April 9, 2013 Inside this issue Caring for hundreds of thousands of patients, training tomorrow’s caregivers while contributing to the economy - that’s just a snapshot of CAMC … Page 2 Prevention First: girl born as a preemie now thriving at 17… Page 3 CAMC Cleft Center earns national recognition … Page 3 THE CUTTING EDGE Surgeon uses new technology and techniques to treat strokes and brain aneurysms … Page 4 Surgeon brings patients the latest advances in hip and knee replacement surgery … Page 4 Connect with us From volunteer to employee CAMC’s volunteers help keep the hospitals running smoothly. Last year 218 community members, ages 15 to 95, collectively gave more than 31,000 hours of their time to CAMC. Many CAMC volunteers have gone on to accept other roles in the health system, including Christena Ross and Cathy Ritchey. Christena Ross, MSM and current director of research and grants administration, became a junior volunteer at the age of 13, and continued until she graduated from college. “When I started we were called ‘candy stripers’ and wore red and white striped dresses,” said Ross. During her time as a junior volunteer, Ross worked in departments all over the hospital. Her duties included everything from running the gift shop and delivering flowers to transporting patients and staffing the pediatric playroom to filing, registration and answering phones. “My favorite ‘job’ was working in the pediatric playroom,” she said. “I always volunteered for that area as much as I could.” Cathy Ritchey began volunteering at CAMC a few years ago, and is now a staff assistant in the clinical trials department. facebook.com/camchealthsystem @camc_hs youtube.com/user/camchealthsystem “When I first started, I volunteered in epidemiology doing hand hygiene data entry,” said Ritchey. “Then flu season started, and I worked in the flu clinics entering data into the state database.” Because of her good work, she was elected to the office of secretary of the General Hospital Auxiliary. After that ended, she volunteered at Women and Children’s Hospital doing data entry and organizing files. During that same time she spent one day each week in clinical trials, training on the clinical conductor program. “The staff assistant in clinical trials accepted another job and someone was needed five days a week to fill that position,” Ritchey said. “So, I was offered a contract job as staff assistant.” Both ladies began as volunteers, but have gone on to become valued employees. Getting started as a junior volunteer helped Ross decide to pursue a career in health care. “Like most people that enter health care, I had a desire to help others,” Ross said. “I wanted to make sure the career I chose would make a difference. I also enjoyed the diverse jobs and activities throughout the hospital. Cathy Ritchey, Christena Ross The most important lesson I learned as a junior volunteer was that I couldn’t stand the sight of blood, or the thought of sticking someone with a needle! This insight led me to the business side of health care.” Ross has worked at CAMC since 2000. She has worked as a fundraiser, educator and now oversees research and grants administration. “CAMC offers a rare opportunity – you can completely change careers without ever leaving the same employer,” she said. “Other than for a few years right out of college, my life - volunteer and work - has been associated with CAMC.” Ritchey offers advice for someone who is unsure about becoming a volunteer. “The best advice I can give someone who is thinking about volunteering is to take the free classes and learn as much as you can during your volunteer work,” she said. “Every department you work in has something to teach you. All the knowledge you gain will help you in the future.” “Junior volunteers learn the ‘spirit’ of volunteering at an early age, and that can carry throughout their lives,” Ross said. “It did for me. Volunteering has always been a part of my adult life.” Save the date! CAMC HealthFest Saturday, June 1 7 a.m. to 2 p.m. Charleston Civic Center Some screenings require registration and are on a first-come, first-served basis. Look for the CAMC HealthFest ad in Charleston Newspapers in the upcoming weeks for registration information. Registration will begin Monday, May 13. For more information about volunteering at CAMC, visit camc.org/volunteer, or call (304) 388-7426. New private rooms help Women and Children’s Hospital celebrate 25 years CAMC leading the charge in workplace wellness Charleston Area Medical Center revamped its wellness initiative with the creation of a new wellness advisory group and wellness committee in 2010. CAMC Women and Children’s Hospital celebrates its 25th anniversary in 2013. What better way to celebrate than by opening private rooms for families having babies? “The opening of the private rooms means that we now can offer an environment that meets the needs of our patients and the community, and that compliments the exceptional care that patients receive at Women and Children’s,” said Denise Burgess, RN, LPC, NBCC, director of obstetrical services. Having an environment that is reflective of the highest level of care and compassion patients and families receive is a source of great pride for the entire Women and Children’s team. “CAMC has invested a tremendous amount of resources