Tuesday, August 27, 2013

Congratulations Dr. Carter!

Congratulations to Dr. Carter for his chapter publication titled "Allograft Meniscus Transplantation: Dovetail Technique", in the book: "Surgical Techniques of the Shoulder, Elbow, and Knee in Sports Medicine (edition 2)" by Brian Cole and Jon Sekiya.


Wednesday, August 7, 2013

Dr's Carter, Lederman and Chhabra will host our first fellow in Orthopedic Sports Medicine, Chris Stevens, MD.

Dr's Carter, Lederman and Chhabra will host our first fellow in Orthopedic Sports Medicine, Chris Stevens, MD. Please welcome Dr. Stevens to TOCA for the 2013-2014 academic year!

TOCA is partnered with Banner Good Samaritan Orthopedic Surgery Residency program to host the only ACGME Accredited Sports Medicine Fellowship program in Arizona. Dr. Chhabra is the fellowship director. Dr's Carter, Lederman and Chhabra are the Sports Medicine Department for the Orthopedic Surgery residency program.


Monday, August 5, 2013

Perry Edinger (PA-C to Dr. Bailie); "Brutal Badwater marathon leaves mark on runner" - azcentral sports

Perry Edinger (PA-C to Dr. Bailie) was interviewed on Sunday by the Arizona Republic concerning the brutal Badwater Marathon and his journey and battle with the resulting heat related health effects. 

"Brutal Badwater marathon leaves mark on runner"

By Bob Young
azcentral sports
Sun Aug 4, 2013 1:49 AM
Perry Edinger felt the lure of “The World’s Toughest Footrace” for most of his adult life.

In July 2009 — partly to complete that quest and partly to find purpose in his life after losing his wife, Samantha, to ovarian cancer in 2007 — Edinger took up this ultimate challenge.

He covered the 135 miles in 29 hours, 19 minutes, 4 seconds to finish ninth among the 86 runners.

Edinger, 52, a Valley physician’s assistant who specializes in treating running injuries, knows this because it’s in the Badwater record book. And his trek was chronicled in photos, video and words by azcentral sports four years ago.

The documentation is fortunate, because Edinger left a piece of himself in Death Valley — including virtually every memory of that brutal run through temperatures that soared above 120 degrees in the lowlands and dipped into the low 50s going across two mountain passes on the way to Whitney.

“I remember, at about 23 miles, getting sick, vomiting,” he said. “Everything else, I really only remember if I see pictures, and then it’s vague. I’ll look at the pictures, and I’ll study it, and it will almost be there, but not really. It’s just not there.”

Signs of trouble

Edinger is an experienced ultradistance runner, who had recorded the best combined total time in four of the oldest races of 100 miles or more, the so-called “Grand Slam” of ultrarunning, before entering Badwater.

He had run in subfreezing conditions and in hellish heat. But he had never found himself at a loss to remember it. He recalls attending a Badwater pre-race meeting and getting sick in those early miles, but his next real memory is sitting in his car at a video store after returning to Arizona and asking himself why he had gone there.

“I remember sitting there wondering, ‘What the hell am I doing here? Oh yeah, I was supposed to get videos,’ ” he said. “I got the videos, and when I got home, I put my keys down for a week. I just didn’t feel good about driving.”

There were other curious signs of trouble. He was experiencing severe headaches. He had not needed reading glasses before Badwater, but now, he was having trouble reading, and the headaches became worse when he tried.

“I needed reading glasses,” he said. “I thought, ‘Yeah, I’m just getting to be that age.’ But I did not need them the day before Badwater.”

There also were intestinal issues, night sweats and trouble sleeping. He finally decided to seek help and underwent a battery of tests at Barrow Neurological Institute under the direction of Dr. Marwan Maalouf (who was killed about a year ago when he was struck by a car while riding his bicycle not far from Barrow).

A standardized concussion test that measures cognitive function based on age determined that Edinger was in the lower 10 percent of his age group nationally.

Only he hadn’t hit his head.

‘There was risk involved’

There is no way to know for certain now exactly what happened.

Dr. Thomas Carter, the Phoenix Suns’ orthopedic surgeon and a longtime friend of Edinger’s, believes that he may have suffered hyponatremia, a condition in which the body loses too much sodium, resulting in an electrolyte imbalance. It can be worse than dehydration.

Carter had warned Edinger that such a run was dangerous to his long-term well-being.

“Your whole chemical balance is out of whack,” Carter said, who added that a run of such a distance also causes muscle breakdown that can affect liver and kidney function.

“People like Perry always try to push the envelope to try to achieve things,” he said. “The thing about him, he pushes his body to the limit, but he’s not 20 years old anymore. Sometimes, the damage can be irreparable.

“Fortunately for him, he’s done pretty well compared to some people who have concussions or brain trauma.”

In the years since the event became an official footrace in 1987, no runner has died at Badwater despite the horrific conditions. Runners must apply for admission and have proven ultramarathon experience at a high level.

“I knew there was risk involved,” Edinger said. “I thought I might end up with a stress fracture, something like that. You can easily deal with that.”

He has studied the work of exercise scientist Timothy Noakes, who is credited with helping to identify hyponatremia. Edinger believes that he put too much emphasis on keeping his spinal cord cool, putting cold water on his neck and back as often as possible during the hottest portion of the run to fend off muscle fatigue. However, he neglected to keep his head properly cooled.

And when he repeatedly tried to ingest electrolyte capsules, he couldn’t keep them down.

