MoMentuMMoMentuMThe Campbell FoundaTion

Enhancing Quality of Life Through the Science of Orthopaedic Medicine • Summer 2008

Spinal surgery helps septuagenarian resume his vigorous lifestyle

In his 72 years, James Googe has led a rich and varied life. He’s been a Naval officer, lawyer, bank counsel, husband and father, runner, and sailboat skipper on excursions at sea with family and friends. Working and playing with vigor have always been part of his daily routine.

So when Googe began to notice 10 years ago that he was losing the “push off power” he once had in his left foot during his daily run, he visited a doctor. “It’s part of the aging process; there’s not much you can do,” Googe said his internist told him.

For Googe, the news was hard to swallow. Through the years, he had continued to exercise and work out in the gym with the discipline you’d expect from a Naval Academy graduate.

The problem grew progressively worse. Googe gave up running for jogging, then had to switch to race walking. The loss of function in his left leg became so troublesome that it affected every aspect of his life.

Surgery corrected a common problem In November 2006, Campbell Clinic surgeon

Dr. Keith Williams performed spinal decompression and fusion surgery on James Googe. Today, the pain and numbness are gone from his leg.

“I’ve been able to walk and not have my leg go dead on me,” Googe said. “Now, it’s a question of doing more exercises and trying to get stronger in my leg and body.”

Googe is one of thousands of Americans who undergo surgery each year for problems related to the spine. The Journal of the American Medical Association (JAMA) recently reported that spending

on spine treatments in the U.S. rose 65 percent between 1997 and 2005. That same report indicated that about 26 percent of adult Americans suffer from spine or neck problems.

For James Googe, the loss of function in his left leg was the result of spinal stenosis. Googe described the condition accurately: Over time, the joints and ligaments in his spine had thickened, narrowing the opening for the spinal cord. The resulting constriction of the spinal cord can lead to chronic pain, numbness and muscle weakness.

“My leg just quit on me”James Googe rarely felt shooting pain.

Occasionally, he had a dull backache. But the frequency of episodes when his leg went numb increased with age.

“My left leg would just quit on me,” Googe said. “I’d be walking, and I’d have to just sit down.”

continued on page 2

James Googe’s career

included serving as a

Naval officer on guided

missile destroyers and

as commanding officer of

the legal services office

at Millington Naval Base

outside Memphis. At 72,

he’s still sailing.

“When Mr. Googe returned for his one-year checkup, he showed strength in his lower extremities, no irritability of the hip or knee, and no instability. His commitment to exercise and fitness is certain to have been a factor in his recovery and continued progress.” — Dr. Williams

Sitting down was not how Googe had envisioned himself spending life after age 65. Although he had retired from his full-time position as counsel in the legal department of First Tennessee Bank, he continued to work with First Tennessee part-time. He and his late wife, Lynda, loved to travel. And Googe had dreamed of doing more sailing when he didn’t go to the office every day.

“Sailing can be very demanding physically,” said Googe, who was on the Naval Academy’s national championship sailing team and is a member of the College Sailing Hall of Fame. “I love ocean racing, and that’s really strenuous. You need to move quickly, jumping from side to side. With any kind of sailing, you have to be able to support yourself on a shifting deck.”

When spinal stenosis is diagnosed, doctors initially recommend a conservative treatment and prevention plan which may involve medication, physical therapy, daily exercise, proper posture, maintaining a healthy weight and other measures.

“Like most people, I avoided surgery as long as possible,” Googe said. “In the end, pain was not the issue. The question was, do I want to be crippled?”

A textbook recoveryDr. Williams performed decompressive laminectomy along Googe’s lower (lumbar) spine. The

lamina is the bone that forms the backside of the spinal canal. Thinning the lamina, ligaments and other tissues results in more room for the spinal cord. Googe’s surgery included fusion from the L3 to L5 vertebrae to help stabilize the lower spine and help prevent spinal stenosis from recurring.

“Mr. Googe’s general physical condition was excellent, so he withstood the long surgery well,” Dr. Williams said. “He had good bone density, which regular physical exercise can help maintain. He followed all my directives, including a physical therapy routine. Overall, he was an exemplary patient.”