to ensure that our region has a state-of-the-art healing environment in which to enjoy the birthing experience,” said Andrew Weber, vice president and administrator of Women and Children’s Hospital. “Pregnant women throughout our region no longer have to choose between the highest level care and the comfort of a private room for themselves and their newborn. Women and Children’s Hospital is THE choice.” During renovations, each room has undergone a complete transformation with warm finishes, soothing colors, flat screen TVs and new private bathrooms and showers. The common areas also have received a new look with finishes, colors and lighting to compliment the patient rooms. “The rooms have more of a hotel-like look now,” Weber said. “All of this change is designed to create a warm, quiet and comforting environment to promote healing and a special environment for parents and families during this joyous occasion.” Misty Bradley, first-time mom, agrees that the new rooms don’t have a hospital feel. “I truly felt like I was at a hotel, not a hospital,” she said. “Really! The room was comfortable, spacious and if I needed anything at all, I just asked and it was taken care of. I didn’t get that cold, sterile, uncomfortable feeling that you usually get in hospitals. I didn’t hear lots of people talking or bells, whistles and alarms going off and waking me up. “ Providing this type of environment helps to make the total patient experience a positive one for women delivering here. Women and Children’s already boasts outstanding providers, the most experienced nurses in both labor and delivery and mother/baby, 24-hour anesthesia coverage and the highest level NICU with 24-hour neonatologists on hand. “All of these things are what we believe to be the gold standard in patient care,” Burgess said. “The new rooms just wrap that up in a beautiful package.” “I had never stayed overnight in a hospital or had a major surgery, so this experience was all very scary to me,” Bradley said. “Pair that with all of the overwhelming feelings I was having as a first-time mom, thank goodness for the kind and wonderful nurses and my beautiful cozy room to help the whole experience, both joyous and bittersweet, be much more tolerable.” The private rooms also have allowed Women and Children’s to change its visitation practice, and parents and families are enjoying the opportunity to share their special occasion with many loved ones in a more intimate environment. For more information about maternity services at CAMC Women and Children’s Hospital, visit camc.org/babies. CAMC Today is a publication of CAMC Health System “In 2011, the committee branded a new program called My Health,” said Maureen Kendall, corporate director of total compensation. “The focus of the My Health program is to develop activities that promote a long-term strategy aimed at improving overall employee health.” It is important for an organization the size of CAMC to promote health and wellness to its employees. “Our workforce is about caring for our community,” Kendall said. “The wellness program is about caring for our workforce.” To help with this initiative, a new wellness coordinator was hired in February. Evan Thoman came to CAMC from the YMCA, where he was director of health and fitness. “Evan’s education and work experience, along with our well-established wellness committee, will move us forward in meeting our long term strategy and commitment of improving our overall employee health,” Kendall said. CAMC is planning a number of new programs in the coming year, including a new walking program, smoking cessation program, diabetes program and online financial wellness program. Continued on P. 3 2 camc.org A Snapshot of CAMC Health System* CAMC Health System Nearly 7,000 people work for companies within the CAMC Health System including: Charleston Area Medical Center, CAMC Foundation, CAMC Health Education and Research Institute, CAMC Teays Valley Hospital and Integrated Health Care Providers, Inc. Charleston Area Medical Center CAMC is the flagship of the CAMC Health System. CAMC offers thousands of families convenience and accessibility through three Charleston locations: CAMC General Hospital, CAMC Memorial Hospital and CAMC Women and Children’s Hospital. CAMC Foundation The CAMC Foundation is the fundraising organization for CAMC. The foundation accepts gifts from individuals, businesses and foundations to support programs and services at CAMC. CAMC Health Education and Research Institute The CAMC Institute provides continuing medical education, outreach education and research support to physicians and allied medical professionals in West Virginia. CAMC Institute also operates schools of cytotechnology and nurse anesthesia as well as the 11 graduate medical, three pharmacy and one psychology residency programs jointly directed by the institute, WVUCharleston Division and the community hospital track jointly directed by CAMC/ WVSOM. Want to become a nurse? Becoming a nurse requires time and dedication, but you can do it. CAMC’s nurse education assistance program will help cover your educational costs in exchange for a work commitment. You’ll finish the program ready to start your career in the exciting, rewarding health care field. Hear our graduates’ stories and apply online at