“I couldn’t get salt down. I did lose 17 pounds that day. I don’t know,” he said. “There are certain things you can’t go back and test. I listen to the video, and there’s a part where I’m climbing a hill and I’m talking about doughnuts and slurring my speech. I was like, where did that come from? Doughnuts? That’s not me.”

What was clear is that he suffered some sort of brain injury during the run, most likely a cerebral edema or increase in fluid around the brain. Hyponatremia is one condition that can lead to cerebral edema.

“When I first saw the neurologist, I already had done a (magnetic resonance imaging test), and the two questions I had for him were: Do you think this will last forever, and is this going to cause the early onset of something, like dementia or something?” Edinger said.

“His two answers were: no and no. I said, OK, I’m good then. I really don’t need anything else. I would like to find out exactly what’s going on, though.”

Edinger had been working as a physical therapist at the Orthopedic Clinic Associates in the Valley, but he decided to enter a physician’s-assistant program not long after Badwater. He said he struggled to absorb the material at first.

“Man, it was horrible,” he said. “I’d have to read things five or six times.”

Lasting effects

Edinger completed the program, and he has continued to improve. Since Badwater, he has married, and he and his wife, Amy Norton, have a son, Miles, who is almost 3.

He didn’t want Amy, whom he was dating at the time of Badwater, or his mother, Jan, present during that race across the desert. He figured that he had the talent to finish in the top 30. He planned, as Carter predicted, to push the envelope and finish in the top 10.

“I didn’t want people there who might pull me out because I overstepped my bounds,” he said. “The people who were there knew what they were there to help me with and let me make my own decisions. I was willing to overstep my bounds. I think I overstepped my bounds.”

And there are other lasting effects. Since Badwater, his system can’t handle dairy products or soy. Neither was an issue before. He does not tolerate extreme heat or extreme cold well. And, for a lifelong runner, maybe the worst effect is that he has struggled to regain his running fitness.

“I went to get an MRI and went to see the neurologist because I was afraid, not only did I screw this up and I may not be able to run, but I may have screwed up because I don’t have very good neurological function and I’m not going to be the same person,” he said.

“The question is: Will it arise again when I’m 65? Or will I continue to get better every day like I have been, and five years from now, I’ll remember the race. I won’t know until I’m 65. And I’m good with that.”

Mark Zimmer, a friend who worked alongside Edinger when Edinger was the head athletic trainer at Arizona State University, said he knew something was wrong when he found out Edinger wasn’t running much.

Zimmer was on Edinger’s crew at Badwater as well as at the Zane Grey 50-mile Endurance Run along the Mogollon Rim and the Western State’s 100. Nobody knew at Badwater that Edinger was having problems, and, Zimmer pointed out, how would they?

“When somebody runs that far, you expect them to be fatigued, not to be as vocal or as conversational; no, I didn’t realize anything was wrong with him,” he said. “Running all day and night for 29 hours through the heat of Death Valley, my expectation was that it is going take a toll on body and mind a little bit.

“But I recall right before we got to the last town before the final climb (Lone Pine), there is a T in the road, and he stopped there and changed shorts. He was having some bad chafing, and he changed into these two-and-one shorts (with a Spandex liner). That was 120 to 125 miles in, and a person who wasn’t thinking straight would not have thought of that.

“It wasn’t like he was talking about pink ghosts and hallucinating. I would have noticed that. Afterward, when I realized he wasn’t running, that’s when I knew it had really taken a toll on him.”

Edinger recently served as a consultant for the “Scottsdale Beat the Heat” race, a 7-mile run celebrating the hottest day in Valley history. He said he didn’t have any qualms about the event because of the distance and because there were a lot of aid stations on the course.

He pre-ran the course a few hours before the event with no problems and then ran it again during the event. But he had to pull up and walk the final few miles when he started feeling ill.

Prior to Badwater, he wouldn’t have considered slowing down.

“I think I’m more sensitive to what’s happening now. I have more valuable things in my life,” he said, noting the birth of his son. “So, I’ll listen a little more (to my body), and if things are going bad, I’ll shut it off.”

No regrets

Despite the post-race problems, Edinger said he has no regrets, other than having no memory of the final miles up to the Portal.

“I had the second-fastest time going up the hill,” he said, smiling, “but I only know that from the stats.

“What I drew from that race makes me understand that everyone is so much better than they believe they are. You can do so much more than you think you can. That was an extreme. Everybody has things in their life they’re hesitant to do. You can do it. I proved that to myself.

“I hit every goal I had in that race. I will not repeat the run. But would I do it again if I had to go through these last couple of years after the race? I’d do it again.”

Edinger now works with Dr. David Bailie at the Orthopedic Clinic Associates, where he plans to build a practice for treating running-related injuries. He conducts clinics on running health each month at Sole Sports locations in Scottsdale, Tempe and Glendale as well as at iRun and Runner’s Den, running stores in Phoenix.

He hopes to run ultramarathons again, but only as a pacer to help other runners achieve their goals. And Edinger looks back at Badwater much as a climber might look back at a summit of Mount Everest.

“Those who have climbed it and come down maybe two or three toes short ask them the same question: Was it worth it to them?” he said. “I bet most all of them would say that it was worth it.

“Great things are not accomplished without a price. And for me, that’s about as great as I’m going to get.”

Bob Young was a member of Edinger’s crew at Badwater and has completed five ultramarathons. He will not be adding Badwater to his bucket list. Reach him at 602-444-8271 or bob.young@arizonarepublic.com.

To View the interview video, click the link below:

To read the artical on azcentral.com, click the link below: