We stand with Orlando

[vc_row][vc_column][vc_column_text css_animation=”appear”]Our Hearts and Thoughts go out to those injured, the lives lost, the family, friends and community in Orlando.

‪#‎LoveforOrlando‬ ‪#‎UnitedWeStand‬ #UnitedOrlando[/vc_column_text][/vc_column][/vc_row]

In honor of National Hand Therapy Week Meet TOCA’s Hand Therapy Manager Gretchen Bachman!

[vc_row][vc_column][vc_column_text css_animation=”appear”]Gretchen is the Hand Therapy Manager at TOCA. Hand Therapists, through advanced study and experience, specialize in treating disorders of the entire upper extremity. All hand therapists at TOCA are Certified Hand Therapists, certified by the Hand Therapy Certification Commission. Hand Therapists help bridge the gap between medical management with a physician and facilitate patients return to their daily work, leisure and life activities.

Gretchen graduated with her Bachelor’s Degree from Saginaw Valley State University in her home state of Michigan. She became a practicing occupational therapist in 1998, then in 2001 went on to earn her Master’s in Business Administration in Health Care Management. In 2007 she completed her Doctorate in Occupational Therapy in a Hand Therapy cohort. She has been working with TOCA since 2010.

Gretchen has peer reviewed publications in the Journal of Hand Therapy and wrote a chapter on fracture management and dislocations of the upper extremity in the book, Advanced Concepts of Hand Pathology and Surgery: Application to Hand Therapy Practice. She has presented nationally and internationally on the topics of fracture management, digital replantation, rheumatoid arthritis, custom splinting/orthosis fabrication, and various topics related to evidenced based practice.

Nationally, Gretchen has served on the Board of Directors for both the American Society of Hand Therapists (ASHT) and American Association for Hand Surgery (AAHS). She has been intimately involved on various committees, task forces, and special projects within these associations. Gretchen has also served on the Editorial Board for HAND, the official peer-reviewed journal for the AAHS.

Internationally, Gretchen has served on the Education Committee for the International Federation of Societies for Hand Therapy (IFSHT) since 2008. She has also served as the IFSHT Special Events Chair for the 2010 International Meeting when hosted in Orlando, FL.

Gretchen was granted an award through the IFSHT in 2009 and organized a multi-discipline educational conference related to disorders of the upper extremity in Lima, Peru. The Peruvian therapist who hosted this conference won a subsequent award and grant from the IFSHT to travel to the USA, contributing to further educational outreach brought back to her home therapy community in Lima.

Gretchen is passionate about a non-profit organization called the Guatemala Healing Hands Foundation. She has been supporting and traveling on medical mission trips with this organization since 2005. The GHHF is a nonprofit organization dedicated to improving the quality and availability of health care in Guatemala through education, surgery, and therapy.

There is a Venn diagram of 3 primary areas of service: Direct patient care, education, and community outreach. Direct service care primarily specializes in the treatment of congenital and pediatric hand injuries.

Direct patient Care: Following a mandatory screening day, where upwards of 200 children are evaluated to determine their best treatment plan: surgery, therapy, or other intervention. Due to GHHF’s unique infrastructure GHHF is able to monitor children year after year to insure they receive the best possible consistent care. Depending on the severity and length of each case, surgical patients are provided with both in and

outpatient care with costs covered 100% by GHHF.

Education: Each mission, a two day educational conference is organized annually, an

d integrates the Guatemalan provider community. GHHF has a unique relationship with the Guatemala Hand Associations, and they are a trusted teaching source and a vital American group providing cutting- edge hand education to both the surgical and therapy communities to over 2,200 doctors, therapists, and students to date.

Community Outreach: The heartbreaking reality and reasons why we meet so many children with serious hand conditions and injuries of the people in this nation cannot be ignored and disregarded. GHHF is committed to addressing the sources behind the problems seen. GHHF has teamed up with the village of Chichoy Alto, in the region of Patzun, Chimaltenango, to improve sanitation, health, education, and the overall quality of life for these 120 families. Community members of Chichoy Alto are required to collaborate and provide a portion of the labor necessary to implement these improvements. Within this community, GHHF has sponsored and constructed 55+ latrines, sponsored and constructed 21 efficient ONIL stoves, distributing crucial fertilizer needed to replenish Chichoy Alto’s barely existent crops, distributed emergency maize to families struggling with malnutrition, helped dig hillside trenches to lay piping to supply fresh water throughout the village, purchased school supplies to the 100+ elementary aged children, and have sponsored many children to attend high school and education beyond.

g4In her free time, Gretchen enjoys traveling; camping, reading, and watching her son grow. She enjoys volunteering at his elementary school, and she and her family all recently started volunteering with the Special Olympics, another organization Gretchen has supported for a long time.