camc.org/nursinged. Applications accepted until May 31. Teays Valley Hospital (TVH) TVH is an acute care hospital offering a variety of critical inpatient and outpatient services in one of West Virginia’s fastest growing counties. The hospital has 70 beds and 156 physicians and allied health professionals on its medical staff. CAMC Physicians Group CAMC Physicians Group is a network of physician practices affiliated with CAMC that provides a continuum of care to patients and their families through a broad range of medical specialties including: bariatric surgery, dentistry, fertility, facial and maxillofacial surgery, general and vascular surgery, neurology, oncology, orthopedics, pathology, plastic surgery, urgent care, urology and urology/transplant. Community Highlights • Served more than 49,000 people seeking health information or community benefit services such as screenings • 386 participants in outreach professional education programs at 20 outreach sites Teaching Hospital (CAMC & CHERI) • CAMC serves as a clinical training site for about 800 students/year through educational affiliations with WV/regional colleges and universities. • 176 residents, interns and fellows • 50% of graduates establish practice/ continue training in WV • Nearly 49% of CAMC’s medical staff received training here CAMC offers two Ornish programs. The heart disease Reversal Program is a research- based, one-year treatment plan with four components: nutrition, stress management, social support and exercise. The Spectrum Program is a sixweek lifestyle improvement program consisting of weekly two-hour educational sessions also focusing on nutrition, exercise, social support and stress management. The next Spectrum class starts July 1. Spectrum is for individuals who want to prevent disease, reduce the risk for developing chronic conditions, or learn lifestyle changes that can help manage diabetes, high blood pressure, heart disease and cancer. The Reversal Program includes onsite exercise, stress management instruction, group support and chefprepared meals. The next Reversal class begins May 20. The Reversal Program requires a physician to authorize participation in the program. Call (304) 388-9411 for more information or to register for any of the classes. Licensed Beds (CAMC) • 838 total • 268 General Hospital • 424 Memorial Hospital • 146 Women and Children’s Hospital Patient Care (CAMC) • 567,956 outpatient visits • 98,371 emergency room visits • 3,169 trauma patients admitted • 40,335 inpatient discharges • 39,400 general operating room procedures • 28,218 ambulatory surgery procedures • 1,390 open-heart bypass procedures • 14,330 procedures performed in cardiac cath labs • 40,659 David Lee Cancer Center encounters (IHCPI & CAMC) • 1,562 newly diagnosed patients with cancer • CAMC treated 12% of the total 2010 adult cancer discharges in WV • 2,910 babies delivered • 401 neonatal intensive care unit admissions • 44 kidney transplants Operating Rooms (CAMC) • General Hospital: 13 • Memorial Hospital: 14 • Women and Children’s Hospital: 6 • SurgiCare (outpatient): 4 Research (CHERI) • 400 active research protocols • 36 various types of industry sponsored trials (not including cancer studies) Employees and Physicians (CAMC) • 5,151 full time equivalent employees • 637 physicians on medical staff Financial Facts (CAMC Health System) • Payroll and benefits = $338 million • Community benefit = $120,971,264 • $39,030,011 in charity care at cost • $29,676,338 to provide health professions education/graduate medical education • $820,674 in subsidized health services to meet identified community needs • $2,950,736 for community benefit programs and services • $17.9 million for Medicaid provider tax • $78,763,643 unreimbursed cost for treating patients with Medicare coverage • $46,283,038 unreimbursed cost for treating patients with Medicaid coverage • $15,217,453 unreimbursed costs for treating patients with PEIA coverage • $21,545,282 written off as bad debt at cost For more information, visit camc.org. *Based on 2011 data. Computerized processes improve care When you’re a hospital patient, you see many outward displays of patient safety practices. For example, providers check your ID bracelet, ask you to confirm your name and birth date, and scan the barcode on your ID and your medication before giving it to you. Additionally, many other processes are going on behind the scenes to improve patient safety and quality of care. About two years ago, physicians practicing at CAMC started using Computerized Physician Order Entry (CPOE), which means that physicians enter their patient CALENDAR Dr. Dean Ornish Program for Reversing Heart Disease • 75 students enrolled in CAMC’s nurse anesthesia program • In 2011, 1,863 continuing education programs were offered with 54,140 hours of CE credit issued Run for Your Life The annual 5-mile run is scheduled for Saturday, June 22 at 8 a.m. It begins and ends at the Capitol. All entry fees from Run for Your Life go to the CAMC Foundation to support colorectal cancer awareness and screening. Call (304) 388-9864 for more information. Register online at camc.org/foundationspecialevents CAMC MEDICAL REHABILITATION CENTER CHALLENGED SPORTS PROGRAM 19th ANNUAL WEST VIRGINIA CHALLENGED SPORTS CHAMPIONSHIPS May 1 – 4, 2013 – Charleston Featuring competitions in Track & Field, Swimming, Archery, Weightlifting and Marksman (sanctioned by the NRA) Open to athletes of all ages with physical disabilities REGISTRATION REQUIRED. To register (athletes) or volunteer to help with any of the events, please contact Jeremiah Gagnon at (304) 388-7608 or jeremiah.gagnon@ camc.org. For more information or athlete entry forms, visit camc.org/challengedsports. care orders directly into CAMC’s electronic medical record system. CPOE is an important step in improving patient safety, quality and efficiency of care. Using CPOE, physicians can enter an order from within the hospital or remotely. Once an order is entered, it goes to the designated department (pharmacy, radiology, etc.) so that it can start being processed immediately and expedites the delivery of care to the patient. Prior to CPOE, physician orders were written into a patient’s paper chart and then had to be entered into the system by a nurse or unit coordinator. The key benefits of using CPOE include reducing errors in the order entry process, gaining faster turnaround times for medications, labs, images and diagnostics, and eliminating duplicate orders. If there is a possible drug interaction, physicians are alerted at the time they place the order. CPOE also eliminates handwriting legibility issues. CPOE is one part of meeting the government’s requirement of Meaningful Use, which provides incentives to organizations who meet guidelines of expanding electronic health record (EHR) technology. These national priorities are seen as important parts of the role of technology in the national effort to improve health care safety, quality and efficiency. “CPOE has been a significant change and opportunity for physicians, nurses, clinical staff, information services and others at CAMC. We appreciate the years of work by all to adopt CPOE as one way to continue to improve how we care for our patients,” said Glen Wright, MD, clinical director for medical informatics. CAMC receives award in stroke care CAMC has received the American Heart Association/American Stroke Association’s Get With The Guidelines®–Stroke Silver Quality Achievement Award. The award recognizes CAMC’s commitment and success in implementing a higher standard of stroke care by ensuring that stroke patients receive treatment according to nationally accepted standards and recommendations. To receive the Get With The GuidelinesStroke Silver Quality Achievement Award, CAMC consistently complied, for at least one year, with the requirements in the Get With The Guidelines–Stroke program. These include aggressive use of medications like antithrombotics, anticoagulation therapy, deep vein thrombosis prophylaxis, cholesterol reducing drugs and smoking cessation. This 12-month evaluation period is the second in an ongoing self-evaluation by the hospital to continually reach the 85 percent compliance level needed to sustain this award. In addition to the Get With The GuidelinesStroke award, CAMC has also been recognized as a recipient of the association’s Target: Stroke Honor Roll, for improving stroke care. Over the past quarter, at least 50 percent of the hospital’s eligible ischemic stroke patients have received tissue plasminogen activator, or tPA, within 60 minutes of arriving at the hospital (known as ‘door-to-needle’ time). A thrombolytic, or clot-busting agent, tPA is the only drug approved by the U.S. for the urgent treatment of ischemic stroke. If given intravenously in the first three hours after the start of stroke symptoms, tPA has been shown to significantly reverse the effects of stroke and reduce permanent disability. Get With The Guidelines® is the American Heart Association/American Stroke Association’s hospital-based quality improvement program that empowers health care teams to save lives and reduce health care costs by helping hospitals follow evidence-based guidelines and recommendations. For more information, visit heart.org/quality. Published by CAMC Marketing & Public Affairs Elizabeth Pellegrin Editor Dale Witte Jessica Duffield Editors/Writers Tony Campbell Graphic Designer Julia Noland Leslie Carpenter Ashley Showen Writers 2013 camc.org Wellness Continued from P. 1 “Employees need to get involved in their wellness,” Kendall said. “We are looking at programs in an effort to offer something for everyone. If you like to run, get involved in our Couch to 5K programs. If you like to walk, watch for announcements about a new walking program. If you are interested in weight loss, look at getting involved in Drop 10 in 10, Weight Watchers at Work or our new Team Lean program. And don’t forget about the Dean Ornish programs, yoga and ZUMBA.” “We are offering Great Living and reducedcalorie entrée and side items daily, and offering fruit as a side option at the grill area,” Foster said. “We are also training our service staff on proper portions and educating them on recommending better for you options that meet our FIT criteria.” CAMC offers a variety of fitness and weight loss options for employees. In an effort to help them make healthier choices when visiting CAMC cafeterias, Morrison’s has established the Morrison Healthy Dining Standards to ensure access to healthy food choices. Some of Morrison’s longer term goals include reducing the amount of fried foods sold annually, increasing annual purchases