Indiana Gazette
March 8, 2016

Highmark Blue Cross and Blue Shield has selected Indiana Regional Medical Center as a Blue Distinction Center+ for Knee and Hip Replacement, part of the Blue Distinction Specialty Care program.
Blue Distinction Centers are nationally designated health care facilities shown to deliver improved patient safety and better health outcomes, based on objective measures that were developed by Blue Cross and Blue Shield companies with input from the medical community.

Knee and hip replacement procedures are among the fastest-growing medical treatments in the U.S., according to studies published in the June 2014 Journal of Bone and Joint Surgery and the American Academy of Orthopaedic Surgeons.

In 2010, the estimated cost of hip replacements averaged $17,500 and the estimated cost of knee replacements averaged $16,000, according to the Agency for Healthcare Research and Quality.

Hospitals designated as Blue Distinction Centers+ for Knee and Hip Replacement demonstrate expertise in total knee and total hip replacement surgeries, resulting in fewer patient complications and hospital readmissions.

Designated hospitals must also maintain national accreditation.

In addition to meeting these quality thresholds, hospitals designated as Blue Distinction Centers+ are on average 20 percent more cost-efficient in an episode of care compared to other hospitals.
Quality is key.

Only those facilities that first meet nationally established, objective quality measures will be considered for designation as a Blue Distinction Center+.
To earn this designation, IRMC was evaluated based on objective, evidence-based selection criteria established with input from expert physicians and medical organization.

The goal of Blue Distinction+ is to identify medical facilities that deliver better overall quality and medical outcomes, and demonstrate cost efficiency for a specific area of specialty care, helping patients and doctors to make more informed hospital choices.

Indiana Regional conducts more than 200 joint replacement surgeries each year.

IRMC is proud to be recognized by Highmark BCBS for meeting the robust selection criteria for knee and hip replacements set by the Blue Distinction Specialty Care program.

“This designation is a tribute to the dedicated team of physicians, nurses, technicians and therapists who helped develop Indiana Regional Medical Center’s comprehensive program in hip and knee replacement surgery,” said Stephen Wolfe, CEO of IRMC.

“Our patients and the community benefit immensely from the clinical expertise in this area of specialty care. This designation puts us in the same class with many top hospitals in major metropolitan areas across the country.”

Since 2006, the Blue Distinction Specialty Care program has helped patients find quality providers for their specialty care needs in the areas of bariatric surgery, cardiac care, complex and rare cancers, knee and hip replacements, maternity care, spine surgery and transplants, while encouraging health care professionals to improve the care they deliver.

“Highmark Blue Cross Blue Shield extends its sincere congratulations to Indiana Regional Medical Center for their dedication to quality, patient safety, and transparency that is required to achieve this great distinction.

“With consumer-driven health care programs like Blue Distinction, and the significant effort of our partner practitioners and facilities, Highmark can now enable our members the opportunity to make wise, value-driven health care decisions,” said Dr. Mark Piasio, medical director, Clinical Services, Highmark Inc.

For more information about the program and for a complete listing of the designated facilities, visit www. bcbs.com/bluedistinction.

by SEAN YODER
Indiana Gazette
March 6, 2016

Terry Anderson first noticed his concussion symptoms during conversations. He said it felt like they were moving faster than he could understand. The symptoms evolved to include double vision and falling down, where he would basically fall over backwards, he said. He began slurring his speech and was unable to drive. He could sometimes only get out a few words on paper before he began to struggle and eventually his left hand would cease to move. His leg began to drag.

“Doctors would ask me about my symptoms and they sounded so crazy because they were all looking for the normal situations,” Anderson said.

“One said it was stress and I said, ‘How can I not be stressed? I’m losing my quality of life.’”

He figures it was probably seven years from the first time he started noticing symptoms to the time he was diagnosed and concussions were found to be the culprit for his problems. For three of those years he kept teaching at Young Brothers Tae Kwon-Do.

“But it was very, very difficult. Just absolutely, horrendously difficult.”

He credits his assistant instructors for allowing him to continue teaching as long as he did.

The weather has an effect on his symptoms. On high-pressure days, they weren’t as bad. But on low-pressure days he could sometimes barely get out of bed.

“Best case scenario, you just feel like you have a bad case of the flu. Worst case scenario is you’re holding on to the walls while you’re walking.”

Anderson said he spent years confused and frustrated about his symptoms. It wasn’t until a physical therapist that was treating his vertigo recommended a doctor at the Center for Orthopaedic and Sports Medicine at Indiana Regional Medical Center to look at his symptoms through the lens of concussions.

He will never get back the full health he had before the years of concussions eroded away his “processor,” as he calls it. He is one of many who are learning to cope with post-concussion syndrome.

LOST YEARS

“I learned there’s a reason people turn to drugs and alcohol. There is. My reason was I didn’t have a place. I lost my place.”

Anderson was forced to sell Young Brothers and quit teaching tae kwon do, his decades-long passion, his identity and his place in the world.