‪#‎HandTherapy‬ ‪#‎Recovery‬ ‪#‎Results‬ ‪#‎Relief‬ ‪#‎Communityoutreach‬‪#‎Patientcare‬ ‪#‎GuatemalaHealingHandsFoundation‬



EMR vs. EHR: what’s the difference?

[vc_row][vc_column][vc_column_text]Over the past several years, the U.S. healthcare industry has been undergoing major changes, one of which is the transition from paper to digital record keeping by hospitals, doctor’s offices, clinics and nursing facilities.

The mandated switch to electronic records has garnered plenty of news coverage, with stories about electronic health records (EHR) and electronic medical records (EMR) peppering both medical and mainstream publications. The terms are often used interchangeably, which can lead to confusion. However, there are distinct differences between EHR and EMR.

What are Electronic Medical Records?

An electronic medical record is a single practice’s digital version of a patient’s chart. An EMR contains the patient’s medical history, diagnoses and treatments by a particular physician, nurse practitioner, specialist, dentist, surgeon or clinic.

EMRs offer several advantages over paper records:

  • Better data tracking over time.
  • Timely reminders for patient screenings and preventative checkups.
  • Improved patient care.

What are Electronic Health Records?

An electronic health record (EHR) is also a digital version of a patient chart, but it is a more inclusive snapshot of the patient’s medical history. Electronic health records are designed to be shared with other providers, so authorized users may instantly access a patient’s EHR from across different healthcare providers.

The benefits of EHRs include:

  • Streamlined sharing of updated, real-time information.
  • Access to tools that providers can use for decision-making.
  • A complete medical history of the patient, from allergies and radiology images to lab results.

How do Electronic Medical Records Differ from Electronic Health Records?

It’s easy to remember the distinction between EMRs and EHRs, if you think about the term “medical” versus the term “health.” An EMR is a narrower view of a patient’s medical history, while an EHR is a more comprehensive report of the patient’s overall health.

Here are a few more ways EMRs and EHRs differ:

  • An EMR is mainly used by providers for diagnosis and treatment.
    EMRs are not designed to be shared outside the individual practice.
  • EHRs are designed to share a patient’s information with authorized providers and staff from more than one organization.
  • EHRs allow a patient’s medical information to move with them to specialists, labs, imaging facilities, emergency rooms and pharmacies, as well as across state lines.

Electronic Records Offer Big Benefits

Both EHRs and EMRs offer benefits to patients and healthcare providers –

  • With fast, accurate and updated information, medical errors are reduced and health care is improved.
  • Patient charts are more complete and clear – no more deciphering illegible scribbles.
  • Information sharing can reduce duplicate testing, saving patients and providers time, money and trouble.
  • Improved information access makes prescribing medication safer and more reliable.
  • Promoting patient participation can encourage healthier lifestyles and more frequent use of preventative care.
  • Complete information means more accurate diagnoses.

Electronic records are expected to make healthcare more efficient and less costly, making the switch a good investment in our nation’s healthcare.[/vc_column_text][/vc_column][/vc_row]

TOCA was a proud sponsor of the annual Book of Lists party

[vc_row][vc_column][vc_column_text css=”.vc_custom_1463084698017{margin-bottom: 1.5em !important;}”]TOCA was proud to sponsor the annual Book of Lists party. Dr. Haber extended a warm welcome and appreciation for all of the attendees at this event.[/vc_column_text][vc_video link=”https://youtu.be/fNnTCPiDWNc” align=”center” css=”.vc_custom_1463084705305{margin-bottom: 1.5em !important;}”][vc_column_text css=”.vc_custom_1463084710910{margin-bottom: 1.5em !important;}”]The 2016 Book of Lists event drew more than 350 people to Clayton on the Park in downtown Scottsdale. This event is held to recognize the Valley’s top companies who have worked hard to land on one of our top 25 lists that the Phoenix Business Journal produces and runs in the weekly print editions of the Phoenix Business Journal.

The party, which has been dubbed the premier networking event of the year, has become an annual tradition for many executives, including the book’s sponsors Alliance Bank and TOCA.[/vc_column_text][vc_single_image image=”639″ img_size=”full” alignment=”center” style=”vc_box_shadow_3d” css=”.vc_custom_1463084717248{margin-bottom: 1.5em !important;}”][/vc_column][/vc_row]

Congratulations to Dr. Christopher Huston!

[vc_row][vc_column][vc_column_text]Dr. Huston’s article “Cervical epidural steroid injections in the management of cervical radiculitis: interlaminar versus transforaminal. A review” was cited by Lee, Jung Hwant in “Comparison of Clinical Efficacy Between Interlaminar and Transforaminal Epidural Injection in Patients With Axial Pain due to Cervical Disc Herniation. Medicine. e2568. Volume: 95. Issue: 4. 2016.”

If you would like to download a copy of Dr. Huston’s article, please click here[/vc_column_text][/vc_column][/vc_row]

TOCA Welcomes Dr. Joseph Blazuk!


TOCA Welcomes Dr. Joseph Blazuk
February, 2016!

Dr. Blazuk has distinguished himself as an expert in the field of Regenerative Orthopedics, Non-Surgical Sports Medicine and Physical Medicine and Rehabilitation.

Dr. Joseph Blazuk is excited to join the team of exceptional physicians at TOCA. He is a fellowship-trained, nonsurgical Sports Medicine specialist. Originally from Boston, Massachusetts, Dr. Blazuk earned his undergraduate degree at Princeton University and then returned to New England to complete medical school at the University of Massachusetts.

After finishing residency in Physical Medicine and Rehabilitation at the University of Chicago, he went on to complete a Primary Care Sports Medicine fellowship in Atlanta at Emory University. He trained under Dr. Ken Mautner, a leader in the field of Orthobiologics treatment and a pioneer in musculoskeletal ultrasound.

Dr. Blazuk has extensive experience working with athletes at the elite level including professional football players and Cirque du Soleil performers. He has provided sideline medical coverage at collegiate and high school games, amateur roller derby bouts, and several running events including the Chicago Marathon. Most importantly, he enjoys working with folks who value staying healthy and active. He strives to get patients back to the activities that add happiness and meaning to their lives, whether that involves running a marathon or simply going up and down stairs without pain. He practices medicine with the mind set that the body’s natural state is one of health and often injury occurs when a cycle of muscle imbalance, improper biomechanics, and pain takes shape, couched in a poor environment for healing. His focus includes using musculoskeletal ultrasound to provide an accurate, timely diagnosis and developing a patient-centered treatment strategy that avoids the costs and complications of surgery when possible. He has published on adolescent throwing injuries and the usefulness of regenerative medicine injections, among other topics.

In his free time, he enjoys grilling, reading, hiking and backpacking. He is continually searching for a hike to match the beauty of Kalalau Valley in Kauai. He holds a purple belt in Brazilian Jiu Jitsu, practices yoga and occasionally pretends he’s still a gymnast.

Learn more about Dr. Blazuk »[/vc_column_text][/vc_column][/vc_row]

Q&A with Dr. Grant Padley: Weight Training

[vc_row][vc_column][vc_column_text]Question: I recently began a weight training program for the first time. What type of injuries can occur during weight training, and what can I do to avoid these injuries?

Answer: There’s no question about it, weight training is a hard work – high reward activity. There are numerous benefits to hauling around those weights, such as a toned, muscular physique, greater muscle and bone strength, increased metabolism, weight loss, improved balance and coordination and more.

However, with the potential benefits comes the potential for injury, and nothing can interrupt your weight training routine and goals quicker than an injury. Tears, sprains, strains, pulls and fractures are not unfamiliar terms for those involved in weight training. Injuries generally fall into two categories: those that are acute and happen suddenly and those that develop gradually. Injuries to the rotator cuff and shoulder, wrists, elbows, lower back and knees are some of the most typical weight training injuries.

The type and severity of injury are highly variable and often depend on the cause. There are several common causes of weight training injuries, such as: poor form or technique, lifting too much weight, overtraining, insufficient warm up and stretching, accidentally dropping weights, and lack of concentration. By understanding and taking precautions against each of these causes, you can greatly reduce your risk of injury. Enlisting the help of a personal trainer or qualified gym staff in the beginning can help instill proper form and techniques that can decrease your chance of injury as well.

Still, one of the best ways to avoid injury, especially serious injury, is to listen to your body. Pain is your body alerting you that something is wrong. Don’t ignore it. If you feel pain, reduce your weight or stop and try again in a few days.

Before beginning any weight training program, always consult your doctor to make sure you are healthy enough to endure a rigorous exercise regimen.

— Grant Padley, D.O.

Learn more about Dr. Padley »[/vc_column_text][/vc_column][/vc_row]

TOCA Talks Tuesday: Sports Nutrition

[vc_row][vc_column][vc_column_text]Just as proper physical techniques should be part of every athlete’s safety routine, maintaining adequate nutrition and hydration is also important. By following basic nutrition and hydration tips, athletes can stay at peak performance before, during, and after activity.

Eating before exercise

Total Energy

Most equations for calculating energy needs consider an individual’s gender, weight, and height as well as the level of physical activity. Given these differences and the importance of consuming adequate calories, it is important to consult a sports dietitian for the optimal energy prescription.