of fresh fruits and vegetables, adding whole wheat and whole grain breads, buns and rolls as a default option, including calorie counts on all available food options, offering healthy FIT combos for every meal, bundling combo meals with bottled water instead of soft drinks and continuing education of the staff. “We have begun reducing the size of dessert portions, offering low calorie and reduced sugar desserts on a daily basis and offering healthier snacks at the register stands, such as baked chips and bottled waters,” said Danny J. Foster, nutrition services. “Marketing and placement of products also is important so that the healthier choices are the default options.” Which means fruit and baked chips at the registers instead of giant cookies and other large desserts, and water placed at eye-level with sugary sodas not as readily available. “In West Virginia, you have the perfect storm—an older workforce, prevalence of obesity, long work hours and work that requires repetitive motion that can lead to sprains and strains or neurological issues,” said Art Lilly, MS, ATC coordinator of the CAMC industrial rehabilitation program. The goal of CAMC’s industrial rehabilitation program, which is part of the CAMC Physical Therapy Center, is to get people back to work quickly after an accident or injury on the job. Utilizing a state-of-the-art testing system, the therapist can determine a person’s level of functionality and assess what steps need to be taken to get that person back to work. The ARCON Functional Capacity Evaluation System measures a patient’s ability through strength testing, musculoskeletal screening, cardiovascular assessment and other functionality. Girl born prematurely thriving at 17 Items marked as FIT meet criteria consistent with current dietary recommendations for the amount of calories, fat and sodium etc., allowed in various items. “Morrison feels that health care institutions should be role models in healthy eating choices,” Foster said. “We feel very fortunate to have been selected as leaders of this nationwide endeavor.” If you have any questions about Wellness related programs at CAMC, please contact Evan Thoman, wellness coordinator, at (304) 388-7593. Industrial rehabilitation program helps patients get back to work Work-related injuries are unfortunately prevalent in West Virginia, largely because of the demanding types of manual labor many of our large industries require. 3 “The program is designed to get people back to work,” Lilly said. “I work with the vocational rehab community, employers, insurance companies, physicians and the injured worker and his or her family to provide a goal oriented, work injury rehab program.” Doug Wallace, 59-year-old native of St. Albans, recently went through the program after falling off a 12-step ladder while working for a painting contractor. Wallace’s work injury left him with a broken hip and knee, and the inevitability of months of rehabilitation. After going through surgery, Wallace completed basic physical therapy and was then sent to the industrial rehab program for work study therapy. From November to February, Wallace attended sessions at industrial rehab. Wallace had nothing but good things to say about Lilly and the program. Lilly, who has been the coordinator of the program for 16 years, is a proponent of employee education. “I felt like I was a member of Mr. Lilly’s family. He had a genuine concern for my health,” Wallace said. “It was very uplifting and gave me a reason to hope. My balance and strength improved.” “Prevention is the key. Monitor your workers, and teach them to work smarter, not harder,” he said. Wallace continues to recover and is working with his employer to determine in what capacity he can return to work. The CAMC industrial rehabilitation program works closely with West Virginia Worker’s Compensation to evaluate patients. The program sees an average of 250 patients each year from all over West Virginia. The industrial rehabilitation program also provides expert testimony, back care education, work hardening and conditioning programs and more. For more information about industrial rehabilitation at CAMC, call (304) 388-4900. Extended hours Open select evening and weekend hours. Call (304) 720-9729 for more information or to schedule. 60 RHL Blvd., South Charleston Located at the Trace Fork Shopping Center behind O’Charley’s restaurant camc.org/imaging Left: Ayla, 1 pound 2 ounces held by her mom Lisa in the NICU. Right: Ayla and Lisa, 17 years later. Lisa Morgan never imagined having to deliver her first baby at 24 weeks gestation, but that possibility became very real on Dec. 8, 1995. “I lived in Southern West Virginia and was planning to deliver in Beckley,” Morgan said. “However, due to preeclampsia that isn’t what happened.” After a routine visit to her obstetrician, Morgan began having severe cramps and went to the emergency room before returning to her home 45 minutes away. There, she was told about CAMC Women and Children’s Hospital and the team of doctors that was available to help someone in her situation. “When they told me what was happening, my blood pressure doubled,” she said. “I was then brought by ambulance to CAMC where they immediately began administering medications to help with my baby’s lungs.” By Dec. 10 the baby, Ayla Chandler