“Ultimately whether a person wants to lost weight with or without bariatric surgery,” says General and Bariatric Surgeon, Dr. Paul Stanish, M.D., F.A.C.S., who is the Medical Director for the Healthy4Life program at Community Hospital in Munster and St. Mary Medical Center in Hobart, “they will need to make lifestyle changes.”
Stanish, the co-founder of Healthy4Life, a program designed as a comprehensive team approach to weight loss. To accomplish this, group’s team of professionals, each with specialized skills and expertise in a multitude of areas including nutrition, exercise physiology, diet, internal medicine, surgery and psychology, are able to work with each patient and address their individual needs.
According to Stanish, even those who are prime candidates for weight loss surgery still need to be in good shape before proceeding to surgery. That’s why the team approach emphasizing education and lasting lifestyle changes is so important.
“Changing eating habits is the most important step,” says Stanish. “We live in an extremely toxic food environment where there’s food everywhere. Much of our fast food is easier to get and cheaper to buy and not good at all for you.”
While most people can county food calories, they aren’t always aware of liquid calories—the amount of sugar in what we drink. Consider this, the largest size Starbucks Caramel Flan Latte with whipped cream has 450 calories; a 16-ounce Coca Cola classic at McDonald’s has 410. And those are empty calories, they don’t fill you up so you’re still hungry. Pile that on with a cinnamon roll at Starbucks (420 calories) or a Big Mac at 540 calories and you have half your 2000 calorie allotment for the day.
But there’s further bad news. Forget about working it off.
“You have to be a highly trained athlete to exercise you way out of a bad diet,” says Stanish. “That’s why education and food journaling where we keep track of what we eat are so important.”
Weight loss surgery is a life-changing procedure requiring many changes before and after surgery says Lori Granich, Registered Dietitian at the Midwest Bariatric Institute at Franciscan St. Margaret Health in Dyer.
“Not only will the surgery center that you choose require you to make changes, but your insurance company also has requirements that must be completed before they approve your surgery,” she continues. “With the help of your bariatric team, you will be asked to start making changes before surgery.”
According to Granich this may include starting a vitamin regimen, increasing fluid intake, quitting smoking and regularly exercising.
“One of the best ways to improve health before surgery is to lose weight,” she says. “Even a small amount of weight loss will decrease the risk of surgery, improve breathing and increase ambulation.”
Kristal Markovich, a registered dietitian at Methodist Hospitals, suggests that prior to surgery it’s important to start a diet that includes low fat or fat free dairy options, lean cuts of meat, whole grains as well as consuming more fruits and vegetables.
“Bariatric support groups allow you to meet people who have had surgery or are preparing to have surgery just like you,” says Markovich. “They are great places to practice your new healthy lifestyle in a positive and supportive environment.”
There’s also a psychological component to why we eat.
“When we do the surgeries, they’re very measured,” says Stanish noting that it’s the patients not the surgeries which vary, making it important to get to the underlying food pathology.
“Meeting with a psychologist is also a prerequisite for most programs,” says Granich. “The psychologist can evaluate if you are ready to make the changes necessary for weight loss surgery and can also help you deal with other issues you may have related to food, stress or family. Most bariatric centers have information seminars and support groups that can educate you and your family on bariatric surgery.”
Often patients are asked to keep a food journal.
“People think of it as a chore,” says Stanish, “but I want people to think when they’re about to eat and ask themselves, why am I eating? Am I eating because I’m hungry? Depressed? As well as the time of the day and what they’re eating”
Bariatric isn’t the end of healthy lifestyle changes.
“It is extremely important to continually stay in touch with your bariatric team,” says Granich, “and attend all preoperative and postoperative appointments.”
When they recognize the signs of patients who aren’t fully committed, Stanish and his team work with them.
“We know what phases they are in and whether they are or are not following the diet and exercising,” he says. I tell them I’m like Santa, I know if they’ve been good or bad.”
There comes a point in an alcoholic’s life when drinking takes over. When opportunities to self-medicate outweigh everything else.
For 60-year-old south suburban Stella, a nightly dose of alcohol helped dull the pain of her husband’s passing. Several days a week, she bought a pint and nursed it in front of the TV. Then she passed out.
For five years, this was Stella’s pattern. She drank alone, and when she ran out, she had a network of 20 liquor stores she bought from.
“I didn’t want them to know I had a drinking problem,” she said. “So I’d switch things up and go to different stores. As if someone who buys a pint of vodka at a time doesn’t have a problem!”
Like many alcoholics, Stella was a private drinker. On rare occasions when she ventured out with friends, she kept her addiction under control.
And unlike the stereotypes often associated with an alcoholic, Stella wasn’t a destitute drinker. On the contrary, she was a doctor’s wife.
“I just wasn’t dealing with life as it was coming at me, and I knew it,” she said. Eventually nighttime drinking became daytime drinking too.
Stella made appointments to see her doctor; she even attended Alcoholics Anonymous meetings. But it wasn’t until she got a DUI that Stella made the decision to get sober for good.
“It was the worst day of my life,” she says of her DUI arrest. “I had never felt so humiliated. Yet it was the best day of my life too. It forced me to do something about my problem. Thankfully, I didn’t hurt anyone else. I had such a sense of grace. Someone was looking out for me, and I wasn’t going to blow it.”
Urged by her doctor, psychiatrist and addictions specialist Joseph Beck, M.D., she voluntarily admitted herself to the four-week program at the Illinois Institute for Addictions Recovery at Ingalls (IIAR). The IIAR is a 16-bed adult addiction treatment facility providing care for a wide range of addictions, including alcohol and drugs; gambling; the internet; video-gaming; sex; spending/ shopping; food; and chronic pain with addiction.
Since her treatment four years ago, she’s never touched a drop of alcohol again.
“The first Saturday night that I was in treatment, a group of us were eating popcorn and watching a movie about addictions,” she recalls. “I was surrounded by people dealing with similar issues, some worse than mine, and it suddenly hit me that this was the best Saturday night I’d had in five years.”
Though she had to conquer the addiction herself, Stella says the IIAR counselors gave her the tools she needed to be successful.
“And for that,” she adds, “I’m forever grateful.”
“What many people don’t realize is that coming to treatment is the first step in a lifelong journey of recovery,” Dr. Beck explains. “Your life (the people, places, and things you’re associated with) has to dramatically change after treatment. That’s really where the rubber meets the road for so many of our clients.”
After her discharge, Stella reconnected with old friends and began volunteering in the community. She repaired fractured family relationships and rediscovered her love of traveling. She even hired a personal trainer and lost 83 pounds in the process.
With the help of the IIAR, Stella emerged from the darkness of her addiction and rebuilt a life that now brings her joy.
To others facing the uncomfortable truth of addiction, Stella advises, “The most important thing is to be honest with yourself. Are you the person you want to be? If the answer is no, you don’t have to do it alone. Help is closer than you think.”
If you or someone you love is ready to reach out for help, call 708.915.4090, available 24 hours a day.
Athletes, with their need for a competitive edge, enhanced speed and being able to play through pain, are at a greater risk of becoming addicted to drugs in general but prescription drugs specifically because of injuries and the rising pressure to keep playing even when injured says Peter Bradley, a therapist at Illinois Institute for Addiction Recovery which has a unit at Ingalls Hospital in Harvey, Illinois. Bradley is certified in working with dual diagnoses involving substance abuse and mental health issues, as well as Professional Compulsive Gambling Counselor and is nationally certified to work in Illinois as well as other states.
Professional sports figures are often afraid if they don’t play because of an injury someone else will take their place while high school and college athletes worry about losing scholarships and prestige.
“And there’s the fan level,” says Bradley. “You want to please them and that feeling just adds to the pressure.”
At times, that’s apparent even to those watching the game. An athlete withers in pain on the floor, is helped back to the bench, he or she is talked to sternly and then suddenly they’re back on the floor.
“Some of the medications they prescribe for injuries can be doozies,” says Bradley. “The opioids used in pain killers are very strong , very potent and they’re meant for short term use because they are highly addictive. Therein lies the problem, a lot of people get addicted who wouldn’t normally have the profile of someone who would become addict.”
“Sports figures are high arousal people says Larry Brewerton, a psychology professor at Indiana University Northwest. In the past Brewerton has set up alcohol and substance addiction programs in Chicago like the Cook County Dept of Corrections and Mt. Sinai Hospital as well as working as a director of a C.A.R.E. unit in the city specializing in alcohol and substance abuse.
By using the term high arousal, Brewerton is referring to the need for extreme physical and emotional stimulation.
“They’re used to high arousal when they’re playing with a lot of adrenaline going on and they really thrive on that,” he says. “When they’re not off, they still need it. They thrive on it and so many use amphetamines, cocaine, things that keep up that arousal. It makes them feel very good as well as omnipotent.”
College and high school athletes like pro stars use for various reasons—steroids for bulking up, diuretics to lose weight (common among wrestlers who have to fit in a specific class) and amphetamines to speed up.
“It puts you in a no win situation,” says Bradley. “If you don’t use them and compete with those who are using, then they have the edge. But you have to look at it as an integrity thing, about what’s right and what is good for you and your body.”
Bradley believes painkillers are the number one misused prescription drug.
“If you use them too many days you develop tolerance and withdrawal symptoms where you try to stop and these are symptoms of drug addictions,” he says. “Pain patients’ withdrawal from opiate use is like having the flu a hundred times over and addicts know in order to stop these dramatically painful withdrawals is to take the drug. I’m a firm believer that certain people need prescription medicines for certain things, but the potential for misuse is pretty amazing”
Brewerton, who used biofeedback when working with sports stars in order to train them to relax, says that there are many people who are addicted who are not aware of it mainly because of self medicating.
“They look at medicine that is prescribed as being okay compared to drugs on the street,” he says. “Unfortunately general practitioners write a lot of prescription and don’t send patients to specialists to figure out why they’re anxious, can’t sleep and instead of just writing prescriptions…many people out there self medicating.”
There isn’t a clear cut profile of who becomes an addict and who doesn’t.
“There are many different reasons,” says Brewerton. “Most people in their lives have experimented with alcohol or drugs but what makes people go into addiction is another subject in itself. Most people stop but others just keep going. That’s why a therapist needs to find the trigger. Why can two people go out and have a glass of wine or two at dinner and another have a half gallon?”
Treatment can make a difference but Brewerton offers some caveats.
“Many times treatment programs for alcohol and substance abuse ask someone to give something up but you also have to replace it with something to give the patient a way to put themselves in a place that’s very awarding but satisfying and healthy as well,” says Brewerton. “Therapists need to make sure the patient has been seen medically in order to ensure there are no medical issues that need to be dealt with. Then it’s important to do a really good history looking for factors that may have caused their use and continuation of use-- traumatic abuse, car accidents, post traumatic stress disorder, to get an idea what that person is about and why they may be using in the first place and why they continue to use.”
Both Bradley and Brewerton agree that the best chance for recovery is when a patient is committed. If not, when confronted by loved ones, the addict withdraws from them and becomes angry as denial is part of the addiction process.
“That’s an important part of recovery,” says Brewerton.
When has the economic impact of healthcare not been front page news lately? Insurance companies, provider systems and state and federal governments, which have been working for years to towards becoming more efficient as well as complaint, are now seeing fruits of that labor. On the other side, the individual customer is embarking on a new world, where research and decision-making will be an obvious and defining factor in the family budget. Just anecdotally, many people I know are making choices that will change their wellness plan for this year anyway, as part of a large social experiment with an unknown (and unknow-able) result.
And while it is difficult to be 100 percent comfortable with trying to predict how healthy we will be in the year to come --- especially when the weather has been an extremely volatile factor in everyday living and working --- there are a items that everyone is relieved to have off the table like pre-existing conditions, or the million dollar insurance caps that have been gone so long that they are almost forgotten. By the way, I don’t mind giving up the old routine of filling out a new set of forms for every doctor visit. Remembering the dates of any past surgeries, illnesses, prescription drugs---generic vs. trademark names, dosage, duration, are you kidding me?---had gotten to be way more than a minor annoyance. Kind of like taking a standardized test before every office appointment; I won’t miss that. I like that a specialist I haven’t seen for 13 years knows exactly what took place that long ago and will gladly show me the report, because I sure don’t remember the details.
Last week I went to the wake of a high school friend’s mother who died at the age of 91, leaving a very sad, but very large group of people including spouse, children, grandchildren, spouses of children and grandchildren, and many great grandchildren, even a few with spouses of their own. While it was obviously very painful for family to lose someone so close and so beloved, it was plain to see what a joy every day of her life had been for all concerned. Living longer and having an improved quality of life is the big benefit of efficient and affordable healthcare, that’s the benefit we sometimes forget about as we study fees-per-paycheck and coverage subsidies.
Communicating, informing and educating readers about what’s going on with healthcare in Northwest Indiana are our mission. The economics that go with supporting healthy life plans are certainly an important part of our work, but we should never forget the point of staying alive. Our common goal of living longer, happier and healthier lives is the reason these things matter so much and commerce, in spite of all the attention it gets, is just a side note.
Next issue we will look at innovative treatments, aching bones and our tired, cold feet.
Associate Publisher and Editor
Negatively charged microparticles potentially could reduce damage from heart attacks, a Chicago-Australia team reported in a study on mice has published.
Researchers from Northwestern University and the University of Sydney in Australia found that injecting mice with the microparticles within 24 hours of a heart attack reduced tissue damage by 40-50 percent. The study, published in Science Translational Medicine, showed similar results for West Nile virus, multiple sclerosis, inflammatory bowel disease and other issues.
“We’re pretty optimistic because of the very potent anti-inflammatory effects we’ve seen,” said Stephen Miller, a researcher and professor of immunobiology from Northwestern University.
The Centers for Disease Control and Prevention reported that heart disease is the No. 1 cause of death in the U.S. In 2009, nearly 25,000 people in Illinois died from heart disease.
One of the researchers, Daniel Getts, a visiting scholar in microbiology-immunology at Northwestern, compared a heart attack to frozen pipes in the winter. “There’s no water getting through and on the other side of the blockage the heart starts to die,” he said.
The blockage causes tissue to die and the body responds by sending white blood cells to clean up the dead tissue cells. However, the white blood cells become inflamed and can cause damage.
In the study, the charged microparticles were injected into the bloodstream and bonded with the inflammatory cells.
“Instead of going to the heart or the brain, they were diverted to the spleen by the cells that ingested them,” Miller said. “A good proportion of those cells end up dying.”
By injecting people with microparticles soon after a heart attack, researchers hope they can minimize damage caused by inflammatory cells.
The microparticles are made from a biodegradable polymer known as poly (lactic-co-glycolic) acid. The Food and Drug Administration already has approved the particles, which are used to make some medical sutures. Scientists do not yet understand what causes the particles to redirect the inflammatory cells to the spleen, or how they signal the cells to die.
“There needs to be future work on how these particles are manipulating the immune system,” said Eric Bachelder, a researcher in drug delivery at Ohio State University in Columbus. He called the treatment both innovative and promising.
“If you told me someone injected it into these animal models…I would have thought that nothing would have happened,” Bachelder said of the microparticles
The study was conducted on thousands of mice in labs in Chicago and Sydney, and Miller said much of its promise lies in the successful replication of the experiments.
“The cool thing I think about the study is that this was a collaboration between labs in Australia and at Northwestern, and the various models were carried out at different places,” he said.
According to Miller, a biotech company called Cour Pharmaceutical Development Co. has been spun off of the experiment to raise capital for a clinical trial focusing on heart attack treatment. Getts is Cour's chief scientific officer and Miller has an interest in the company. The therapy will need to go to the FDA for approval of a phase one trial in humans, which could happen within the next two years.
“The bottom line is this seems to be a very potent protective therapy for different inflammatory disease models,” Miller said.
It may start with a feeling as if the heart is skipping a beat or beating too hard or fast.
Those heart palpitations may lead to shortness of breath, or even fatigue or chest pain.
While these symptoms can mean many different medical conditions, they also may lead doctors to suspect atrial fibrillation - the most common type of heart arrhythmia.
While catching any long-term health condition early is important, Dr. Adarsh Bhan, a cardiologist on staff at Advocate South Suburban Hospital, said diagnosing atrial fibrillation early in patients reduces the risk of stroke and heart failure - two major complications of AF.
And as age goes up, so does the risk.