Carbohydrates are essential for peak athletic performance, as the body uses this nutrient more efficiently than fat or protein. The timing of carbohydrate intake is also important. Athletes should consume 1.0 to 4.0 g/kg of body weight one to four hours prior to exercise, focusing on longer-lasting sources of carbohydrate combined with a source of protein (e.g., peanut butter on whole grain bread). Recommendations for carbohydrate intake are higher for endurance training and competition (7.0 to 10.0 g/kg/day) and high-intensity athletics (5.0 to 8.0 g/kg/day).


The recommendation for daily dietary protein intake is 1.2 to 1.7 g/kg/day. The amount of protein depends not only on the level of physical activity, but also on the athlete’s rates of growth or healing. For example, athletes who are in a critical growth period at or around puberty may need more protein.


Dietary fat serves several functions. It is an additional source of energy, provides essential fatty acids that the body cannot synthesize on its own, and assists in the absorption of fat-soluble vitamins. Athletes should follow the same consumption guidelines as those recommended for the general public: 20 to 35 percent of total calories should come from fat, with less than 10 percent from saturated fat.

Eating during exercise

The focus for eating during exercise is on carbohydrates, especially sources of glucose and electrolytes. If exercise lasts longer than an hour, it is necessary to consume an additional 30 to 60 grams of carbohydrates during the activity.

Eating for recovery

The focus during recovery is on carbohydrates, especially within 15 to 30 minutes after the activity, when cells are especially receptive to the uptake of glucose. During this time, athletes should consume 1.0 to 1.5 g/kg of a rapid-acting carbohydrate or a ratio of 4 grams of carbohydrates to 1 gram of protein (e.g., lowfat chocolate milk). After 30 minutes, the focus should be on a mixed meal with adequate carbohydrates, protein, and fat.

The focus during recovery is on carbohydrates, especially within 15 to 30 minutes after the activity, when cells are especially receptive to the uptake of glucose. During this time, athletes should consume 1.0 to 1.5 g/kg of a rapid-acting carbohydrate or a ratio of 4 grams of carbohydrates to 1 gram of protein (e.g., low-fat chocolate milk). After 30 minutes, the focus should be on a mixed meal with adequate carbohydrates, protein, and fat.

Athletes must drink fluids to stay adequately hydrated, as even a loss of 1 percent body weight can reduce athletic performance. Water is a sufficient fluid for hydration. Athletes should consume at least 16 ounces of fluid two hours prior to exercise, and 5 to 10 ounces during exercise, taken every 15 to 20 minutes. Athletes should get into the habit of weighing themselves before and after exercise to determine how much water weight they lose through activity—and consume 16 to 24 ounces of water for every pound lost. Sports drinks are appropriate for athletes involved in endurance activities (e.g., marathon, triathlon) or stop-and-go sports (e.g., soccer, sprinting) to replace lost fluids, carbohydrates, and electrolytes. The most effective sports drinks consist of 6 percent to 8 percent carbohydrates (14 to 19 grams carbohydrates per 8 ounce serving). Diluting sports drinks lowers the carbohydrate concentration, thus providing too few carbohydrates for replenishing those lost.[/vc_column_text][/vc_column][/vc_row]

Dr. Jon Zoltan: Stem Cell Injections

[vc_row][vc_column][vc_column_text]Stem cell injections appear to be a ‘hot topic’ of discussion for our patients. To our patients stem cell is a term that really encompasses a variety of tissues which include stem cells, bone marrow aspirates, fat cells,and platelet rich plasma, etc. These injectable treatments can provide relief for a variety of musculoskeletal conditions involving joints, tendons, and ligaments.

There isn’t a single answer for the appropriate use for these treatment modalities, but our physicians are qualified and knowledgeable to address these issues. Feel free to contact one of our physicians at TOCA to see if your condition qualifies for one of these treatment modalities.

Learn more about Dr. Zoltan »[/vc_column_text][/vc_column][/vc_row]

Dr. Harmsen to be published in The Journal of Shoulder and Elbow Surgery

[vc_row][vc_column][vc_column_text]Congratulations to Dr. Harmsen who has co authored a paper that will be published in an upcoming issue of The Journal of Shoulder and Elbow Surgery:

“Radiographic and clinical outcomes of total shoulder arthroplasty with an all-polyethylene pegged bone ingrowth glenoid component: prospective short- to medium-term follow-up.”

This publication reports that excellent outcomes and stable fixation can be reliably achieved with shoulder replacement surgery. In particular, the use of this particular glenoid implant can produce lasting, stable component fixation, pain relief, and improved motion when used to treat patients with arthritis of the glenohumeral joint (shoulder).

Learn more about Dr. Harmsen »[/vc_column_text][/vc_column][/vc_row]