Anderson said he hid in alcohol when his quality of life was taken away by PCS. He had his usual stool at his usual watering hole. When the doctors asked him how much he drank, he told them, “However much I damn well please until you fix me.”

“I wasn’t a bad person and it isn’t even because I wanted to drink. It was because I wanted to hide from reality.”

“The first thing people say is, ‘Well, you know that’s only going to make it worse.’ You know what, not at that time it doesn’t.”

It was at this time that he joined a motorcycle club. He wouldn’t name it, but said “It was not your local firemen, it was the real deal.”

He was able to ride due to the high pressure that would build when he was moving. Just like he experiences reduced symptoms on high-pressure days, the pressure of the wind would allow him to ride his Harley-Davidson.

This was how he spent some of his four years between Young Brothers and the true diagnosis of his symptoms.

DIAGNOSES

Anderson said he never knew when his symptoms would strike. This made diagnosis of the root of his problem even more difficult for the doctors.

“Finally, after all of these doctors, I was so frustrated. I’d lost the school, lost everything, lost my quality of life. I could not walk two blocks without having to sit down and come back home for the rest of the day.”

Eventually a friend gave him a brochure about balance work at COSM. But this required him to be rediagnosed before he could seek treatment. He returned to UPMC for vertigo tests. It did not go well.

“I think it was a worse failure than the first time,” he said after a laugh.

He sat in a round room with a swiveling chair at the center. They gave him goggles that allowed them to see his eyes, but he couldn’t see anything.

The chair would then turn slowly to the right or the left and they would watch what his eyes do.

“The chair moved about three inches and I fell forward and started throwing up,” he said.

He told them, “That’s just the way it is.”

He was then recommended to Dr. Eric Bohn, who specializes in concussions, and physical therapist Jamie Chichy.

“I went there very skeptical because of the length of time I suffered with it,” Anderson said of his first visit to Bohn.

Bohn is from the Reading area and played high school football. At a mere 165 pounds, he was playing on the line and taking frequent hits. He figures he had about five or six concussions of his own from football.

“The mantra of those days was ‘Shake it off, get back in there,’” he said.

He finished his residency at St. Joseph’s in the Reading area and was six years into his family practice before he decided to focus again on sports and concussions.

During his exposure to concussion patients, he realized there was much more to diagnosing than having a patient simply wiggle their fingers back and forth and asking them if they feel OK. He said he realized there was a psychiatric component.

Bohn checked Anderson’s symptoms off a list for concussions at one of their first meetings.

“He had just about every single component there was,” Bohn said. “So that made it a challenge. He was very pessimistic. He was not in a good frame of mind.”

“But I looked at him and I knew deep down that this guy needed help.”

Bohn said concussions play dirty, in that they exacerbate any prior emotional or cognitive problems a person had before. If you have a short fuse, it becomes even shorter when the brain is trying to recover from concussion damage. The same goes for anxiety, depression and other mood disorders.

“To use a Spinal Tap reference, it goes to 11,” Bohn said.

He said he sees this especially through his younger athletes since their bodies are developing and there is often drama going on with a team or in their home lives.

The amplification of mood disorders comes from an overload of stimuli on the brain. Anderson referred to it as processor overload, an analogy Bohn likes. He said it’s like when too many programs are running on a computer and things get slow and choppy. Simple things like too many conversations happening in a room at the same time or cars going by can cause problems for an injured brain.

“Simple stimuli to acclimate yourself becomes almost overwhelming,” Bohn said.

Anderson said he would sit in his chair in his apartment with the lights out and ear plugs on just to cut off the stimuli.

RETRACING THE DAMAGE

High school football was where, like for many athletes and Bohn, Anderson experienced some of his first concussions.

“I got some dandies there,” Anderson said. “At that time nobody considered that it doesn’t show until a certain age.”

But also years of tae kwon do training contributed to his brain damage.

It was difficult for him to put a number on his concussions, but he figured there were about five serious ones. Two knocked him unconscious and put him in the hospital. There were several smaller, less noticeable concussions, perhaps even some that he didn’t realize at the time.

“You can actually kick and punch so hard that you can shock your own brain without hitting something. You punch so hard and you hit the end of your stroke, or kick so hard, that at the end of your stroke you see them little sparklies, you’ve just done it. So I’ve had to modify how I punch and kick.”

Headgear came into the scene for Anderson in about 1990. Tae kwon do safety had been building to that point with other safety gear, starting with footgear and gloves. The uniform also now includes chest protectors.

This is not all necessarily a good thing, Anderson said, though he said he believes headgear should have been instituted from the very beginning.

“What the footgear did as a negative was now students think because they have gear on, chest protectors, head protectors and foot gear and shin gear, they think they can hit each other hard.”

“Now, students have less physical control of what they’re doing because the consequences aren’t as big.”

He himself buys the double-layered headgear for obvious reasons.