"The incidence rate is pretty high," Bhan said. "At 60 years old, the incidence rate is 4 percent, and at 80, it's 10 percent."
Diagnosing AF can be challenging, however, at times. While an electrocardiogram test is often the tool for catching it, Bhan said not everyone exhibits signs and symptoms often associated with the heart problem.
"Not every atrial fibrillation stays all the time, either," he said. "It can come and go."
According to the National Heart, Lung and Blood Institute, AF is more common in people who have high blood pressure, coronary heart disease, heart failure, rheumatic heart disease, structural heart defects and congenital heart defects. It's also more common in those who are having heart attacks or who have just had surgery.
To understand AF, Bhan points to the heart's electrical system, which controls the rate and rhythm of the heartbeat. In a healthy adult heart at rest, an electrical signal begins a new heartbeat 60 to 100 times a minute. If a person is suffering from an arrhythmia, the heart may beat too fast, too slow or with an irregular rhythm.
Once a physician diagnoses a patient with AF, the next course of action involves preventing further damage, Bhan said.
"Once we diagnose, our treatment involves preventing a stroke and relieving the symptoms," he said.
Because blood can pool in the heart's upper chambers, a blood clot may form, he said. If that clot breaks off and travels to the brain, it can cause a stroke.
"Doctors will prescribe a blood thinner, such as Coumadin," Bhan said.
Bhan said once patients are prescribed blood thinners for AF, they likely will be required to take them for the duration of their lives.
"Over the last couple of years, however, blood thinners have been more effective and have simplified patients' lives because no monitoring is needed," he said.
Other courses of treatment include medications, procedures to restore a normal heart rhythm and surgery.
Following a healthy lifestyle, however, can lower a person's risk for heart disease that may then help prevent atrial fibrillation.
The National Heart, Lung and Blood Institute recommends following a heart healthy diet that's low in saturated fat, trans fat and cholesterol, as well as not smoking, being physically active and maintaining a healthy weight.
The year 2013 saw some promising advances in cardiovascular drugs and treatments — good news for doctors and their patients. According to northwest Indiana-area cardiologists, this year should offer patients more comfort and hope and doctors a bigger arsenal to combat the threats of heart disease and stroke.
New medicines to prevent dangerous blood clots are “A big deal,” said Dr. Sabrina Akrami, cardiologist and cardiovascular physician at Ingalls Health System in Harvey, Ill., said, “New anticoagulant medicines are very exciting. People with heart issues like atrial fibrillation have risk for a blood clot and stroke. Benefits include fewer blood tests than for Coumadin or warfarin and patients don’t need to avoid certain foods that have a negative effect with the older drugs,” Akrami said.
Dr. Michael Wheat, director of the Advanced Heart Failure Program at Porter Regional Hospital in Valparaiso, Ind., agreed. “Newer drugs are very promising for treating atrial fibrillation. They don’t require monthly blood tests because they’re working better and are more stable.”
Coumadin and warfarin are still good medicines for most people who have been on them a long time and do well, but for most of my newer patients I’ll use the newer drugs,” said Akrami. Another benefit is a shorter hospital stay. “The newer ones usually will kick in with 24 hours, so you can give one or two doses and usually send the patient home the same day.”
Wheat said one problem is “The newer drugs cost quite a bit and many patients can’t even afford the co-pays.”
Another drawback: “If patients develop a life-threatening bleeding issue, we can reverse that quickly with warfarin or Coumadin, but the newer ones don’t have an antidote,” said Akrami
Mechanical devices are helping cardiologists discover trouble spots.
“The infrared catheter we’re using identifies vulnerable plaque,” said Dr. Andre Artis, Methodist Hospital Director of cardiology for the Northlake campus, and co-director of Methodist Hospital Cardiology Service Live. “It allows us to look at the inside of the blood vessel wall, and that’s good for the patient who is likely to develop heart disease. It identifies the most vulnerable area” of fatty deposits, which eventually irritate and erode the inside of the vessel and fat is released into the bloodstream. The body tries to defend against it by sending a blood clot that can cause a heart attack.
“We are also able to perform better procedures to remove blood clots in patients,” said Dr. Sammi Dali, heart specialist and director of cardiovascular medicine at Franciscan Alliance St. Anthony Hospital in Michigan City, Ind. “A catheter is put in and medicine is infused and spread to the clot to dissolve it more.
“Other procedures include placing a stent for a clogged carotid artery. St. Anthony’s also does ablation for atrial fibrillation, which destroys where the arrhythmia may be coming from.”
What’s in, what’s out
For some patients it’s best to start all over with an LVAD -- an artificial heart. “That’s one of the most exciting things,” said Wheat. Originally connected to a large external apparatus, “Artificial hearts are becoming quite small and battery operated.”
Sometimes what’s new is what’s not being used. “I have not been using a lot of niacin in the past year or so,” said Wheat. “Just a few years ago it was thought to be wonderful for reducing plaque, but we’re finding patients aren’t at less risk with it.”
“It’s the side effects, like flushing,” that patients don’t like, said Artis. “Statin (drugs) are better, good at raising the good cholesterol and lowering the bad cholesterol like triglycerides.”
Said Dali, “When you reach a point where the medicines are working well, adding new medicine (like niacin) isn’t helping and you might have more side effects.”
Understanding genetic heart disease can guide treatment. We perform genetic testing after coronary angioplasty,” said Community Hospital’s Dr. Samer Abbas. The interventional cardiologist explained the testing is “to make sure that patients will response in an appropriate way to anti-platelet therapy,” a regimen of powerful anticlotting drugs.
“Determining medications depends on genetic variations,” said Dali. “The genetics of heart disease is still a work in progress. It will help us understand treatment depending on those variations.”
Other points to ponder:
• “We’re learning that even a low-level inflammation can trigger the buildup of plaque leading to heart attacks,” said Wheat.
• “We know heart disease is an inflammatory process, so the presence of intestinal microbes (found in red meat) can contribute to developing heart disease.” -- Dali
• “They’re coming out with newer and better stents; they last longer and have medicine in them.” -- Akrami
• “The future holds hope for better blood pressure control. Current trials will likely lead to making a new device available in close to two years that will cause damage to the nerve that sends the message to constrict vessels, which raises blood pressure.” -- Artis
“It’s exciting, because it’s better for patients to have more options,” said Akrami.
A few years ago, a very well-respected Northwest Indiana CEO-physician predicted with certainty that in the future, for routine medical check-ups, monitoring medication, screening tests and other wellness care, most people would not be visiting doctors. The great majority of patients would be seeing healthcare professionals specializing in a particular service or treatment. In theory, not too far into the future, a typical healthy person could go for years without ever seeing a doctor.
This was not very surprising to most people in the room including me. I had already had plenty of experience with highly trained nurse practitioners, mammography technologists, physicians’ assistants, midwives, physical therapists, audiologists and personal trainers.
The first time I had a routine annual exam by a physician’s assistant happened by accident---my regular obstetrician was at the hospital delivering a baby. This had probably happened a half dozen times over the years I had been a patient of that group. And, though I had usually re-scheduled the appointment hoping for better luck, this time I was offered the opportunity to have an assistant do the exam. I was delighted.
The next time was an emergency on my side of the scheduling matrix. I had the option to see an assistant physician immediately even though my regular doctor was unavailable. I began a course of treatment for the problem that was holding up a surgery and within a few days and the surgery was scheduled.
The world of routine health and wellness maintenance started evolving a long time ago by adapting new models to fit patient’s needs. While we were out leading healthy lives and having busy careers, training of health care professionals had split into thousands of sub-specialties. Hospitals were replaced by health systems and in-patient treatment, with a few rare exceptions, became out-patient treatment. Nurses are now routinely complete continuing education units or get specialized training, but their career options have never been better.
A couple of months ago, another Northwest Indiana CEO said that health care consumers would soon be scrolling through prices for medical procedures and treatments similar to the way we search in real time for airfares and hotel rooms. Though that seems hard to imagine, anyone who has ever looked at an explanation of benefits would welcome a quick search tool to use before the doctor visit or procedure, wouldn't they?
This issue of Get Healthy, as usual, contains a handful of miracles large and small, but don’t forget the rapid transition into the new world of wellness where even the patients can have something to say about decisions about the care we get.