Edwards, had to be delivered by c-section, weighing 1 pound, 2 ounces. She was 105 days early, and Morgan was able to see her baby briefly before she was taken to the neonatal intensive care unit (NICU). “Being born at 24 weeks gestation 17 years ago meant that there was a possibility of a dismal outcome,” said Stefan Maxwell, MD, medical director of the NICU at CAMC Women and Children’s Hospital and the neonatologist who was present when Ayla was born. “Extremely premature babies like Ayla have a high risk of mortality, not to mention other complications such as growth restrictions and possibilities of hearing and vision loss, intra-cranial hemorrhage with the associated morbidity of compromised neurodevelopment, etc.” Ayla spent three and a half months in the NICU, from Dec. 9, 1995 to March 23, 1996. She was on a ventilator for 40 days and had an intestinal perforation, which was surgically repaired. Despite those setbacks, she was discharged from the hospital on her original due date. “It meant so much to have a high standard of care for Ayla,” Morgan said. “It was all very magical to me. She has remarkable vision for someone who was born that early, and has no lasting respiratory issues. We had to come back to the hospital monthly for IV therapy the first year of her life, but other than that she hasn’t had any major issues that stemmed from her prematurity.” Today, Ayla is a thriving 17-year-old who loves the theater and performs in many school plays. She also excels in her school work, and scored a 28 on the ACT when she took it for the first time before the beginning of her junior year of high school. “I like science,” Ayla said. “I want to get my PhD or medical degree and go into something like genetics.” “Like any preemie, Ayla had many problems, but she has gone on to be a genius,” Maxwell said. Many babies like Ayla are still being born or transferred to Women and Children’s Hospital every day. Funds raised through the CAMC Foundation Gala help to provide care for these babies. For more information about the gala or how you can help these tiny babies, visit camcfoundation.org or call (304) 388-9860. CAMC cleft center earns national accreditation The Cleft Center/First Appalachian Craniofacial Deformity Specialists (FACES) at CAMC has been recognized by the American Cleft PalateCraniofacial Association (ACPA) as an accredited center for the disciplinary care of children with cleft and craniofacial differences – the only clinic in West Virginia to earn this designation. The ACPA, which is the governing association of cleftDrs. Bruce Horswell (left) and Michael Jaskolka with cleft craniofacial centers in North lip and palate surgery patient Bradley Blankenship, 9, of America, is comprised of health Gilbert, W.Va. care professionals whose work involves treating and researching birth defects such as cleft clip and As stated in the ACPA notification letter, “The cleft palate, as well as other facial conditions. purpose of the Commission on Approval of Earning accreditation means that the Teams is to assure patients and families that CAMC cleft team is committed to providing the teams to which they are referred meet the comprehensive, quality care for patients Standards for Cleft Palate and Craniofacial affected by craniofacial conditions. Teams as set forth by the ACPA and Cleft Palate Foundation.” In 2012, the Cleft Center/FACES had 722 patient visits for cleft and craniofacial-related The CAMC Physicians Group Cleft diagnoses. Center/FACES is located at Women and Children’s Hospital and specializes in the “We have always focused on providing management of congenital and acquired the best care to children who need our craniomaxillofacial deformities (skull, scalp, services, and to be recognized among some eyes, ears, nose, jaws, lips and mouth) and of the best cleft centers in the country is an other related problems. Under the direction honor,” said Bruce B. Horswell, MD, DDS, of Drs. Bruce Horswell and co-director MS, FACS, co-director of the Cleft Center. Michael Jaskolka, the team is comprised of “This was a very lengthy and consuming craniomaxillofacial surgeons, neurosurgeons, application, which required demonstration ENT surgeons, pediatric dentists, of a closed-loop evaluation and treatment orthodontists, geneticist and counselors, process among patients/families, referrals speech pathologists, dieticians and social and primary care physicians, and involved workers. health care professionals with outcomes results and a database acquisition of those For more information visit camc.org/faces. results. We couldn’t have done it without the perseverance and hard work of our clinic team coordinator, Lola Forester, RN, and clinic manager Amy Dean.” 4camc.org Surgeon brings latest advances in hip/knee replacement surgery Hip and knee surgery have come a long way, baby. Just ask Alexander Rosenstein, MD, who has been instrumental in helping to advance orthopedic surgery for his patients over the past 25 years. Rosenstein was a bioengineer before going into medicine, which led him to improve some of the very techniques and devices used in his profession. He holds U.S. and Canadian patents as well as approval for implant designs used in joint reconstruction. “I like to bridge the gap between engineering and medicine so patients can have a better