Sports medicine doctors converge at South Lake Tahoe | TahoeDailyTribune.com

Sports medicine doctors converge at South Lake Tahoe

More than a hundred doctors from five countries and 32 states are in South Lake Tahoe this week to attend a comprehensive sports medicine update and board review course organized by Barton Memorial Hospital. Sports medicine doctors have come from as far away as Australia, Thailand and the United Arab Emirates to take the course to prepare for board examinations required after fellowships and every 10 years thereafter. "They want to go to a great resource where they can learn all of the latest and greatest and prepare for the test, so we have 15 faculty from around the country, all internationally-known experts in medicine," said Dr. Jonathan T. Finnoff, an osteopathic physician at the Tahoe Center for Orthopedics and director of sports medicine for Barton Health. "We cover in four days the entire scope of the (sports medicine) specialty." Recruited to Barton from the Mayo Clinic and one of two Barton doctors who worked with U.S. athletes in this year's Winter Olympics, Finnoff organized the sports medicine update and board review course, now in its third year. It's the only course of its kind in the United States and is co-sponsored by the American College of Sports Medicine, American Academy of Physical Medicine and Rehabilitation and American Medical Society for Sports Medicine. Expert speakers cover the latest research and treatments in the entire breadth of sports medicine, "anything from sports cardiology and endocrinology up to shoulder injuries and standard musculoskeletal stuff," Finnoff said. "I thought (the event) would be great to highlight our community and get Barton Health more well known as a sports medicine specialty area. We have really high-level sports medicine in this area and we'd like to make this a destination site for people to get medical care. One of the ways of doing that is by demonstrating that you are the expert in the field and doing courses like this is one of the ways of doing that," Finnoff said. "It also has economic benefits here. We're bringing people in, they're renting hotels, buying food and getting out and seeing the area. It's just good all around." The comprehensive sports medicine update and board review course, held at Harveys Lake Tahoe, started Tuesday and continues through Saturday.

Bones, joints and muscles galore

A bone snaps on a rock; a knee dislocates; a shoulder tears from its socket. It’s an orthopedic doctor who can help. They treat bones, joints and muscles. Since 1987, South Shore has become a magnet for some of the finest orthopedists in the country in part because of the Tahoe Sports Medicine Fellowship. The fellowship is six-month training program that has allowed more than 60 young doctors, some from Harvard Medical School and the Mayo Clinic College of Medicine, to work with Tahoe sports medicine specialists. They do surgery and examine patients alongside Dr. Randy Watson and Dr. Keith Swanson, co-directors of the fellowship program, and four other South Shore doctors. “When Dr. Swanson and I started doing sports medicine it didn’t have a name,” said Watson, who has practiced at South Shore for 31 years. “Fellowships were being started elsewhere in the country and we said ‘Why not start one in Tahoe?’ We have a lot of experience and a lot of patients.” Watson and Swanson work at the Lake Tahoe Orthopaedic Institute at Round Hill. They treat people who get hurt while hiking, skiing or climbing, but they also help mend people such as Shaun Palmer, the famous snowboarder, and other world-class athletes. “I’ve got a guy who jumps off 100-foot cliffs,” Watson, 62, said. “A pro extreme skier. That is his job, to jump off cliffs. He dislocated his knee. This guy may not ever get back to the place he was before. Having him understand that is hard.” That kind of communication skill is what the young doctors come to learn. Jad Dorizas, 34, finished his residency in South Carolina before he started his fellowship at Tahoe in August. “It’s their ability to integrate the science and art of it, and individualize the treatment,” Dorizas. “That’s what I kind of hope to take away.” Orthopedic medicine, like most medical fields, requires an ever-expanding field of knowledge. The fellowship program allows young doctors to share what they just learned in medical school and during their residency with the doctors at Tahoe. Every Tuesday morning at Barton Memorial Hospital, orthopedists and physical therapists gather at 7 a.m. to share information. Dorizas recently made a presentation about knee cartilage. “Not a day goes by I don’t learn something from the fellows,” Swanson said. “The interchange between colleagues raises the level of knowledge and understanding of how to treat patients.” Some of the doctors who become fellows stay on to work in the basin. Dr. Scott Southard, an orthopedist in South Lake Tahoe, was the first doctor to work alongside Watson and Swanson. Southard, 48, said he asked the doctors to take him on as their first fellow because he saw how much the area had to offer and how much orthopedic knowledge the doctors had. Southard ended up working at Tahoe Fracture & Orthopedic Clinic in South Lake Tahoe, which also participates in the fellowship program, before starting his own practice more than two years ago. “I think it has raised the level of excellence of orthopedics in our community,” Southard said. “The fellows bring in the latest techniques and they get discussed and evaluated with a more mature perspective and it improves (treatment) for patients in the region.” – Gregory Crofton can be reached at (530) 542-8045 or by e-mail at gcrofton@tahoedailytribune.com