Associate Publisher and Editor
Pain and scarring is often a reality of surgery that is difficult to avoid.
However, physicians say certain actions before and after surgery can help minimize the discomfort and scarring a patient experiences.
Here are some tips from local doctors about what you can do to minimize scarring and best prepare for the discomforts of surgery.
Dr. Jay Dutton, a plastic surgeon and otolaryngologist on staff at Adovcate South Suburban Hospital, says it's important to make sure a patient is getting the proper nutrients prior to surgery.
"You should make sure your vitamins aren't deficient because they are important for the wound healing process," he says.
Dr. Mubarak Mirjat, founder and president of Maximum Rehabilitation Services in Munster, says patients should also spend time in advance preparing for the weeks immediately following surgery. These preparations can help minimize pain that could be experienced during the process of adapting afterward, and can be made with the help of physicians and physical therapists.
"If they need crutches to walk or have any needs where they must have proper training beforehand, a few visits with us beforehand will help them," he says.
Even practicing exercises that will be performed in physical therapy or at home following surgery can minimize discomfort, as well as figuring out a plan on how to best move up and down stairs in multi-level homes.
"Communication is so important," Mubarek says. "Surgery is hard, but post surgery is the mother of harder."
Dr. Adam Conn, a member of Porter Physician Group and part of Associates in Surgery, says talking with a doctor about minimally invasive procedures, which are available for a number of surgical diseases, can produce a game plan that results in less discomfort post surgery.
"We always try to choose the least painful, and the best procedure for the patient," he says.
Laparoscopic and robotic are all options for major abdominal operations, and doctors can perform minimally invasive procedures on hernias, gallbladders and colons, for example, as well.
"The smaller incisions lead to less pain, quicker recoveries and lower risk of post operative infection in most cases," Conn says.
Other options to minimize pain after surgery include using a long-acting local anesthetic that improves pain control for up to three days and using endoscopy to perform anti-reflux surgery for heartburn, he says.
One of the most important things patients should do post surgery is to protect themselves from sun exposure to minimize scarring.
"It can affect the pigmentation of the wound," Dutton says. "You want to have maximum sun block for at least six months after surgery."
Wounds also heal better in a moist environment, so keep it covered with a dressing and moist with a topical treatment, he says.
While Neosporin can speed the healing process, Dutton says he cautions patients to watch out for topical allergic reactions.
"So if you have redness, make sure you stop," he says.
Avoid alcohol early on after surgery, and choose acetaminophen like Tylenol over ibuprofen like Motrin and Aleve.
"Those promote bleeding and will make you bruise more," Dutton says.
If acetaminophen is not strong enough to help with pain, Dutton advises talking with the patient's physician about a controlled substance prescription.
"Continue taking a multivitamin as well," he says. "Make sure you don't have a vitamin deficiency."
Parents with young children know immunizations is a common topic at the pediatrician's office. However, doctors warn vaccinations aren't only for kids. Here are some vaccinations doctors recommend for adults.
All adults should get the influenza vaccination each year, says Dr. Geraldine Feria, a member of the Porter Physician Group and a physician with Wanatah Primary Care.
This is especially important for new parents if their babies will not have reached the 6 month mark yet during the winter period, she says.
"We cannot give the flu shot to babies younger than 6 months," she says.
Those with high risk of serious complications if they catch the flu, such as the elderly or people with chronic illnesses and weakened immune systems, also are advised to get vaccinated.
While some vaccinations last several years - even decades - the flu vaccine only protects for one year because it is based on what experts believe will be the top three or four virus strains that year.
"The flu shot should be given yearly, as the formulation within the vaccine changes every year based on existing circulating strains," says Dr. Kamo Sidhwa, who is part of Metro Infectious Disease Consultants and on staff at Advocate South Suburban Hospital.
"Pertussis (Tdap) vaccine is certainly one of the very important vaccines for adults," says Dr. Charlene Graves, chairman of the Immunization Committee of the Indiana Chapter of the American Academy of Pediatrics.
More commonly known as whooping cough, pertussis cases or outbreaks were reported in a majority of states in 2012, with 49 states and Washington, D.C. seeing increases in cases compared to 2011, according to the Centers for Disease Control and Prevention.
While pertussis can have a mild effect on adults, it can be deadly to young children.
"Influenze and pertussis in particular can cause mild upper respiratory illnesses in adults, but in babies, can cause severe respiratory distress and occasionally death," Sidhwa says.
The Tdap is a 3-in-1 vaccine that offers protection against diphtheria, tetanus and pertussis. The Centers for Disease Control recommends getting a Tdap vaccine once, and then a Td (tetanus and diphtheria) booster every 10 years.
Feria says it's especially important to get immunized if routine contact will be made with a young child.
"The OB community is doing a good job in advising parents to get it and advising grandma and grandpa to get a booster, so when new baby comes along, they won't give pertussis to the baby," she says.
The shingles vaccination, called the Varicella Zoster vaccine, should be considered for older adults because the virus can be especially debilitating in this patient population, Sidhwa says.
Shingles is a painful localized skin rash caused by the same virus that causes the chickenpox. Anyone who has had the chickenpox can develop shingles because the virus remains in a person's nerve cells even after the infection clears. The virus can reappear several years later - causing shingles.
The vaccination protects a person's body from a reactivation of the virus.
Though the CDC recommends the vaccine be given to those 60 and older, the vaccination has been licensed and approved for those 50 and older.
Like the flu, contracting pneumonia at an older age can be a serious health threat, Graves says.
"The pneumonia vaccine is recommended for seniors and for other people of all ages who have medical conditions that make them high-risk for pneumococcal infections," she says.
The CDC recommends those with certain risks related to their health, job or lifestyles that put them at higher risk for contracting pneumonia receive the vaccination in one to three doses throughout adulthood. However, doctors also recommend every adult over 60 to 65 receive the immunization.
"Sixty and over we want them to get the pneumonia shot, especially if they're diabetic, asthmatic or have bad COPD," Feria says. "Those are really the ones you want to target, along with those whose immune systems are compromised."
"A potential new vaccine that adults should be aware of is the HPV, which is indicated for young adults age 19 to 26," Sidhwa says.
Human Papillomavirus - or HPV - is a common virus spread through sexual contract. Most who have HPV have no symptoms, and there are about 40 types of the virus - including some that can cause cervical cancer in women and other types of cancer in both men and women.
The HPV vaccine prevents the most common types of HPV that cause cervical cancer and genital warts, and it's given in three doses.
Though babies are given Hepatitis B vaccinations as part of their routine schedule of immunizations, doctors say adults who haven't been vaccinated, should.
A virus causes Hepatitis B, a disease that attacks the liver. It can cause infection, cirrhosis of the liver, cancer, liver failure and even death.
"This is one of few vaccines that can prevent liver cancer," Feria says.
Forty-year-old John Babista, of Woodridge, is a nurse. However after crossing the finish line at a Hammond triathlon, he suffered a heart attack and became the patient.
“What had happened to me is shocking but I am very thankful to everybody and especially to our good Lord that I am still here to tell our story,” says John.
John, who for the past four years has trained year round for races, was competing in Wolf Lake’s Leon’s Triathlon back in June.
John’s wife Alma, who is also a nurse, was with their two sons, ages 15 and 8, at the finish line cheering John on.
“As I saw him coming to the finish line, I was relieved. I was standing by the arch and he gave his sons his signature airplane run before he crossed the finish line - I even took pictures of him. Then we walked and as I tried to find him, my brother-in-law, yelled, 'Kuya (big brother) is on the ground,'" says Alma, who still gets emotional
when speaking about the experience. “I called out his name, but he was losing consciousness and gasping for air. I cried for help and yelled, ‘check his pulse’. People all around were helping: doing CPR, hugging me and hugging my kids. It was the longest minute of my life.”
Karen Callahan, R.N. at Franciscan St. Margaret Health-Hammond Emergency Department, says the team in the Emergency Department were prepared to deal with John’s grave condition when he arrived due to a phone call the department’s Emergency Medical Services had made to them.
“The staff in the ED that day work every other weekend together for years and we just ‘click’ when it comes to critical situations. We know what each other does best and we flow in a methodical, systematic way. John was our focus from the minute we received the EMS call,” says Callahan.