“We’re finding out that it’s not so much the really big hits that cause the issues,” Bohn said. “It’s the repetitive trauma. Those damages occur microscopically on a cellular level over time.”

Think smoking, he said. It’s not the one or two packs that get you, it’s the 40 years of damage.

HEALING

Bohn said it takes time with patients to find out the extent of the damage.
“You have to pick a little bit,” he said.

He asks patients about their sleep and relationships and about simple tasks like reading or balancing their checkbook. He said he’s trying to treat the whole of the patient and not just look at it like chemical interactions and numbers. But there is no definitive set of questions and Bohn will pursue different avenues for different patients. He said he doesn’t always get the time he needs.

He said he’ll wait about a minimum of two weeks before considering medications like SSRIs (selective serotonin re-uptake inhibitors) to regulate mood. When mood is regulated, usually the headaches get better because the brain can heal itself without added stresses.

Bohn believes counseling of some kind is very important to help “cut through the muck.” It could be with a psychiatrist, or faith-based counseling or just having a friend or family member to regularly talk to.

For Anderson, Bohn soon realized they would need to tackle a brain chemistry problem along with the physical problems.

“Because we are trapped in these bodies, we are relegated to our serotonin and our dopamine.”

Part of Anderson’s physical therapy involved a large light board where he would touch the bulbs and they would go off. It started simply enough, just touching lights with one hand or the other. Then it evolved to touching only certain colored bulbs, then bulbs in certain circles. Eventually, they incorporated multitasking where he would touch bulbs and do math problems.

He said they would usually go for as long they could until he couldn’t take any more. He’s learned when to pull back in everyday life and take it easy when he’s reached his physical limit for the day. He figures on a good day he’s at about 90 percent of what he used to be able to do. On a bad day, it can be 60 percent or lower.

He likely won’t find him now at his usual stool putting back drinks, and though you might see him on the back of his Harley, he has since left the motorcycle club.

ON THE OTHER SIDE

“I have been given back my life. A second chance at life,” Anderson said.

Anderson’s new tae kwon do studio in the 200 block of Philadelphia Street has enough space for the mat floor gym, a small office and two changing rooms. He handles many fewer students than he did at his old school. He opened the new studio in 2014.

He still takes the ones with the “situations,” as one of his former students and now an instructor in Pittsburgh put it to him recently. Anderson is known locally for teaching students with special needs, many of whom are on the autism spectrum. He said he also has students with life-threatening or terminal illnesses.

Anderson prides himself in being strict with his students, but when he talks about them he refers to them as his children.

“If I was here for money, over half the people in that picture wouldn’t be here,” he said, pointing to a recent photograph of his students.

“I only have enough time to make a difference. I don’t have enough time to make the money.”

He said he believes he is helping the students cope with the problems in their life by giving them confidence and control. He sees the psychological scars of bullying all the time through the resulting emotional pain. From his point of view, tae kwon do can mitigate that pain.

“If you don’t provide an answer for some of them they’re going to be just as lost as I was, just as devastated as I was.”

Though he’ll probably never be back to where he was before his symptoms pulled him down, he said the struggle has reinforced his beliefs on helping others and injecting discipline and confidence into others.

“It changed how I see the value of people in trouble,” he said.

FUTURE OF MEDICINE

Doctors may soon be able to learn about concussions through a patient’s blood, Bohn said. He said it’s not ready for primetime, but blood serum markers may show if the brain is inflamed or damaged, similar to when doctors draw for cardiac enzymes when someone has suffered a heart attack.

“The brain, we’re finding out now, is releasing chemicals that we may be able to pick up.”

Bohn said doctors are also learning about gene sequences related to concussions, and testing may determine if a person is especially susceptible to the damage of a concussion and could take longer to heal.

He also referenced diffused tensor imaging that allows doctors to visualize intricate parts of the brain.

All of these things may help keep athletes safe, but it may also feel unfair and the subject is worth some ethical considerations. Football, ice hockey and wrestling are the most high-risk sports, he said, but other sports like cheerleading are sending more his way. He said he would like a way to screen people to let them know if they are susceptible to brain damage.

CONSIDER THE FACTS:

• Nationally Certified Hip & Knee Replacement Program
• High Patient Satisfaction: 96% of patients report satisfaction with shared decision making educational tools provided by surgeons
• Advanced Technologies and Surgical Procedures in the NEWEST operating rooms in the region
• Quicker Hospital Discharge: 4 out of 5 elective hip and knee replacement patients are discharged in 1-2 days (national average is 3.3 days)
• Fewer Complications which leads to lower readmission rates in comparison to state-wide averages
• Comprehensive Pain Management that meets national standards of care in anesthesiology
• Personalized Care Navigation with a health coach and preoperative education (both online and classroom options)
• Very Low Infection Rates

For more information about our hip and knee replacement program, contact the Center for Orthopaedics and Sports Medicine (COSM) at (724) 465-2676.