Local returns home as spine specialist for Barton Health

A South Lake Tahoe-raised doctor has joined the Barton Health team as a spine specialist at the Tahoe Center for Orthopedics and Tahoe Orthopedics and Sports Medicine. Dr. Zachary Child is a board certified orthopedic spine surgeon and musculoskeletal oncologist. Child attended medical school at the University of Nevada, Reno School of Medicine and completed his residency at the University of New Mexico. For his postdoctoral training, he completed fellowships in spine surgery at Harborview Medical Center (University of Washington) as well as orthopedic oncology at Massachusetts General Hospital (Harvard Medical School). Child has participated in research concerning complex spine surgery and oncology, taught courses at the University of Texas Health Science Center in San Antonio, and was on the adjunct faculty at the University of Washington in Seattle. His research has been published on multiple occasions. Child's list of spine specialties include: chronic back pain, injury and complication prevention in spine care, orthopedic trauma and spinal cord injury care, complex adult deformities, artificial disc replacement and microscopic discectomy, musculoskeletal oncology (bone tumor surgeries), and spinal cord infections.

GUEST COLUMN: Barton cares about your health

Long ago, physicians would make house calls to families and individuals in need. In the last several decades, patient’s needs were met by visiting the doctor through an individually owned facility, called a private practice or they were seen in a hospital setting. This model continues to change throughout the nation. Today, many specialists and primary care physicians are taking on a new kind of health care model and are affiliating themselves with medical groups or large hospital systems such as Barton Health. Many people have expressed their concerns to Barton staff and myself that Barton is purchasing most of the health care facilities around Tahoe and that we are building a “monopoly” to charge our patients more. This is far from the truth. In the last few years, physician practices such as Emerald Bay Center for Women’s Health, Tahoe Women’s Care, Barton Family Physicians and Tahoe Orthopedic and Sports Medicine have affiliated with Barton in order to keep their individual practices viable due to increasing overhead expenses. This model does not alter medical decisions – each physician is independent to provide medical care in the best interest of his or her patients. At Barton we pride ourselves in recruiting and retaining primary care and specialty physicians for our patients and our community, which might otherwise be difficult due to the rising expenses in private doctor’s offices. Physicians want to continue to live here and our community continues to need their great care. Barton Health provides the partnership that makes it feasible for physicians to stay in our great community. An internal medicine physician, Dr. Allison Steinmetz, said, “Private practice overhead is quite high and I would not want to employ people and not be able to provide my employees with adequate benefits due to rising costs.” Dr. Steinmetz recently joined Barton Internal Medicine after 10 years of medical practice in Santa Cruz with Dominican Hospital. She is a perfect example of “the new model,” which enables physicians to focus on the most important task at hand: quality patient care. “My goal is to be able to treat families and help them with their medical decisions,” Steinmetz said. “I want to focus on being a doctor, not on the business side of medicine.” Barton proudly partners with more than 140 physicians, nearly 40 departments and oversees numerous facilities in Tahoe and in the Carson Valley, including our acute-care facility, Barton Memorial Hospital. By managing the business side of medicine for physicians, physicians can focus on their patients and Barton is able to utilize the talents of its staff in business, finance, contracting, billing, building maintenance, purchasing and marketing in the private office setting. This allows our doctors to focus on their patients and creates a more efficient and cost effective business model that will be sustainable into the future. This new business model enables Barton Health to continue to meet the community’s health care needs through improved access to a wide range of physician services. In 2011 alone, Barton is proud to have added much needed services to our small community including cardiology, audilogy and psychiatry. As the health care industry continues to change nationwide, Barton Health is committed to providing consistently exceptional care to our community. – Dr. Clint Purvance is the chief medical officer for Barton Health

NIAA adopts national guidelines on management of concussions

Student athletes at Whittell and South Tahoe high schools have been granted another layer of protection concerning head injuries. The Nevada Interscholastic Activities Association on Monday adopted guidelines from the National Federation of High Schools regarding the management of concussions. Game officials are now authorized to remove a player from a game whom they suspect suffered a concussion. Under such circumstances, the athlete will be required to sit out the remainder of that game and not be permitted to practice or play until cleared by an appropriate health care professional. However, if a health care practitioner is at a game site and their examination of the removed player doesn’t reveal a concussion, then the player can return to the game. Under the new concussion guidelines, an official diagnosis of concussion must be determined by a medical doctor, doctor of osteopathy, physician’s assistant, advanced registered nurse practitioner or licensed athletic trainer, paramedic or school nurse. Athletes suffering concussions experience headaches, dizziness, confusion, balance problems and nausea, or loss of consciousness. Once diagnosed with a concussion, an athlete can’t return to practice or be available for games until the school receives clearance in writing from a medical doctor or doctor of osteopathy. School administrators will then notify the corresponding coach that the athlete is OK to return to practice. The NFHS has developed a new 20-minute online coach education course – Concussion in Sports: “What You Need to Know.” The course also includes the NFHS’s suggested guidelines for management of concussion in Sports brochure, the NFHS sports medicine handbook and materials from the CDC Heads Up program. For more details, go to niaa.com.

Tahoe doctors head to Olympics

It appears Lake Tahoe will be well represented at the Winter Olympics this year, as two South Shore doctors join a handful of local athletes headed for Sochi, Russia. Dr. Jonathan Finnoff and Dr. Terrence Orr will support two different U.S. ski teams at the games. They will help keep athletes safe and healthy about 7,000 miles from home. "I'm very excited, " Finnoff said. "It's quite an honor. I think it's wonderful we have two physicians from here in Tahoe." Finnoff, the director of sports medicine at Barton Health, will be a team physician in Sochi for the U.S. Nordic Combined Ski Team. He will be available for medical advice if an athlete gets injured or has a medical emergency. However, he expects to spend most of his time performing preventative treatment — or keeping the skiers as healthy as possible, he said. "They train really hard," Finnoff said. "They're kind of running on that edge between being over-trained and being sick, and being undertrained." This year will mark the second time Finnoff has served as a physician in the games. The doctor was the director of the Athlete's Medical Clinic in the 2002 Winter Olympics, which were held in Salt Lake City. There, Finnoff helped treat dislocated shoulders, lacerations and other relatively minor injuries, many of which occurred from various ski jumping accidents, he said. Since then, the physician has been working with the U.S. ski team and has watched the athletes develop their talents. "I think it's great …" he said. "I see people's careers evolve, and I see all the hard work they put into it." Orr, a physician with Tahoe Orthopedics and Sports Medicine, has also spent a significant amount of time tending to athletes in his focus: the men's U.S. Alpine Ski Team. For about 15 years, he has been the head team physician while volunteering his expertise during training camps, work championships and World Cup races and finals, according to Barton. "When the physicians who have been there by the athlete's side during their competitions are able to follow them through to the Olympics," Orr said in a statement, "it gives the athlete a sense of ease, because we know them, their medical background, as well as the sport." The Alpine Ski Team participates in a number of events, including various slaloms and downhill. Orr said he's glad to be at the games. "The Olympics has always been my favorite sporting event," he said, "and it has been great to be able to be a part of the games."

Tahoe doctors head to Olympics

It appears Lake Tahoe will be well represented at the Winter Olympics this year, as two South Shore doctors join a handful of local athletes headed for Sochi, Russia. Dr. Jonathan Finnoff and Dr. Terrence Orr will support two different U.S. ski teams at the games. They will help keep athletes safe and healthy about 7,000 miles from home. "I'm very excited, " Finnoff said. "It's quite an honor. I think it's wonderful we have two physicians from here in Tahoe." Finnoff, the director of sports medicine at Barton Health, will be a team physician in Sochi for the U.S. Nordic Combined Ski Team. He will be available for medical advice if an athlete gets injured or has a medical emergency. However, he expects to spend most of his time performing preventative treatment — or keeping the skiers as healthy as possible, he said. "They train really hard," Finnoff said. "They're kind of running on that edge between being over-trained and being sick, and being undertrained." This year will mark the second time Finnoff has served as a physician in the games. The doctor was the director of the Athlete's Medical Clinic in the 2002 Winter Olympics, which were held in Salt Lake City. There, Finnoff helped treat dislocated shoulders, lacerations and other relatively minor injuries, many of which occurred from various ski jumping accidents, he said. Since then, the physician has been working with the U.S. ski team and has watched the athletes develop their talents. "I think it's great …" he said. "I see people's careers evolve, and I see all the hard work they put into it." Orr, a physician with Tahoe Orthopedics and Sports Medicine, has also spent a significant amount of time tending to athletes in his focus: the men's U.S. Alpine Ski Team. For about 15 years, he has been the head team physician while volunteering his expertise during training camps, work championships and World Cup races and finals, according to the Barton. "When the physicians who have been there by the athlete's side during their competitions are able to follow them through to the Olympics," Orr said in a statement, "it gives the athlete a sense of ease, because we know them, their medical background, as well as the sport." The Alpine Ski Team participates in a number of events, including various slaloms and downhill. Orr said he's glad to be at the games. "The Olympics has always been my favorite sporting event," he said, "and it has been great to be able to be a part of the games."

‘Hand Guy’ named Barton’s Doctor of the Year

The votes have been tallied and Daniel T. Robertson, MD, has been selected as Barton Health's Doctor of the Year. Robertson is an orthopedic surgeon for Tahoe Orthopedics and Sports Medicine. Known as "the hand guy" by one voter, he specializes in treating injuries of the hand, wrist, elbow and shoulder. To honor Doctor's Day, Barton employees and physicians vote for the Doctor of the Year. A special recognition ceremony was held March 31. Dr. Clint Purvance, chief medical officer, praised Dr. Robertson for the "remarkable job" he does for patients. Robertson received votes across many different Barton departments. In the ballots, peers recognized Robertson for providing "exceptional patient care every time." He goes above and beyond his duties and "always makes himself available even when he is not on-call." One Barton employee said that Robertson is a team player who "appreciates that we are all on the same team and all here for our patients." Robertson also received kudos from his patients. One patient described him as a "cool cat." Another patient, who was visiting from out of town, said "I was so lucky to get Dr. Robertson as my surgeon. He stayed late to get me into surgery the same day … I feel like I'm in the best hands."

Doctor wants marijuana in medicine cabinet

Granny didn’t want to smoke marijuana. She didn’t want to puff away on a controlled substance, in fact, she didn’t even know how. But, she had a doctor’s recommendation. “It (the marijuana) helped her wonderfully with her nausea,” said Dr. Lester Grinspoon of the 76-year-old pancreatic cancer patient. Grinspoon, a professor of psychiatry at Harvard Medical School, has been studying the issue of medical marijuana for years. He’s also written two books on the subject, one, “Marihuana: The Forbidden Medicine,” is published in several languages around the world. Due to the recent arrest of former California gubernatorial candidate, Stephen Kubby, for growing marijuana in his Olympic Valley home, the issue of medical marijuana has wound its way back to the foreground in the public sector. Although Kubby says the 265 marijuana plants confiscated by the multi-agency North Tahoe Task Force in January were for personal, medical use, Placer County deputy district attorney Christopher Cattran claims that 265 marijuana plants and four separate grow rooms at the Kubby residence is a little too much for merely personal use. According to Kubby’s attorney, Dale Wood of Truckee, Kubby uses marijuana to stave off the adrenal cancer he was diagnosed with 22 years ago. Repeated attempts to reach Kubby prior to press time were unsuccessful. Kubby, 52, and his wife Michele, 32, were arrested Jan. 21 and charged with possession of marijuana for sales, cultivation of marijuana and conspiracy following a six-month investigation by the North Tahoe Task Force. The Kubby’s are disputing the charges, claiming that the marijuana was for their own personal, medical use as prescribed by their doctors under Proposition 215. “As far as I’m concerned, they’ve jailed him (Kubby) for using the least toxic medicine available to anyone,” Grinspoon said. “Nobody has ever died from using marijuana and there are very few drugs you can make a statement like that about. Two thousand people die from aspirin every year.” Although Grinspoon is doubtful that the cannabis has kept Kubby’s malignancy in check over the years, he says that’s not the point. “It’s given him relief and it’s not hurting anyone,” Grinspoon said. Some, however, believe that smoking marijuana has indeed saved Kubby’s life. Dr. Vincent DeQuattro, a professor of medicine at USC Medical Center, initially treated Kubby when he was first diagnosed with malignant pheochromocytoma. DeQuattro treated Kubby with the usual medical therapy until his tumor spread to his liver. He then referred Kubby to a new physician. That was 12 years ago and DeQuattro is surprised that Kubby is still alive. In a letter DeQuattro wrote to the Tahoe City Superior Court, he urges the superior court judge to “consider supplying Steve with sufficient supplies of his specific marijuana product in order to control his life threatening disease.” It wasn’t just Kubby’s physiological reaction to abstinence from his medical marijuana that convinced DeQuattro of the plants’ powerful therapy, he also contacted Kubby’s physician and found that every other patient with Kubby’s condition had died. “Steve was the only survivor,” DeQuattro said in his letter. “Faith healers would term Steve’s existence these past 10 to 15 years as nothing short of a miracle. In my view, this miracle, in part, is related to therapy with marijuana.” Although Grinspoon believes Kubby’s survival and use of marijuana is merely a coincidence, he does advocate the use of marijuana as a medical treatment. “Once our society comes to its senses with this drug, they’ll find it’s remarkable,” Grinspoon said. Until then, however, who is allowed to use marijuana under Prop. 215, commonly known as the Compassionate Use Act? According to the text of Prop. 215, patients who use marijuana for cancer, anorexia, AIDS, chronic pain, spasticity, glaucoma, arthritis, migraines or “any other illness for which marijuana provides relief” are protected by the initiative. Dr. Kenneth Ritchie, however, an opthamologist in Truckee, said marijuana is no longer prescribed for glaucoma patients. “Anybody who says they’re using it (marijuana) for glaucoma is blowing smoke in your face,” Ritchie said. “I don’t know anybody who legitimately prescribes marijuana for glaucoma.” According to Ritchie, marijuana only has an effect on glaucoma (damage to the eye due to intolerable pressure) for two to three hours. “You’d have to stay high 24 hours a day and you can’t keep the pressure down at night. You’re slowly going blind during the night,” Ritchie said. But for other conditions, only small amounts of marijuana are needed. “It’s useful for nausea from chemotherapy, for AIDS patients, various convulsive disorders, migraines and muscle spasms,” Grinspoon said. “There are about 30 different syndromes for which it is useful.” According to Grinspoon, most people don’t need an entire joint to get relief from their ailments. “Usually you just need a couple of puffs to get relief,” Grinspoon said. “I have yet to see a patient smoke a whole joint for relief.” For example, someone going through chemotherapy may smoke twice during the session or someone with severe nausea may smoke marijuana twice a day. That’s about all the skeptical 76-year-old grandmother suffering from cancer needed to keep her nausea in check, Grinspoon said. “I told her to light a joint, take a puff, wait five minutes and do it again,” Grinspoon said. “I told her to stop when one of two things happened. Either she felt uncomfortable or her nausea stopped.” According to Grinspoon, marijuana is such a wonder drug partly because it doesn’t have any serious side effects. There are health concerns associated with inhaling the smoke, much like tobacco, but since very few people smoke marijuana like they smoke cigarettes, Grinspoon said there isn’t as great a risk for cancer.