quality of life,” Rosenstein said. Rosenstein graduated from the University of Minnesota Institute of Technology with a degree in bioengineering. He then earned his medical degree from the University of Minnesota School of Medicine and completed his orthopedic residency training at the University of California, San Diego Medical Center. Rosenstein was awarded the Girdlestone Scholarship and completed his fellowship training in adult reconstruction and joint replacement at Oxford University. Rosenstein is one of the first U.S. orthopedic surgeons to implant the Oxford Unicompartmental Knee, which allows for restoration of complex, normal motion of the knee. This minimally-invasive procedure preserves bone and ligaments and is usually associated with less discomfort after surgery, faster recovery and a shorter hospital stay. “With unicompartmental knee replacement, we don’t have to replace the entire knee,” Rosenstein said. “We can preserve the parts of the knee that are still in adequate condition, and only replace the damaged parts of the knee. It only requires a small incision, and it does not completely change the mechanics of the knee as total knee replacement devices do.” Muskuloskeletal issues are at the forefront of the aging U.S. population, with an estimated 50 million Americans suffering from arthritic disorders and half of them reporting significant disability. But orthopedic problems don’t just affect the elderly. According to the National Foundation, baby boomers are now at prime risk for arthritis. More than half those affected are under age 65, and as a result, arthritis is now the leading cause of disability in the U.S. “Hip and knee replacement surgery is one of the greatest medical advances of our time. These procedures can improve a person’s quality of life by relieving pain, improving range of motion, and restoring function. There are also many effective non-surgical techniques, including a variety of injections and bracing that can prolong the use of joints before surgery is necessary.” It is estimated that over 700,000 hip and knee replacements are performed in the United States each year. A replacement joint that wears out, loosens or develops a problem can be resurfaced or revised with a second procedure, called joint revision surgery, which Rosenstein specializes in. Joint revision is more complex than the original procedure because of the alteration to a patient’s bone structure that was made during the initial surgery, but it is likely to become more common as an increasing number of younger patients (under 55 to 60) have joint replacement surgery and as the population continues to live longer and outlive their implants. To promote patients’ comfort and to expedite the recovery after joint replacement surgery, Rosenstein uses “multi-modal” pain management techniques that involve combining medications and administering them at key times during and after surgery to effectively control pain with fewer side effects. In the past when using narcotics alone following joint replacement surgery, patients had to experience pain before it was treated, which resulted in more pain and required more medication to relieve pain, thereby increasing the chance of side effects. With modal pain management, the goal is to stay ahead of the pain so patients can recover faster. With so many options in joint replacement surgery and therapies, Rosenstein says people don’t have to live in pain or leave the area for the most advanced procedures. “We’ve redefined orthopedic surgery in recent years so patients of all ages have more options and can live active lives longer,” Rosenstein said. “Best of all, everything patients need can be found right here.” Dr. Rosenstein is board certified by the American Board of Orthopaedic Surgery and specializes in adult hip and knee, joint preservation, joint replacement and revision surgery. Before joining CAMC Physicians Group as director of reconstructive and orthopedic surgery in January 2013, Rosenstein served as professor of orthopaedic surgery and chief of adult reconstruction division at the University of Texas Medical School Houston and adjunct professor of biomedical engineering at the University of Texas Austin. He has held academic positions of assistant clinical professor of orthopaedic surgery at the University of California Irvine and associate professor of the department of orthopaedic surgery and adjunct associate professor of the department of mechanical engineering at Texas Tech University. Rosenstein has also served as chief of surgery and chief of medical staff at South Coast Medical Center in Laguna Beach, Ca. Rosenstein has co-authored a book for arthritis sufferers titled: “Everything You Ever Wanted to Know About Shoulder, Hip and Knee but Didn’t Know What to Ask.” For more information visit camc.org/orthosurgery. New technology, techniques treat strokes, brain aneurysms drugs or devices can be delivered directly to the site of a blockage to remove it to prevent the stroke from completing; and in brain aneurysms, specialized coils can be inserted into the aneurysm to prevent it from rupturing and to treat aneurysms that have ruptured. According to the National Brain Aneurysm Foundation, an estimated 6 million people in the United States (1 in 50) have an unruptured brain aneurysm. Of those, 