Once John arrived he received a therapeutic hypothermia treatment from the hospital staff that is new to Northwest Indiana. The treatment is performed by covering a patient’s back, chest and legs in cooling pads. Cooling the body helps to preserve the brain and heart. The process decreases the body’s metabolic rate, which protects the brain from neurotoxins that usually attack 24 to 48 hours after cardiac arrest.
“Therapeutic hypothermia is fairly new to the staff at Franciscan St. Margaret Health. We were in-serviced approximately 6 months prior and John was the first patient I personally had to start it on,” says Callahan.
John was hospitalized at Franciscan St. Margaret Health-Hammond hospital for nearly 3 weeks.
After undergoing a slew of tests back home it was discovered that John’s right artery was 100% blocked, the left artery was almost 100% blocked and the posterior artery was more than 25% blocked.
“It sounds strange because I have an active lifestyle and live healthy and still got those blockages in my heart. We are convinced that it is genetics since a few of my family members have had heart bypass surgery in the past.”
Fortunately, John was able to resolve his heart problems without open-heart surgery. After five and half months of rehabilitation, John successfully completed his Cardiac Rehabilitation Exercise Program on Nov. 21 and returned to work Nov 25.
Alma says there were countless people who provided support and made John’s recovery possible including visits from Leon’s Triathlon founder, Leon Wolek.
“Our family is very thankful to all first responders, paramedics, co-cyclists, co-workers, staff at St. Margaret Hospital, Catholic Charities, Chicago Asian Running Endurance, family and friends. They all became our immediate family, who provided us with everything to make our life easier while John was in the hospital,” says Alma. “Of course the whole hospital staff - we are so glad we ended up at St. Margaret. They are all God’s instruments.”
Callahan says as an ER nurse she rarely sees the outcomes of critical patients, due to most times they are not good outcomes.
“I have been an ER Nurse here for 27 years and John, his story, his family and the true spirit of how the whole hospital pulled together is something I will never forget,” says Callahan. “John is a miracle and I am so blessed to have been a part of that miracle.”
Dr. Cherukuri, a leader in Northwest Indiana for minimally-invasive cosmetic procedures for the face and neck, has helped thousands of patients since 2003. Dr. Cherukuri, a member of Carepointe Ear Nose and Throat Sinus Center, has offices in Munster, Merrillville and St. John. For more information, visit his website at theweekendlift.com or call (219) 836-2201.
How are you different from other plastic surgeons?
Facial plastic surgery is a sub-specialty of plastic surgery and ear, nose and thoat (ENT) surgery. If you go to the Yellow Pages to find a plastic surgeon, most of the plastic surgeons in Chicago and the Midwest spend three-quarters of their time doing breast augmentations and tummy tucks and other non-facial procedures. We spend 100 percent of our time on the face and neck. We have the most experience in reconstructive and aesthetic procedures, including face lifts, eyelid lifts, nose jobs, Botox and other facial fillers.
Why is it important to go to a plastic surgeon who specializes in the face?
When you have the most experience, you have the most natural-appearing results. What’s unique about the face is you can’t really hide it under clothing. Everything is out there for everyone to see, so it’s important to do it right.
What are some trends in facial plastic surgery? What’s the difference between visiting you versus a medical spa?
The trend over the last 10 years has moved from extreme makeovers to minimally-invasive “no down time” procedures. People are becoming more accepting of improving body image. We perform eyelid lifts, which helps your eyes look less puffy and tired-looking. We also do Botox and facial fillers. It’s very important that the person doing your procedure be a surgeon. When it comes to these procedures, cheaper is not better. You want someone who has done this for 15 years, not learned how to do it during a weekend-long course. We offer free consultations so people can learn what will and won’t work for them, and so they know what to expect. We want well-educated, happy patients.
What is “The Weekend Lift?“
In 2003 we pioneered a minimal-incision procedure called “The Weekend Lift.” A normal facelift takes four to six hours, requires general anesthesia, has extensive recuperation time and can cost up to $20,000. The Weekend Lift is designed for active people who don’t want much down-time. The Weekend Lift can get similar results, but relies on local anesthesia. It takes about an hour, recovery is many times the length of a weekend, and gets excellent results. It generally costs under $5,000. We aim for natural-looking results, making people look like they did five to 10 years ago. We have done more than 600 of these, and have more than 99 percent patient satisfaction.
What kinds of skin cancer treatments do you do?
We also work with dermatologists to treat facial lesions and skin cancer. Many dermatologists don’t want to cut on the face and neck because they want their patients to have the least visible scar. We have extensive training in skin cancers and other lesions, and most patients have almost scar-free healing. If they have a suspicious lesion or mark on their face or neck, they can come see us directly. When it comes to lesions that are itching, bleeding or not healing right, we urge them to come see us immediately. Depending on the type of lesion, patients here are treated with local anesthesia in the office and in most cases can drive themselves home afterward. This saves time and money compared with going to a hospital setting.
What are the things we can do to help prevent signs of aging and skin cancers?
Avoid tanning beds, don’t smoke and stay out of the sun whenever possible. Always use sun block, even if it’s cloudy or if there’s snow on the ground. We recommend using SPF 30 or higher, but any SPF is better than none. It helps prevent aging from UV rays and it helps prevent skin cancer.
All patients want a pain-free answer to their problems and new technologies and knowledge are helping doctors provide that. Whether it is an implantable pain blocker, a new technique for spinal surgery or advancements in anesthesia, local doctors are helping their patients alleviate pain.
Blocking pain signals
Minimally invasive technology like spinal cord stimulation helps Ramesh Kanuru, MD, lessen back pain for his patients.
Kanuru is an interventional pain management specialist at Kanuru Interventional Spine with locations in Highland, Valparaiso and Merrillville. He says the stimulator treats back pain by blocking the pain signals traveling to the brain. It’s an implantable system, which is entirely inside the body.
One of the advantages of this system is that patients do a trial run with an external version of the device to see if spinal cord stimulation works for them. The trial can be easily done in the office, Kanuru says. During the one-week trial, the system is connected to an outside battery.
“If they get a minimum of 50 percent relief and are able to sleep better and are able to do daily activities better, then we’ll do the permanent implant,” Kanuru says. The permanent procedure involves implanting electrodes in the spine connected to a generator, which is the size of a pacemaker in the body. The battery for the generator is rechargeable with a remote control.
Most patients get at least 75 percent pain relief and are able to be off of narcotics or significantly cut down their pain medications, Kanuru says.
The stimulator is indicated for people who had failed back surgery and continue to have pain, patients with sciatica who are not candidates for surgery for other medical reasons and patients with diabetic neuropathy, diabetes with tingling and numbness in the feet that is not controlled by medication. It is also used to treat complex regional pain syndrome, post herpetic neuralgia and intractable abdominal pain.
“It’s a simple system patients can manage themselves,” Kanuru says. Patients can turn it on or off any time they like. “This helps to reduce their pain medications significantly. Because they’re not under the influence of narcotics, the alertness of their brain is not compromised. This is especially important in the elderly who under narcotics may sustain injuries secondary to falls. If they can control the pain without pain medication, they can be really sharp.”
If major spinal surgery is needed in the future, the system does not get in the way, Kanuru says. Some patients, like plumbers and construction workers, elect the stimulator over surgery because their occupations require a lot of twisting and bending .
“If they have spinal fusion, they may not be able to do their jobs, he says. With the spinal cord stimulator, they can keep working and have the surgery done at a later time. For more information, visit controlyourpain.com and painkanuru.com or call 219.838.1100.
State of the art spinal surgery
An advanced surgical technique has revolutionized a Northwest Indiana doctor’s ability to take care of his patients.
Nitin Khanna is an orthopedic spine surgeon and founder of Spine Care Specialists in Munster, a division of Orthopedic Specialists of Northwest Indiana. He co-developed a minimally invasive approach to back surgery, known as MAS PLIF.
“The area where patients can be helped the most with surgical intervention is in the face of neurologic compression. By that I mean something pinching or pressing on a nerve,” Khanna says. The new technique allows doctors to free those nerves with minimal disruption to the surrounding tissue, allowing patients a more consistent and quick recovery.
The fusion operations are performed through incisions that are typically 1.5 inches in length and patients typically go home within 23 hours of their procedure, Khanna says. There’s minimal blood loss and most patients are off all pain medication within two weeks.