Teaching elite surgeons

SOUTH LAKE TAHOE, Calif. – Orthopedic surgeon Dr. Brian Duggan came to South Lake Tahoe to join the Lake Tahoe Sports Medicine Fellowship Program. After completing his residency at the University of Maryland Medical Center, Dr. Duggan decided Tahoe was the right place for him to not only continue his research and handle complicated surgeries, but also to learn from some of the most advanced orthopedic surgeons in the nation. “I chose this place for the wide variety of exposure to sports injuries,” Dr. Duggan said. “There is a large quantity of shoulder and knee injuries – it’s a good fit for complicated sports trauma,” Dr. Duggan arrived in summer 2010 so he could take advantage of the outdoors before starting the program. “I’m a big outdoors person – camping, hiking – and I’ve learned to kayak and mountain bike,” he said. Dr. Cecilia Pascual Garrido also was chosen to participate in the orthopedic fellowship program. Pascual Garrido and Duggan were chosen out of more than 20 applicants. In addition to faculty member Dr. Rupp, doctors Keith Swanson, Steve Bannar, Jeffrey Cummings, Roger Rogalski, Kyle Swanson and Daniel Robertson all donate time as faculty to teach the fellows on a daily basis. “The clinical component of the fellowship includes approximately 10 to 15 surgical cases a week and two days of clinical examination, diagnosis and treatment in the office setting,” said Dr. Swanson, director of the fellowship program. Dr. Duggan said he is here to take care of patients with more complicated fractures from outdoor sports such as skiing, climbing and even high school sports injuries. “The sports trauma aspect is something you won’t get in most places,” Dr. Duggan said. While participating in surgeries, the fellows also participate in research, conferences, lectures and several cadaver labs. “We focus on knee and shoulder arthroscopy, shoulder and knee ligament reconstruction, and operative and non-operative treatment of extremity trauma,” Dr. Swanson said. Thanks to Smith and Nephew Endoscopy, the fellows were able to receive hands-on practice of a nerve decompression procedure on a cadaver shoulder. Dr. Swanson also commented on the great qualities the fellows bring to Tahoe. “With resumes a mile long, including extensive education, volunteer work, publications, research and surgical expertise, these fellows are considered elite,” he said. For more information on Tahoe Orthopedics and Sports Medicine, visit www. laketahoesportsmed.com.