BOWLING GREEN In recent years, the evolution of America’s healthcare system became inevitable. Phillip J. Singer, MD, an orthopedic surgeon with Western Kentucky Orthopaedic & Neurosurgical Associates (WKONA) explains, “The Affordable Care Act caused a lot of changes in how medicine is both practiced and delivered. In Bowling Green, we are not immune to these market forces. We felt it was time to start integrating our orthopedic care with primary care.” So, last year, WKONA joined Gilbert-Graves Clinic. The union allows WKONA to lower costs and provide patients with more comprehensive, convenient, and streamlined care. In addition to Phillip Singer, MD, 10 WKONA physicians were part of the merger, including orthopedic surgeons, Keith D. Morrison, MD, and David B. Richards, MD, and neurosurgeon, Todd Shanks, MD.
WKONA provides Warren County and surrounding counties with comprehensive orthopedic and neurosurgical care, such as joint replacement, spine care, hand and arm surgery, sports medicine, treatment of trauma and fractures, craniofacial pain, movement disorder surgery, and brain and spine tumors. Also offered within their facility are functional and neurologic testing, Hines Pharmacy, Lifeline Home Health, and ProRehab, which provides comprehensive physical therapy services. The physicians and providers at Interventional Pain Specialists (IPS) are also on hand to provide full-service pain management.
According to Richards, “I am fortunate to work with a group of very talented and well-trained physicians and we are able to manage just about anything that comes our way, so we don’t have to refer many things out.” Morrison elaborates, “We are large enough that we have our own MRI, our own physical therapy and hand therapy, and do our own nerve testing and our own X-rays. So, we have the capability that if a patient comes here they can get almost everything done without having to go to multiple facilities.”
Each physician brings the latest innovations and technologies to their specialty.
Prior to coming to Bowling Green in 1991, Singer completed his medical degree, internship, and orthopedic residency training at the University of Louisville (U of L). His special interests include adult degenerative conditions of the cervical and lumbar spine, spinal deformity, and lumbo-pelvic disorders, including sacro-iliac joint dysfunction.
Singer’s patients typically have multiple concerns, including both loss of function and significant pain. He says, “The challenge of pain is for us to identify the primary generators of pain. Once these are identified and a hierarchy is established, we can then begin the process of knocking them off the list from the top down, usually giving us a lot happier patient.” Ensuring that patients have realistic expectations is also a priority. He informs them, “As a general rule, our first goal is to restore function and then pain relief; if one can accept only a 50 percent reduction of pain, then expectations are realistic.”
After his residency at the University of Kentucky, Morrison completed a Cleveland Clinic University hand and upper extremity fellowship, making him the only physician in the area who is hand fellowship trained. His patients range from newborns with congenital conditions to geriatric patients dealing with arthritis. He treats a wide variety of problems, including carpel tunnel syndrome, tendonitis, ganglion cysts, degenerative joints, and trauma. Due to the high density of British, Scottish, and Irish ancestry in western Kentucky, he also sees a high incidence of Dupuytren’s Contracture, a hereditary disease causing the gradual thickening and tightening of tissue under the skin in the hand.
In recent years, Morrison notes a vast improvement in both surgical technology and hardware specially developed for the hand and wrist.
Richards, who holds a specialty CAQ board certification in sports medicine and is also fellowship trained in arthroscopy and sports medicine, offers fracture care, arthritis and advanced arthroscopic treatment, adult joint reconstruction, tendon repair, and the full spectrum of sports medicine. His patient population spans from injured toddlers to high school and college athletes to elderly individuals with degenerative diseases. The diversity of the work is one of the reasons Richards was drawn to orthopedics.
When surgery is called for, Richards opts for arthroscopy. “Arthroscopic surgery is a particular aspect of orthopedics that uses a small camera, about the diameter of a ballpoint pen, and small incisions. Smaller skin and muscle incisions hurt less, certainly, so recovering from the initial discomfort of surgery can be quicker.” He adds, “An arthroscopy allows you to do procedures on an outpatient basis, and the results, for the most part, are every bit as good as the old open techniques we used to use 20-plus years ago.” Still, post-surgery lies his greatest challenge in convincing “the patient to be patient” and not rushing to resume normal activities.
After practicing for nine years in Louisville, Shanks was recruited to Bowling Green to assist in building the type of neurosurgical service line that people are accustomed to in larger cities. He is a board-certified neurosurgeon who is fellowship-trained in functional neurosurgery. Shanks performed his residency at Louisiana State University in New Orleans and completed his training at U of L after Hurricane Katrina. He performed his fellowship in functional stereotactic neurosurgery at Vanderbilt University in Nashville, Tenn., and is still actively engaged in collaborative research there.
While the focus of his practice is primarily brain, spine, and peripheral nerve tumors, Shanks also performs surgery for adult degenerative spinal disease, and his fellowship training is in surgeries for movement disorders including deep brain stimulation, cancer pain, and craniofacial pain syndromes.
Whenever possible, Shanks prefers minimally invasive surgeries, utilizing technology such as Brainlab navigation and Visualase® laser ablation for real-time visualization and improved accuracy. For spinal surgery, the O-arm™ Intra-operative Imaging System allows for more precise hardware placement and much less disruption to the spine’s supporting tissues.
In their ongoing efforts to provide unparalleled treatment, WKONA physicians are dedicated to bringing the latest breakthroughs to Bowling Green.
In conjunction with the pain medicine and rehab departments, Shanks is developing a Brain and Spine Institute, which will focus on a multidisciplinary team approach and offer treatments such as deep brain stimulation for movement disorders. Morrison will continue to explore arthroscopic diagnosis, the use of carbon-fiber implants for artificial joints, and early range of motion therapy. Richards is employing the reverse total shoulder joint replacement, which is better suited for rotator cuff deficient shoulders than conventional anatomic shoulder replacement. And Singer says there’s a renewed awareness among spine surgeons that they “are either fixing a deformity or creating one. There are long-term repercussions in back and spine surgery.”
In the words of Shanks, this is all to provide, “integrated healthcare with patients being addressed in a multidisciplinary team fashion to provide the most appropriate and effective care with the best risk benefit profile.”