30,000 will suffer an aneurysm rupture. David Carrington, MD, describes himself quite simply as a “brain plumber.” But there’s nothing simple about what he does. As CAMC’s only interventional neuroradiologist, Carrington uses tiny catheters and state-ofthe-art imaging techniques to treat complex vascular diseases of the brain and spine without open surgery. Instead, he performs surgery inside tiny, delicate blood vessels. “Similar to a cardiac catheter that goes to the heart, an endovascular surgical neuroradiologist uses long, specialized tubes (microcatheters) over microwires, and stateof-the-art imaging equipment to treat blood vessel problems in the brain,” Carrington said. Shorter recovery times and decreased procedural risks are among the benefits of endovascular surgical neuroradiology and minimally-invasive neurointerventional techniques. In stroke cases, clot-busting There are two approaches to treating an aneurysm: the traditional surgical approach, which involves making an opening in the skull to repair the aneurysm by surgically clipping it; or coil embolization, which is a non-surgical endovascular approach where a tiny catheter is guided from an artery in the groin into the brain vessels and the aneurysm is packed with tiny coils. Coils accomplish from the inside what a surgical clip would accomplish from the outside: they stop blood from flowing into the aneurysm but allow blood to flow freely through the normal arteries. “An aneurysm is a ballooning of a defect in the blood vessel, much like a tire inner tube balloons out when there is a defect,” Carrington said. “As the bulge gets larger the wall of the blood vessel gets very thin and may rupture or give way. Through a tiny catheter, I place coils inside the ruptured aneurysm, which stops bleeding from reoccurring, and also causes the blood to clot, heal and form a scar.” According to the American Stroke Association, most people develop aneurysms after age 40. They tend to develop at branching points of arteries and are caused by constant pressure from blood flow. Aneurysms often enlarge slowly and become weaker as they grow, just as a balloon becomes weaker as it stretches. Carrington and the team of neurologists, neurosurgeons, radiologists, emergency medicine physicians, pharmacists and medical rehabilitation specialists at the CAMC Stroke Center at General Hospital provide rapid, comprehensive evaluation and management of stroke to provide patients with the most advanced treatment options. “Aneurysms happen in about 6 percent of the population, and generally there are no symptoms,” Carrington said. “But if an aneurysm leaks, called a sentinel bleed, it causes tremendous pain. Patients feel an extreme headache, which is like being hit in the head with a baseball bat. That pain often subsides for several days or a week before it fully ruptures.” “The intra-arterial treatment for stroke is to go where the stroke is happening, or to the blocked artery itself, and either dissolve the clot using medicine in the microcatheter or capture the clot using a device that can be placed through the microcatheter.” While it is unknown why an aneurysm bleeds or exactly when it will bleed, Carrington says there are risk factors people can control to reduce their chance of bleeding from a brain aneurysm. Most notably the risk factors are smoking, high blood pressure and heavy alcohol use. These are some of the same risk factors for stroke, which occurs when a clot blocks the blood supply to part of the brain or when a blood vessel in or around the brain bursts. Treatment for stroke depends on the type of stroke: an ischemic stroke is most common, where an artery is blocked; whereas a hemorrhagic stroke involves bleeding into the brain. To treat an ischemic stroke, blood flow must quickly be restored to the brain via intravenous clot-busting medications or endovascular procedures. The key to optimal stroke treatment is quick and accurate action. The longer blood flow is cut off to the brain, the greater the damage. “Many people still don’t recognize when they’re having a stroke. At first their symptoms may not be perceived as symptoms of a problem, but when they don’t get better or when symptoms progress to a profound weakness or difficulty speaking, then they might think it is a stroke.” Carrington says when it comes to stroke, the most important step to survival and reducing disability is seeking immediate medical care at the onset of stroke symptoms: sudden numbness or weakness of the face, arm or leg (especially on one side of the body); sudden confusion, trouble speaking or understanding; sudden trouble seeing in one or both eyes; sudden trouble walking, dizziness, loss of balance or coordination; and sudden severe headache with no known cause. Carrington is certified in neuroradiology by the American Board of Radiology. Carrington came to West Virginia because of the large number of patients with neurovascular disease. “Interventional neuroradiology has revolutionized how we treat complex cerebrovascular diseases,” Carrington said. “We can perform any neuroendovascular procedure that can be done anywhere in the country, which can give some of our most complicated patients a chance for better outcomes.” JOB surfing? Apply online camc.org
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