Historically, it would take months and years for patients to recover due to significant damage to surrounding tissues that were otherwise healthy and normal. Scar tissue, consistent pain and blood loss would lead to prolonged hospital stays for many patients.
“The concept of being able to move those patients to typically overnight stays is a major, major step forward for both patients and for medicine in general,” says Khanna, who teaches this technique around the country.
“Everybody is wanting to learn how to do this because it’s so revolutionary … I’m as blown away by it as my patients are and my colleagues are.” Ninety-seven percent of his patients have a positive outcome, Khanna says.
He encourages everyone in the Region to get a second opinion before having surgery to make sure it is the right choice for them. By seeing a specialist, they can insure that their particular issue is being properly addressed. They should also see if there’s a good minimally invasive surgical option available.
“I’ve done spinal surgery 11 years, all day, every day with 400-plus cases a year. That anatomy, you know better than you know anything else.”
For information, visit spinecarespecialists.com or call 219.924.3300. For information on the MAS PLIF technique, visit nuvasive.com.
Post-op pain advancements
How pain is treated before and after surgery is an important part of a patient’s recovery and a hot topics among doctors.
Joseph Hecht, an orthopedic surgeon specializing in joint replacement with Orthopaedic Specialists of Northwest Indiana in Munster, says, “there are different protocols to make post-op pain more tolerable. Almost every surgery we do, there’s a certain amount of forethought in terms of trying to make the patient comfortable.”
Hecht’s most common operations are hip and knee replacements.
“There is a lot of discussion in meetings nowadays about controlling the pain around the surgery and different protocols.”
Those protocols may include giving pre-medications or anti-inflammatory meds during the surgery. There are also options of using general anesthesia or a spinal.
“We inject an anesthetic mixture of medicines in the knees during the surgery,” Hecht says. “It has become more popular in last five years or so and helps to control some of the post op pain.”
The actual medicines used during a joint replacement are fairly wide ranging, he says. In the last year or two, an intravenous Tylenol has been used that is effective up to 24 hours after a surgery.
Hecht, who does 150 to 200 knee replacements in a year, says not everything works on every patient and that balance is key. Sometimes a second medication is needed to counter side effects from medications.
“When they have a really good pain experience it’s gratifying but it’s a wide range. If their pain is higher, we have other things in protocol to control pain. There are layers. If one thing isn’t working as well, we go to something else. You have to have a lot of tools in the toolbox to make it work for everybody.”
A new twist on the traditional ice pack also helps treat pain. Polar Care is a sleeve that can be wrapped like a brace around the knee. It’s connected to a cable, which connects to a small cooler. An electric motor in the cooler circulates the cold water produced by ice. The technology is portable so patients can take it home.
“The cooling effect also has pain killing effect and keeps swelling down,” Hecht says. “Swelling is a problem in itself, creating stiffness and more discomfort.”
For information, visit osni.org or call 219.924.3300.
Scoliosis, which is a sideways curvature of the spine, can be a mysterious condition with a mind of its own. In its mildest form, it can correct itself over time, but in severe cases, it can require spinal surgery. While typically thought of as occurring in adolescents, this condition can also affect adults.
Mohammad Shukairy, neurosurgeon on staff at Community Hospital and St. Mary’s Hospital, treats both adults and adolescents with scoliosis.
His adolescent patients typically have already been diagnosed and are seeking evaluation for treatment. In the adult population, the cases often present with more of a general complaint such as back pain or discomfort and he is the one who diagnoses the condition.
“Many times children and young adolescents present with scoliosis that is idiopathic, which means that it is something that we don’t have a cause for, we don’t understand why people get the curvature of the spine,” Shukairy says. “Adults often present with degenerative scoliosis. This occurs because of the aging process of the spine.”
Shukairy, who is part of the Community Spine and Neurosurgery Institute in Munster, says adolescents with mild scoliosis can be treated conservatively, but if the curve is greater than 45 or 50 degrees surgery is often recommended.
Shukairy says scoliosis is not uncommon in the young population. For adults, the risk tends to increase with advanced age. Still, he says, in the adult population, scoliosis does not have to be a debilitating problem. There are several lifestyle factors that can modified to prevent worsening of spinal problems.
The main lifestyle modifications are to quit smoking, which advances the degeneration of the spine, and to pursue weight loss. Patients can also focus on exercises that increase the strength and posture of the spine – yoga and pilates and those types of exercises.
Although it is ideal to catch adolescent scoliosis early, the disease can be “sneaky” and difficult to diagnose, says Nancy Trimboli, a chiropractor and owner of Trimboli Chiropractic with offices in Munster and Cedar Lake.
“The problem is that a lot of times by just looking at posture or looking for a rib hump, you don’t see (the scoliosis.)” The best way to see any curvature is through an X-ray, she says. Free scoliosis screenings via X-ray are offered at both of her offices.
Less than 50 percent of those she screens have it, she says, and in the general population, it would be even less. Most parents who bring their children to be checked have a reason such as the child slouching, having a high shoulder or having a family history of scoliosis.
Trimboli, who has been practicing in Munster for 20 years, says the chiropractic approach is to correct pelvic unleveling. That can involve adjustments of the pelvis and sacrum, the foundation bone of the spine.
Other times, her young patients have a short leg, which can be as short as ¾ of an inch, she says.
“They’ve been diagnosed with a spinal curvature and meanwhile, it’s the spine compensating for a short leg.” Because legs grow at different rates, they will sometimes take a “wait and see” approach to see if the legs and spine even out. Older teens may need a lift in the shoe and monitoring of their leg length as they continue to grow.
Once the scoliosis curve is at a certain point, doctors may recommend a brace, but Trimboli says the brace has its own set of physical and emotional challenges.
“The jury is still out on whether the braces do any good at all,” she says. When the child wears the brace 23 hours a day, the supportive muscles of the spine get weaker and weaker.
With chiropractic, there is a different approach, she says.
“Just like anything else, try every available option that is noninvasive that works with your body’s own healing ability,” Trimboli says. “There’s always room for surgery later but you can’t undo that once it’s done. There are no guarantees on anything so try the most logical, easiest less invasive thing first.”
Dana Andric, whose children are Trimboli’s patients, learned about scoliosis the hard way this summer.
While hugging her 13-year-old son, she felt an abnormality in his back. After having it checked, they learned he has a 48-degree curve, considered severe in the scoliosis field. He will most likely have to have surgery to correct it.
Following his diagnosis, she tested her two other children and found that her 7-year-old daughter has a 28-degree curve and her 11-year-old son has an 18-degree curve
“It really hit us shockingly. I diagnosed all my kids,” Andric says.
Her son, even with his severe curve, never complained of back pain. She says they attributed his aches to normal growing pains.
“I would really just tell people to explain to their kids to watch for anything that looks visually strange.” As children get older, they take care of their own bodies more. “We can’t see what lies underneath all that clothing. In puberty, a lot can go on.”
“When I saw his X-ray, like a backwards S, I almost passed out. It was shocking to see when you never even knew that a problem existed.”
Nitin Khanna is an orthopedic spine surgeon and founder of Spine Care Specialists in Munster, a division of Orthopedic Specialists of Northwest Indiana.
He says scoliosis treatment has undergone what he would term “revolutionary” changes over the last 10 to 15 years. While early treatments were painful and debilitating, new advances have made it possible for patients to recover quickly.
Early treatments primarily focused on bracing and traction. The early surgical procedures involved a large incision with significant amount of blood loss. They would also put patients in body casts for multiple months.
“It was arguably one of the most painful and debilitating operations that existed at its times with very mediocre results,” Khanna says. It was still done that way as recently as 15 years ago.
Internal fixation allowed surgeons to use spinal metallic implants to help create structural support for the spine and help correct the curvature. Other advances include treating the spine from both the front and back with spinal instrumentation.
“There were significant advances as both result in the ability to correct the curvature and maintain that new curvature for many patients for many years. But it was still the most painful and debilitating operation that existed.” It took up to one year to fully recover.
With the advent of the minimally invasive surgical technique over the last five years, many of these issues are resolved. These procedures only disrupt the tissue in and around the problem, diseased or pathologic segment, Khanna says. This minimizes scar tissues, minimizes operative time, decreases blood loss, decreases the length of stay for patients and allows patients to resume their every day activities in the order of weeks as opposed to months.