Dr. Keith Williams

Trainer Tonya Tittle with

Energy Fitness coaches

Googe using exercises

to increase his core

strength and balance.

“My goal is to be physically active for as long as possible. I have a lot more sailing to do.” — James Googe

Following the surgery, Googe spent three days in the hospital, then recovered for two weeks at his daughter’s home. “I was a Naval officer, so I’m not a wimp,” Googe said. “I was back to my normal routine in three weeks. I had a textbook recovery.”

“When Mr. Googe returned for his one-year checkup, he showed strength in his lower extremities, no irritability of the hip or knee, and no instability,” Dr. Williams said. “X-rays indicated the instrumentation implanted was in excellent position, and the fusion was well-healed. Mr. Googe’s commitment to exercise and fitness is certain to have been a factor in his recovery and continued progress.”

Today, Googe continues to work out with a personal trainer. He’s doing weight training, building core fitness and working to strengthen his lower body.

“My goal,” Googe said, “is to be physically active for as long as possible. I have a lot more sailing to do.”

One of the most common causes of back pain and

neck pain is disc degeneration.

Over time, the discs in the spine may harden and

thicken, pushing into the spinal canal. The narrowing of

the lumbar spinal canal is known as spinal stenosis.

Symptoms of spinal stenosis include pain or numb-

ness in the back and/or legs, as well as cramping and

weakness in the legs. Symptoms may worsen with

prolonged standing or walking.

Non-surgical treatments of lumbar spinal stenosis

may include anti-inflammatory medications, physical

therapy, and spinal injections, or “blocks,” used to relieve

symptoms of pain. These treatments do not correct the

spinal canal narrowing but can provide pain control and

improved life function.

Surgery may be advised for patients whose pain cannot

be relieved by non-surgical treatment methods. The goal

of the surgery — which is termed “lumbar decompression

surgery,” or “laminectomy” — is to open up the bony

spinal canal to improve available space for the nerves.

Spinal Stenosis Facts

SOURCE: North American Spine Society

Spine with and without Spinal Stenosis

Healthy Spine Spine with Spinal Stenosis

Vertebra

Disc

Spinal Canal

Stenosis (narrowing)

Welcome to the Resident Class of 2013The Campbell Foundation is pleased to welcome eight outstanding new residents to our training program this year. They are a diverse group, coming to us from as near as the University of Tennessee and as far away as the University of California, but all share a background of academic excellence and a commitment to orthopaedics.

Tyler Cannon, M.D., a graduate of the University of Tennessee College of Medicine

Michael Cusick, M.D., from Louisiana State University School of Medicine

Justin Hall, M.D., a graduate of University of Alabama School of Medicine

Nick Larsen, M.D., from University of Louisville School of Medicine

Joshua Miller, M.D., a graduate of UCLA David Geffen School of Medicine

Brian Norton, M.D., from University of Arkansas for Medical Sciences

Chris Potts, M.D., a graduate of Mercer University School of Medicine

Cason Shirley, M.D., from University of Tennessee College of Medicine

These new residents will spend their first year rotating between a general hospital and emergency room, veterans hospital and a trauma center, developing their knowledge and surgery skills in a variety of medical disciplines to prepare for their intensive orthopaedic studies. They will work in general surgery for six months, orthopaedic surgery for three months, and a combination of general and orthopedic surgery for an additional three months.

The Campbell Foundation also welcomes these Fellows who have completed an orthopaedic residency and will spend up to 12 months of additional training in their chosen orthopaedic subspecialty:

Dr. Daniel Judd – Foot & Ankle Surgery, from Kailua, Hawaii

Dr. Seth Rosenzweig – Sports Medicine, from Birmingham, Alabama

Dr. Shiraz Younas – Pediatric Orthopaedics, from Houston, Texas

E d u c a t i o n n E w s

(Front, l-r) Jeremy Swymn, M.D.; Tony Mascioli, M.D.; Anthony Rankin, M.D.; Michael Davis, M.D;

John Hicks, M.D. (Back row, l-r) Patrick Toy, M.D.; Matt Rudloff, M.D.; Hassan Mir, M.D.; Amir

Jahangir, M.D.

Senior residents presented papers at Ingram lecture

Annual lecture honors Dr. Alvin Ingram

In May Campbell senior residents participate in an annual lecture program, named in memory of Campbell Clinic physician Dr. Alvin J. Ingram. The residents present their research papers, which are the culmination of some of their research efforts during their residency.

A nationally-known orthopaedic surgeon is invited to participate in the program and this year’s special guest speaker was Dr. E. Anthony Rankin, Professor at Howard University and current president of the American Academy of Orthopaedic Surgeons. His presentation was entitled “Carpal Tunnel Syndrome: Then and Now.”

The Alvin J. Ingram Memorial Lecture was established by the Ingram family, following his death in 1999. Dr. Ingram was raised in Jackson, Tennessee, and received his BS, MS and MD degrees from the University of Tennessee, Memphis. After two fellowships at Campbell, he joined the staff in 1947 as a pediatric surgeon and served as chief of staff from 1969 to 1976. He retired in 1983.

A World War II Army veteran, Dr. Ingram was the only orthopaedist in a group of 10 physicians who were invited by President Lyndon Johnson in l968 to tour the active field hospitals in Vietnam. He served as president of many organizations, including the Tennessee Orthopaedic Society, American Orthopaedic Association, and American Board of Orthopaedic Surgery.

Among his honors, Dr. Ingram was given the Distinguished Alumnus award from UT Memphis, Distinguished Southern Surgeon Award from the Southern Orthopaedic Association, and the Pioneer Award from the Pediatric Orthopaedic Society of North America.

Dr. Alvin J. Ingram

Foundation to edit new publication Campbell Clinic surgeon Dr. Andrew H. Crenshaw has recently become Editor-in-Chief of Current Orthopaedic Practice, a peer-reviewed, general orthopaedic publication designed to translate clinical research into best practices for diagnosing, treating and managing musculoskeletal disorders.

Published bimonthly, this journal covers the spine, shoulder, elbow, wrist, hand, hip, knee, foot and ankle, as well as pediatric orthopaedics, orthopaedic trauma and sports medicine. Four-color photographs and illustrations assist in conveying key information orthopaedic surgeons need to effectively practice in today’s fast-paced healthcare environment.

The Campbell Foundation editorial staff of Kay Daugherty, Linda Jones and Shawn Maxey will work with Dr. Crenshaw in writing and editing the articles, along with graphics director, Barry Burns, who will provide the accompanying photos and illustrations.

Campbell Clinic surgeons contribute to many other medical journals and textbooks such as:

Foot & Ankle International (Editor-in-Chief Emeritus, E. Greer Richardson, M.D.)

AAOS Now (Editor-in-Chief, S. Terry Canale, M.D.)

Fractures in Children, 5th, 6th, 7th editions (Co-Editor James H. Beaty, M.D.)

Numerous articles by staff, fellows and residents in national orthopaedic journals, including Clinical Orthopaedic & Related Research, Journal of Knee Surgery, Journal of Pediatric Orthopaedics, and American Journal of Sports Medicine.

Daugherty has been with the Foundation for 30 years. She and Jones, an 18-year veteran, provide research, editorial and clerical support in the production of Foundation textbooks and journals. They work with Campbell Clinic staff physicians in the writing and editing of research articles for publication, prepare presentations for conferences and meetings, and serve as liaisons with the publishing companies. Burns has been with the Foundation for 17 years. He produces all photographs, illustrations and videos for Campbell Clinic publications and presentations.

Campbell Foundation editorial staff members

Dr. Andrew H. Crenshaw

Kay Daugherty Linda Jones Barry Burns

Dr. Karen Hasty

R E s E a R c h n E w s

The Alpha Omega Alpha Carolyn L. Kuckein Student Research Fellowship has been awarded to David Holt, a UT-Memphis medical student, in collaboration with Hongsik Cho, Ph.D., UT-Campbell Clinic Biomedical Engineer; Ray Gardocki, M.D., Campbell Clinic surgeon; and Karen Hasty, Ph.D, chief researcher for the UT-Campbell Clinic Department of Orthopaedic Surgery.

