Hess Orthopaedics Sports Medicine PLC

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					                 Hess Orthopaedics & Sports Medicine, PLC
                    4165 Quarles Court ● Harrisonburg, Virginia 22801 ● 540-434-1664 ● 540-434-5931 (fax)

                                                            become much more convergent and overlapping in the
                    ASK THE DOCS                            past decade. Even professional educational meetings
                                                            typically include both specialists on the faculty.
                                                            Classically, orthopaedists were better trained on spinal
                                                            instrumentation and neurosurgeons more adept with the
 Orthopaedic Spine Surgeons vs. Neurosurgeons               difficult re-do cases, but this has changed.
  Are there different criteria for spinal surgery           Neurosurgeons have become much better educated in
         between these two specialties?                     application of instrumentation, and orthopaedists have
                                                            learned much from their neurosurgical colleagues.

                                                            I personally trained with an excellent orthopaedic spinal
                                                            surgeon at Duke University, but also have learned a
                                                            great deal of neurosurgery while "on the job." After
                                                            completing my 6-year residency at Duke, I worked with
                                                            both types off specialists in the Air Force as well as Drs.
                                                            Ritchie Gillespie and Crysl Willison, neurosurgeons here
Robert C. Kime III, M.D.        Olumide “Ollie” Danisa,
                                                            in Harrisonburg. Earlier in my career I performed
Orthopaedic Spine Surgeon       Orthopaedic Spine Surgeon   numerous surgeries jointly with these neurosurgeons,
                                                            bringing our collective abilities together for the patient's
                                                            benefit. I learned how to perform dural repairs and
In current practice there is a lot of overlap between       difficult re-do decompressions. My experience has
orthopaedic spinal surgeons and neurosurgeons. We           enabled me to now perform the majority of these
both perform surgical procedures that involve               procedures independently. My partner Dr. Ollie Danisa
decompression of compressed nerves and/or fusion of         has also trained extensively with both orthopaedic spinal
spinal elements. However, the background from which         surgeons and neurosurgeons at the University of
we approach these problems differs slightly.                Virginia as well as at Duke University. He has also
Neurosurgeons operate on the brain as well as the spinal    completed an additional year of spine fellowship training
cord, and have extensive training in working with these     beyond his orthopaedic residency. Application of new
delicate structures. They still remain the specialist of    technology to the spine has been largely spearheaded by
choice (over orthopaedists) for dealing with intra-spinal   orthopaedic spinal surgeons. New technology such as
tumors and masses. Although they do work with bone,         minimally invasive spinal surgery for removal of
to some degree, (skull, vertebrae), they do not have        herniated discs, lumbar or cervical decompressions, or
extensive experience with treatment of fractures of other   even fusions is now available right here at Hess
bones. This becomes important when dealing with             Orthopaaedic Center.
spinal fusions, which involve creating new bone across
and/or between spinal segments. The knowledge and           Our background in performing arthroscopic procedures
clinical experience of the orthopaedic spinal surgeon       in other joints, such as the knee and shoulder, has helped
tends to be superior in this arena.                         to facilitate this. Dr. Danisa and I attend regular
                                                            continuing medical education courses in spinal surgery,
Orthopaedic spinal surgeons are able to diagnose and        and employ some of the newest technologies. We are
treat a large variety of spinal conditions with equal       currently using BMP, or bone morphogenic protein in
ability to neurosurgeons, including herniated discs,        select cases for spinal fusion. This substance enables the
spinal fractures, degenerative disc disease, discogenic     formation of new bone fusions even more effectively
pain disorders, and facet disease. The primary goal         than iliac crest bone grafting, which was the old "gold
when assessing a spinal problem is to try and determine     standard." Disc replacement surgery for both cervical
the exact cause for the patient’s symptoms. An              and lumbar discs is on the near horizon. However,
orthopaedists’ understanding of both bony anatomy and       embracing new technology must always be done with a
neuroanatomy uniquely qualifies him to accomplish this.     modicum of caution, to ensure both patient safety as well
This also allows the formulation of a treatment plan        as to ensure that we are not compromising long-term
tailored to the patient's specific problem, greatly         results. One of my Duke professors used to say, "Never
improving the chance for a successful outcome.              be the first or the last surgeon to do a new procedure."

While previously separate and distinct, training of         In conclusion, there is tremendous overlap between
orthopaedic spinal surgeons and neurosurgeons has           orthopaedic spinal surgeons and neurosurgeons.
Perhaps we should just call ourselves spinal surgeons.         very seriously and works as patient advocates while
Neurosurgeons remain the specialist of choice for              assuring the comfort and confidentiality of each patient.
tumors within the thecal sac, but other than this we both
treat spinal conditions equally well. We treat cervical        Today’s orthopaedic practice looks different from those
and lumbar disc herniations, degenerative disc disease         of the past. Today we see new technology, higher
and most fractures of the spine. The vast majority of          demands and more educated patients with instant access
patients can be treated non-operatively and can benefit        to medical information and guidance from the internet.
from a combination of medications, physical therapy,           The look and demands have changed, but our core
activity modification, weight loss, smoking cessation,         commitment and mission statement have remained the
bracing, and epidural steroid injections or nerve root         same: to treat each patient as an individual with respect
blocks.                                                        and interest in their concern.
These initial treatments can be facilitated by our non-
operative providers, Dr. James Schwartz and Nurse              I have asked our Clinical Administrator and
Practitioner Mary Koogler. Both of these providers have        physicians to commit to seeing all new patients within
a ready pipeline to Dr. Danisa and me for referral of          8 working days and urgent patients within 2 working
those patients that fail these non-surgical treatments.        days. Patients will be seen within these time
Cases that involve rapid neurological compromise or            constraints by the first available physician available
intractable pain are quickly referred to one of us for         at our practice. Emergencies will be seen same day at
surgical consideration. We have an extremely well-             our practice. Some emergencies can be treated in the
qualified physical therapy team at our downstairs              office; however, some (depending on the injury) may be
rehabilitation center that can assess and treat many           referred to the Emergency Department and the
spinal problems. Aquatic therapy is also available and         Orthopaedist on-call at the hospital. When a patient or
can be a tremendous benefit to the overweight patient          referring physicians’ office calls to schedule for a
with back problems who claims he "can't lose weight."          particular provider and that provider is booked at the
                                                               time of request, the patient will have the opportunity to
This arrangement ensures rapid access of our patients to       schedule with another provider at our office. Our staff
appropriate care, with an emphasis on conservative             will help direct the patient to a provider that is able to
management and surgery only when necessary, as a last          treat their specific orthopaedic needs. Of course, if a
resort. We believe in treating patients just as if they were   patient only wishes to see a particular provider in our
our own family. You can feel confident that a patient          group, and the issue is not emergent, the patient will be
that is referred to Hess Orthopaedic Center will be            scheduled for the next available appointment with that
well cared for and will receive the most                       specific provider. Emergencies and extended patient
contemporary treatment available.                              visits often occur, but we have creative scheduling
                                                               options that will help alleviate some of the wait time for
Robert C. Kime III, M.D.                                       the patient.
Orthopaedic Spinal Surgeon
                                                               We appreciate the relationships that we have created
                                                               with our referring physicians. If there are any questions,
              A NOTE FROM THE CEO                              suggestions or any problems, please contact us
                                                               immediately so that we may work out an appropriate
In today’s ever-changing healthcare industry, one              solution. You may reach us at 540-434-1664. Please
thing stands clear: our commitment to provide the              ask for Sue Sipes, our Clinical Administrator, who will
most appropriate healthcare with consideration and             be glad to assist you. We look forward to your
professionalism to those that we serve. With the               feedback and the opportunity to serve our
population in our service area growing, we are faced           community.
with many new challenges. There are new insurance
plans with different requirements for both our patients        B.E. “Bucky” Chisholm, III
and our practice. Changing State and Federal                   Chief Executive Officer
compliance issues along with immense differences in
insurance carrier contracts place more responsibility on
the practice and press our staff to constantly update and
upgrade their skill sets. Our staff takes this challenge
FROM THE CLINICAL PRACTICE                                  of Dukes Basketball and of several soccer teams
ADMINISTRATOR                                               too. He is also an enthusiastic participant in an
                                                            adult soccer league, and has traveled extensively as
                                                            the Team Physicians with some of the world soccer
The orthopaedic news of the day: we now have 6              teams. He is a current Member of the American
Orthopaedic Surgeons, 1 Office-Based Orthopaedist,
                                                            Society of Sports Medicine.
and 1 Orthopaedic Nurse Practitioner. The 6
surgeons take emergency room call every week, do
surgery 2-3 days per week, and are in the office 2-3 days   Dr. Battaglia has a subspecialty in Sports Medicine.
per week. We schedule most of our physicians to be          He has special skills with the arthroscope and does
finished at 5:00 m or 6:00 pm, but due to volume, we        some very specialized knee and shoulder surgeries
have to work some much later to see work-ins and            using this tool. He and Dr. Barnes attend many of
urgent need patients. For your reference, the               the local games and guide and assist the trainers and
following is a brief outline of each physician’s            athletes in strengthening and rehab.
                                                            Mrs. Koogler is well known in the area as a very
Dr. Kime and Dr. Danisa are the only local                  efficient and knowledgeable Board Certified Nurse
orthopaedic physicians who routinely operate on the         Practitioner and has certification in several areas
neck and lower back. In addition to General                 including Advanced Education in Orthopaedics.
Orthopaedics, Spinal surgery, if needed, can be             She also treats non-operative patients for many
done by them for all of the common and complex              orthopaedic problems including pre operative spinal
problems people may have with their spines. They            problems and is active in the Spine program. In
are both very experienced and also do many general          addition she also treats non-operative fractures,
ortho procedures (as their schedules allow) on their        injuries and lacerations referred to our group from
established patients.                                       the ED at RMH.

Although Dr. Schwartz is also a Board Certified
general orthopaedist and spine surgeon, he elects to        Sue Sipes
focus on an office-based practice, and he guides pre        Clinical Practice Administrator
operative and sometimes operative-preventative
back care for patients. He is also certified to
perform legal evaluations, Independent Medical
Exams, second opinions and disability evaluations.

Dr. Hendren is our senior partner and can help you
with any orthopaedic problem (other than spine). He
has a lot of patients who needs foot surgery, carpal
tunnel releases, arthroscopic knee surgery or “mini-
open” or “open” shoulder surgery. His sub
specialty is in Total Joint Replacements and he has
one or more of these procedures scheduled every
day he is in surgery in addition to his General
Orthopaedic surgeries.

Dr. Hardigree and Dr. Barnes also perform all
orthopaedic surgeries, including total joint
replacements, and are very versatile as General
Orthopedist. Dr. Hardigree does a wide range of
procedures and we are happy to have his expertise
in so many areas.

Dr. Barnes is our Director of Sports Medicine. As
are several of our Duke graduates, he is an avid fan

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