While the majority of scoliosis patients do not require surgery, Khanna advises seeking a decision from an expert whose entire career is dedicated to spinal treatment.
“As time goes forward and we understand some more of the genetic links associated with scoliosis we may be able to intervene at an earlier stage to treat curves that predictably will be more severe in nature,” Khanna says.
Khanna, who trained at Rush University Medical Center, says that today’s advances in scoliosis care are remarkable compared to what he saw in his training.
“I’m very proud to have been part of the design team in developing some of these minimally invasive techniques,” he says.
Before his deep brain stimulation procedure, Parkinson’s disease patient Frank Maver could not drive his car or get out of a chair without assistance. After the procedure he says, “my life has improved so much it’s unbelievable.”
The deep brain stimulation, commonly compared to a pacemaker for the brain, and DaTscan, an imaging technique used to track dopamine in the brain, are two technologies local hospitals are using to benefit Parkinson’s patients.
“It’s been hugely successful,” says Andrea DeLeo, a neurologist at Northwest Indiana Neurologic Associates and on staff at Community and St. Catherine hospitals.
“The main focus is to give patients back the quality of life that they have been missing and it really has been able to do that. Patients are driving again, able to go shopping, bathe themselves, feed themselves, many different things. It’s also improved the quality of their (family) relationships by the fact that they are not needing as much help.”
Maver, who had the deep brain stimulation done this spring, is a 77-year-old Highland resident. About six years ago, he had trouble with one of his fingers while trying to cut meat. It got progressively worse, he says, and his Parkinson’s had progressed to stage 3 by the time he decided to try the deep brain stimulation therapy.
“It took me about a year or more to decide if I wanted somebody to fish in my head, somebody to play with my brain,” Maver says. “I investigated and it was either be chair ridden or be able to walk. I had to do something.”
He says he recommends the procedure to anyone considering it saying it’s worth it even just to be able to drive again.
He says his doctors – DeLeo and Wayel Kaakaji – were amazing and that although it doesn’t work for every patient, he and his family are happy it worked for him.
She says they typically try to do the procedure while the Parkinson’s is in its early stages but it can be done with any patient based on symptoms.
“It’s not an end stage salvage thing at all. It’s really not,” she says. “It’s really for the patient who wants to maintain an active lifestyle and isn’t actively controlled on medication and is requiring more and more medication to keep that level functioning.”
Arif Dalvi, director of the Parkinson’s Disease Center at Methodist Hospitals’ Neuroscience Institute in Merrillville, says the center focuses on 21st century treatments of Parkinson’s, including the deep brain stimulation and DatScan technologies.
About a year ago, the hospital started using DatScan, which can estimate what dopamine is doing in the brain. The new test is superior to imaging studies like MRI and CAT scan for diagnosis, says Dalvi, a Methodist Physician Group doctor.
“The older studies just show the structure of the brain, not the chemical imbalance,” he says.
In addition to the DatScan, the center also uses the Unified Parkinson’s Disease rating scale, developed by Columbia University, to diagnose and measure Parkinson’s.
“It’s a very lengthy diagnosis and has a lot of implications short term and long term so we want to make sure we get the diagnosis right the first time around.”
Treatments are individualized following a comprehensive program Dalvi developed with his 15 years experience in surgical and pharmaceutical treatments for the disease.
“We take a holistic approach,” he says. “Instead of just relying on medications alone, these patients come in for an extended visit. They are seen by a physical therapist to see how we can help with walking and balance. They are seen by a pharmacist to see if there are issues with drug interactions. They’re seen by a nutritionist so we can make sure there are no food interactions with their medications. And they are seen by me and measured by the scale. It’s an extensive two-hour visit that really gives us a sense of what this Parkinson’s disease patient is about and then we can tailor treatment for that particular patient.”
For a more comprehensive overview of Parkinson’s, visit emedicine.medscape.com/article/1831191-overview to read a chapter Dalvi co-authored.
Samantha Amezcua of Munster says self-examining her skin for signs of melanoma has been incorporated into her daily routine for the last four years.
“I am looking at my moles on a daily/weekly basis. I look for brand new moles, moles with dark black coloring, changes in existing moles with color and shape along with new lesions that appear red, squishy or dry,” says Amezcua. “I see my dermatologist every three months since my melanoma.”
Both basal cell carcinoma and melanoma are hereditary in Amezcua’s family and in 2009, at age 30, Amezcua was diagnosed with melanoma. To date she has had 75 moles removed—55 of which were removed in the past 3 years.
According to the Melanoma Research Foundation, melanoma is one of the fastest growing cancers in the United States and worldwide. Despite melanoma being a form of skin cancer, it can also develop on other areas of your body such as scalp, mouth, nails, or eyes.
“While skin cancer historically occurs on the head and neck area 85% of the time, the important thing to be aware of is that they can occur anywhere on the body. Over the years I have had patients referred from their gynecologists as well as podiatrists,” says Dr. Michael Malczewski of Cosmetic & Plastic Surgery of Northwest Indiana. “In my practice we see new cases of basal cell carcinoma of the skin daily, new cases of squamous cell carcinoma of the skin weekly, and new cases of melanoma, or its precursors, just about weekly as well. It has exhibited a more dramatic increase in incidence than any other cancer, and why it doesn't get more press is beyond me.”
Malczewski, who has been caring for melanoma patients since 1987, says he has treated melanoma in a patient as young as 8.
“The prognosis for melanoma overall is actually quite good, but that hinges on early diagnosis,” says Malczewski.
Dr. Mitchell Bressack, a dermatologist at Dermatology Center of Northwest Indiana and Malczewski agree that early diagnosis is contingent on thorough self-examinations.
“Self-exam is the most important thing, and, if someone sees a mole that they think is changing or is suspicious to them, they should see a dermatologist, regardless of age,” says Bressack.
Joan Filipowski, a nurse at Franciscan Alliance, says when doing self-exams to remember that not all moles on your body go through a series of changes, only some of them.
“The ones that do go through changes can become a basal cell carcinoma or a squamous cell carcinoma and others can become melanomas. Melanoma can also suddenly appear as a new dark spot on the skin,” says Filipowski.
Malczewski says the key to early detection is patients being vigilant and doing monthly self-exams of their skin—nose to toes.
“If you can look at a mole, freckle, red spot, lump, bump, etc. and say "this looks very different from a couple of months ago, that is relevant and warrants a trip to your doctor,” says Malczewski.
Bressack says in addition to self-exams he stresses to his patients that protection from the sun is the best thing they can do to protect themselves from skin cancer.
“In general, if an area is not covered by adequate clothing, it should have sunscreen applied to it,” says Bressack.
Bressack says to determine if what you are wearing can protect you from the sun, hold the clothing up to the light. If you see light coming through it, it is not protecting you from the sun, and sunscreen should be applied beneath that piece of clothing.
“By not wearing sunscreen the chances of having basal cell skin cancer is high and many people are not aware of that,” says Amezcua. “Speaking about melanoma and sharing my story is something I do with every opportunity possible. My hope is to encourage people to see a dermatologist, educate them on the dangers of not using daily sunscreen and help them see that skin cancer can happen to someone as young as I.”
For support or information on melanoma visit melanoma.org.
Possible picture caption: Samantha and Manuel Amezcua of Munster ran Miles For Melanoma, sponsored by the Melanoma Research Foundation, in July. They formed a team called Cancer Crushers and came in second place for the most funds raised. The Amezcuas are in preliminary works with the Melanoma Research Foundation to host the first gala in Chicago in order to drive awareness to a younger demographic.
For years, Jennifer Zukley lived with chronic pain in her left arm, elbow, shoulder, chest area and fingers. It wasn’t until she woke up one night paralyzed and in excruciating pain that she would learn it was all related to an underlying issue with her spine.
Zukley, 47 and a Schererville police officer, had seen several doctors regarding her chronic pain prior to this incident. She was always prescribed medication, with no investigation into the cause. She was told it was tendonitis and nerve damage from previous injuries and car accidents she had been in throughout the years.
“No one ever said the pain was from something in my spine. That was never introduced to me so I had no idea that was connected.”