This prestigious national fellowship will support Holt in working with the Campbell research team to study the effects of platelet-

rich plasma on halting the progressive degeneration of a damaged intervertebral disc. Human discs removed following disc herniation surgery will be incubated with platelet growth factors.

“We would like to see an increase in collagen synthesis and a decrease in collagenase (enzyme) that breaks down collagen,” Dr. Hasty said. The disc research is in line with the growing popularity of regenerative medicine, in which naturally-occurring substances are being used to encourage healing and repair.

Dr. Adam Fosnaugh, Campbell Sports Medicine Fellow, is the 2008 winner of the Aircast Award for Basic Science for his cartilage research, in collaboration with Frederick Azar, M.D., Campbell orthopaedic surgeon, and UT-Campbell Clinic researchers Jinsong Huang, Ph.D.; Hongsik Cho,

Ph.D.; Yongxing Liu, Ph.D.; Yunzhi Yang, Ph.D.; and Karen Hasty, Ph.D.

New cartilage for damaged knees was created by growing chondrocytes (the cells that produce and maintain joint cartilage) in culture and then implanting the cell construct mounted on a synthetic bone anchor into a cartilage defect. The engineered new cartilage tissue shows promising results for better stability with this anchor when implanted in cartilage defects in the knee in an experimental pig model.

Dr. Richard Smith, a basic scientist who is an Assistant Professor of Orthopaedic Surgery, is study- ing what happens when certain growth factors are inserted into a damaged disc. Dr. Hongsik Cho, a biomedical engineer in the Department of Ortho- paedic Surgery at UT, has been engineering an intervertebral disc in the laboratory, experimenting with ways to culture the cells in order to make them proliferate and create the water-filled network needed.

“There could come a day when, if an MRI reveals degeneration in one of your discs, a surgeon could take some bone marrow from your hip, process that, add collagen, take some of your platelets, put them into the mix, inject that into your disc — and your disc will begin to regenerate itself,” Hasty said.

When does Hasty expect that day to come?“As always, the more resources that go into the

research, the faster it will go,” Hasty said.

At some point in their lives, eight out of ten adult Americans will experience low back pain. In approximately one-third of those cases, the pain will be due to degeneration of the intervertebral disc, the tissue that separates the vertebra in the spine.

Surgical solutions can help relieve the pain and other symptoms of disc degeneration. Now Campbell Foundation-supported researchers are looking at solutions from a different angle.

Dr. Karen Hasty leads a research team that is studying ways to repair the disc itself, correcting the defect rather than treating the resulting problems. Dr. Hasty is the George Thomas Wilhelm Professor of Orthopaedics and chief researcher for the UT-Campbell Clinic Department of Orthopaedic Surgery.

The intervertebral disc consists of a central water-filled nucleus surrounded by a tough, fibrous ring of cartilage. Over time, the central nucleus can lose fluid, so the disc is less effective as a cushion between the vertebra.

“We are conducting several research projects in which we are growing intervertebral disc replace- ment tissue in culture in the lab,” Dr. Hasty said.

“We are looking at ways to repair the nucleus using collagen, plasma and other components that encourage regeneration.”

Research studies focus on using body’s own cells to repair damaged discs

“The biologics approach encourages replacing

human parts with natural parts instead of

metal or substances.” — Dr. Karen Hasty

Research Awards

Dr. Adam Fosnaugh

Hospital Corporation of America (HCA) is a new supporter of The Campbell Foundation’s resident education program. HCA and The Campbell Foundation share a commitment to provide the highest level of patient care through surgeon education. HCA, based in Nashville, is the nation’s leading provider of healthcare services with locally-managed facilities that include 169 hospitals and 115 outpatient centers in 20 states and England. We are grateful for their support.

