                   consists of two                                                        National Commission on Certification
                                                                                          of Physician Assistants (NCCPA) and is
                                                                                          a member of the American Academy of
                                                                                          Physician Assistants, the Society of
                                                                                          Army Physician Assistants, the South
                                                                                          Carolina Academy of Physician
                                                                                          Assistants, and the Physician Assistants
                                                                                          in Orthopaedic Surgery.

                                                                                                       G. Emmitt Carter III, PA-
                                                                                                       C, trained at Methodist
                                                                                                       College in Fayetteville,
                                                                                                       North Carolina. He is
                                                                                                       board certified by the
                                                                                                       NCCPA and earned special
                                                                                          recognition in surgery. He is also a

                                                                                                              Blue Ridge Orthopaedics   13
         member of the American Academy of Physician Assistants
         and the South Carolina Academy of Physician Assistants.          Blue Ridge Orthopaedics
                                                                          Welcomes New Physician
                       Frank Mlinar, PA-C, received his Bachelor of
                       Science degree in nursing from Alfred University                 A native of New Orleans, James C. Mills III,
                       in New York and graduated as a nurse practi-                     MD, joined Blue Ridge Orthopaedics in 2005.
                       tioner from Albany Medical College, also in New                  Dr. Mills earned his medical degree from
                       York. In 1979, he passed his physician assistant                 Tulane University School of Medicine
                       exam. Mlinar is NCCPA certified and is a                         in New Orleans and completed an ortho-
         member of the American Academy of Physician Assistants,
                                                                          paedic   surgery    residency   program   at   that school’s
         the South Carolina Academy of Physician Assistants, and the
         Physician Assistants in Orthopaedic Surgery.                     Department of Orthopaedics, also in New Orleans. Dr. Mills
                                                                          completed a sports medicine, arthroscopy, and joint replace-
                      Wallace S. Liggett, PA-C, graduated from the        ment fellowship at the Hughston Orthopaedic Hospital in
                      physician assistant program at Mountain             Columbus, Georgia.
                      State University, Beckley, West Virginia. He is
                      NCCPA certified and is a member of the              Dr. Mills is board certified by the American Board of
                      American Academy of Physician Assistants and        Orthopaedic Surgeons. He is a member of the Arthroscopy
                      the South Carolina Academy of Physician             Association of North America, the American Academy of
         Assistants. He also served in the U.S. Navy as Master Chief      Orthopaedic Surgeons, the Southern Medical Association,
         Hospital Corpsman. BR
                                                                          the South Carolina Medical Association, the Eastern
                                                                          Orthopaedic Association, the American College of Surgeons,
                                                                          and the Southern Orthopaedic Association.

                                                                                               Local Independent Pharmacy
                                                                                                    Rob Hubbard • Ron Young
                                                                                              Serving the Clemson Community
                                                                                                      For over 30 Years
                                                                                                402 College Avenue • Clemson, SC

                                                                                             Trust, Service, Dependability

                                                                                                  Clemson Apothecare
                                                                                                 Compounding Pharmacy
                                                                                                   Specializing in Custom
                                                                                                 Prescription Compounding
                                                                                                  103 Knox Road • Clemson, SC

14 Blue Ridge Orthopaedics
                                                                                          Blue Ridge Orthopaedics
Advertiser Directory                                                                      Associates thanks:
  Erwin & Duncan CPA Firm, PA                                      ..........................                        see page 15
  Pazdan-Smith Group Architects
    200 E. Broad St., Ste. 300 • Greenville, SC 29601
    (864) 242-2033 • (864) 242-2034 Fax
Computer Services
  Complete On-Site Solutions                              . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .see   page 15
Financial Services
  UBS Financial Services Inc.                           ..................................                              see page 7
Home Health Services
  Interim Healthcare Inc.                         .........................                     see inside front cover
Orthopaedic Implants & Supplies
  Biomet Orthopedics, Inc.
    1061-B Sparkleberry Ln. Ext. • Columbia, SC 29223
    (803) 462-0504 • (803) 462-0097 Fax
  DePuy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .see page 10
  OrthoPro, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .see page 12
  Smith & Nephew . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .see page 15
  Zimmer, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . see page 7
  Sammeth Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .see page 12
  The Hubbard/Young Pharmacy, Inc. . . . . . . . . . . . . . . . . . . . . . .see page 14
Physical Therapy
  Clemson Sports Medicine and Rehabilitation                                                   . . . . . . . . .see    back cover
  Mountainview Medical Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . .see page 14
  SourceOne Healthcare Technologies, Inc. . . . . . . . . . . . . . . . . . .see page 7

                                                                                                                                                    In Business since 1990
                                                                                                                                               Providing IT Consulting
                                                                                                                                                  Sales & Service
                                                                                                                                              •   IT Support
                                                                                                                                              •   TurnKey Installations
                                                                                                                                              •   Medical Network Systems
                                                                                                                                              •   LAN & WAN Connectivity
                                                                                                                                              •   HIPAA Compliance
                                                                                                                                              •   PACS
                                                                                                                                              •   Practice Management
                                                                                                                                              •   Software Implementation

                                                                                                                                         189 Beaver Lake Dr • West Union, SC 29696
                                                                                                                                          (864) 985-7700 phone • (864) 638-1969 fax
Blue Ridge Orthopaedics Associates, PA     PRSRT STD
10630 Clemson Blvd., Ste. 100             US POSTAGE
Seneca, SC 29678                           PAID
                                          SENECA, SC
                                         PERMIT NO. 501

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