Baptist Memorial Health Care Foundation continued its generous support of resident education with the “Excel- lence in Orthopaedic Surgery” Awards, presented to this year’s senior residents. The awards recognize excellence in patient care and surgical skills and provide scholarships that enable residents to attend an important training course in preparation for the national

orthopaedic board examination. The awards are named in honor of four of Campbell Clinic’s distinguished retired physicians, Dr. Allen Edmonson, Dr. Lee Milford, Dr. Robert Tooms, and the late Dr. Rocco Calandruccio. The 2008 recipients of the “Excellence in Orthopaedic Surgery” Awards are: Michael Davis, M.D.; John Hicks, M.D.; Amir Jahangir, M.D.; Anthony Mascioli, M.D.; Hassan Mir, M.D.; Matthew Rudloff, M.D.; Jeremy Swymn, M.D.; and Patrick Toy, M.D.

Foundation receives gifts for education program

Dr. Susan N. Ishikawa

The Campbell Foundation’s Board of Trustees is composed of an outstanding team of physicians, business executives, and community leaders. They provide valuable insight and expertise in guiding the Foundation’s mission of enhancing the quality of life for patients today and future generations through orthopaedic medicine. We welcome these Trustees to the Campbell Foundation Board:

Susan N. Ishikawa, M.D.

Dr. Ishikawa, a native of Hawaii, received her undergraduate degree in biology from Harvard University and attended Jefferson Medical College in Philadelphia on an Army Health Professions Scholarship. To complete her military obligation, Dr. Ishikawa served seven months in Iraq as an orthopaedic surgeon in Baghdad. After completing a one-year fellowship at Campbell Clinic, she joined the staff in 2005 as a foot and ankle surgeon. Dr. Ishikawa is also an Assistant Professor at the University of Tennessee-Campbell Clinic Department of Orthopaedic Surgery.

James D. Lackie

James Lackie is president of Lackie Trading, a commodities futures trading firm, and is registered as an Introducing Broker with the Commodities Futures Trading Commission. Mr. Lackie is active in private equity investments in real estate, finance, insurance and retail businesses. He serves on the boards of several corporations, civic groups and non-profit organizations.

David R. Richardson, M.D.

An orthopaedic surgeon whose subspecialty is foot and ankle surgery, Dr. Richardson completed his residency at Campbell Clinic, followed by a one year fellowship at Carolinas Medical Center. He joined the Campbell staff in 2005. Dr. Richardson is an Assistant Professor at the University of Tennessee-Campbell Clinic Department of Orthopaedic Surgery and serves as a foot and ankle consultant to the athletic departments at the University of Memphis, Rhodes College and the Memphis Grizzlies.

Distinguished Additions to the Foundation’s Board

James D. Lackie

Dr. David R. Richardson

Dr. Allen Edmonson Dr. Lee Milford Dr. Robert Tooms Dr. Rocco Calandruccio

Excellence in Orthopaedic Surgery

The awards are named in

honor of Campbell Clinic’s

distinguished retired

physicians.

F o u n d a t i o n n E w s

c a m p b E l l F o u n d a t i o n

Your tax-deductible gift to The Campbell Foundation will:

Educate the next generation of outstanding orthopaedic surgeons through our distinguished residency and fellowship programs.

Support promising research to discover new treatments for patients with spine disorders, like James Googe, our featured patient. Important research is also being conducted in areas such as osteoarthritis, joint replacement,

cartilage regeneration, trauma care, and children’s bone and joint diseases.

Provide orthopaedic care to children and adults, regardless of their financial circumstances, through our community outreach clinics.

Consider making a gift... to The Campbell Foundation in your will or other estate plans and you will be enhancing the quality of life for patients today and for generations to come.

For more information Carol KirbyExecutive Director of Development1400 S. Germantown RoadGermantown, TN 38138(901) 759-5490ckirby@campbell-foundation.org

ho w Yo u ca n hE l p

For a fuller life. For a better future. Support The Campbell Foundation.

The Campbell Foundation www.campbell-foundation.org

S u r g e o n e d u c a t i o n • o r t h o p a e d i c r e S e a r c h • c o m m u n i t y h e a l t h c a r e

MoMentuMMoMentuMCampbell Foundation, Office of Development1400 South Germantown RoadGermantown, TN 38138-9861

Non-Profit Org.U.S. Postage

P A I DMemphis, TNPermit 4362