She learned the true source of her pain on April 3, 2013, when she tried to get out of bed after 2 a.m. and was paralyzed on her left side.
Later that same day, Zukley saw Gregory McComis, MD, an orthopedic surgeon and owner of North Point Orthopaedics (nportho.net) in Munster. The Schererville resident had a herniated rupture, which required a surgery called a discectomy, removal of the herniated disc.
“From the time I entered that office until my surgery a week later, it was completely the most investigative, intensive care I’ve ever received in my life,” she said. “When they did the MRI, it looked like a career ending devastating injury.
“(Dr. McComis) had the most compassionate look on his face and he said ‘We can fix this. You will return to work. You will have no more pain. It will be better than before.’
Everything he said was correct.”
McComis said many of his patients have been previously misdiagnosed.
In Zukley’s case, “This is something that had been going on for a long period of time. People thought she was having a heart attack, had shoulder problems. She was misdiagnosed for several years.” He said some other physicians concentrate on only one part of the pain and miss other underlying problems.
In Zukley’s case, it was a pinched nerve in her neck, he said.
Zukley’s discectomy was done April 12, 2013, at Franciscan St. Margaret Health in Dyer. She arrived at 6 a.m. and was home by noon the same day and already feeling better.
She was surprised by how pain free she was after she woke up from recovery.
“I had full use. There were so many things wrong with my left arm. Some days I couldn’t even pick up a coffee cup.” Now she said she could go run a marathon.
“Actually now I have a better life than I did before. I don’t have pain. When you have pain, it limits your outlook, limits your motivation, limits your attitude.”
Zukley said she had learned to live with her chronic pain and planned to retire from the police force when she turned 50 but doesn’t feel like that now.
“Being a police officer, it’s a very physically demanding job and you have to have all your faculties. You have to be able to work out, you have to have stamina,” she said.
“I’m capable now. I have all the ability to continue with it. I don’t know what I would have done had I not met Dr. McComis.”
McComis said he has great success with his minimally invasive, outpatient technique for the discectomy.
“One of the hospital systems in the area has looked at the outcome of how patients do and I have the best outcomes for neck and back surgery of the surgeons who do that.”
He is also in the top 1 percent of those outcomes in the country. He said this technique doesn’t injure the muscle and causes patients less swelling and thus, less pain. They go home the same day and their recovery is that much shorter.
Zukley said she had no idea her injury could have been prevented had she received proper treatment sooner.
“I accepted that I would live my life in pain. I didn’t know that this kind of injury existed in people. It had never happened to me or anyone I knew. If you are dealing with chronic pain, there are doctors out there who will investigate it and take every avenue possible to seek out the source of the pain and heal you.”
McComis said that like Zukley, about one-third of his patients have been previously treated for issues they don’t have.
He said one of the most critical parts of any office visit is the doctor’s examination of and listening to the patient. If that doesn’t happen, you should consider going elsewhere.
“That’s critical,” McComis said. “Everyone wants me to look at their MRI, but I have a good idea what the problem is before seeing it. Ninety five percent of the time I can tell from their description and exam.”
Two years of McComis’ training were done pre-MRI and the surgeons who taught him told him he just needed to listen to the patient. They didn’t rely on technology to make a diagnosis.
“That’s an art, that’s what medicine was for 2,000 years dating back to Hippocrates and all the great thinkers.”
“A lot of people think they have to have neck pain to have a neck problem and that’s not necessarily the case,” said Gregory McComis, an orthopedic surgeon.
• Look for what’s called “The Statue of Liberty sign,” he said. If you only have comfort when holding your arm above your head, that is a sign of a pinched nerve in the neck.
• Pain in the shoulder that goes down into the arm and hand is almost always a pinched nerve
• Numbness, tingling or any kind of weakness are other symptoms.
As one of Northwest Indiana’s most accomplished ear, nose, and throat surgeons, local surgeon Dr. Bethany Cataldi also brings a vast amount of expertise in facial plastic surgery and cosmetic enhancement procedures to her patients.
With a life-long passion for providing medical care along with many years of extensive training, Dr. Cataldi focuses on a unique ‘one to one’ approach when it comes to patient care. As one of the very few female facial plastic surgeons in the region, Dr. Cataldi is especially in tune with the issues of beauty and aesthetics requested by her patients.
“When discussing any mini face-lift or wrinkle reduction procedures, rather than speaking broadly to large groups of potential candidates in a seminar setting, I prefer to direct my attention to and evaluate what each individual needs in a private and open dialogue to address each patient’s specific and unique concerns,” she explains. “My experience has shown that an honest “one-to-one” approach with patients is best when it comes to cosmetic procedures, and it is clearly evident in the results.”
Evaluating each patient’s own expectations is something Dr. Cataldi takes very seriously. “It’s my privilege to be able to help them achieve their aesthetic goals,” says Dr. Cataldi, who founded Center for Otolaryngology & Facial Plastic Surgery in Munster in 2006. “I always look at the process as a journey that a patient and I will take together, so we need to be on the same page as far as what is achievable and what is not through the services I can provide them.”
Dr. Cataldi is especially noted for her wonderfully natural-looking mini face-lifts, full face-lifts, and neck-lifts that go far in tightening the musculature of the face. Dr. Cataldi also frequently performs blepharoplasty, a surgical procedure that entails the tightening the upper or lower eyelid skin, as well as rhinoplasty, otoplasty (a cosmetic surgery procedure to change the appearance of a patient’s external ears) and skin cancer and skin lesion surgery.
She also regularly performs non-invasive cosmetic enhancement procedures such as the applications of chemical peels, as well as Restylane®, Juvederm™, and Botox® that help reduce the visible effects of aging and are done in an office setting.
“The impact of cosmetic surgery and cosmetic enhancements on a patient is great,” says Dr. Cataldi. “Overall it helps improve one’s self confidence, one’s self esteem, and gives one a better quality of life. My ultimate goal in treating a patient is for a result that looks as natural as possible. Many of my patients are referred from other satisfied patients, and I try to put all of them at ease. An ideal candidate for cosmetic procedures is a patient who is realistic about what aesthetic improvements we can achieve. We’re on a journey together, and I want them to be happy at the end of it.”
The art of robotics: Technology advancements help surgeons to be more precise and patients to heal quicker
Is it a science fiction movie? It looks like the future, a robot operating on a human being with movements so precise they rival a surgeon’s.
The future is now, it’s not science fiction, and the robot has a name. But despite appearances, a robot isn’t actually doing the surgery.
“There’s a misconception about that," says Dr. John Taylor, obstetrician and gynecologist at IU Health La Porte. “The da Vinci robot is not doing the surgery -- it’s just a tool, like any other instrument. The arms of the robot are guided by the physician.” The robot can’t be programmed nor make any decisions on its own.
The da Vinci does allow the surgeon to guide precise movements for delicate procedures, and doctors are enthusiastic. “I love it. It’s the difference between a hammer and an electric drill,” says Dr. Tyler Emley, who has a private practice at Urologic Specialists of Northwest Indiana and is affiliated with Methodist Hospital’s Northlake Campus in Gary. “Robotics is now a more common approach to surgeries. Well over 80 percent of prostate surgeries are done with robotics.”
A small incision is made through which the instruments are guided -- so what makes the da Vinci so different from a laparoscopic surgery? Dr. Nabil Shabeeb, director of robotic surgeries at Community Hospital in Munster, Ind., explains: ”The robotic arm has much more mobility and maneuverability, with better range of motion. And the da Vinci view is three-dimensional; laparoscopic is one-dimensional, with a flat screen like a TV.” The latest version of the da Vinci allows all the instruments, including the 3-D camera, to be passed through a single, one-fifth-inch incision, while laparoscopic requires three to five incisions. “The first single-site surgery was in San Diego, Calif., in 2012; I was the first to do it in Indiana,” says Shabeeb. “(Single-site incision) is much more advanced, and they’re coming out with new improvements all the time.”
Once the incision is made, says Taylor, a tubular structure called a trocar goes through the incision and is attached to the robot. “It’s like passing a straw through to the abdomen, then passing a smaller one through the straw.” With the camera in place and showing crisp images, the surgeon guides the instruments with his or her fingers. Three-D, magnified imagery gives natural depth of field, allowing the surgeon to perform delicate tissue dissection and precise suturing.
Taylor, at IU Health La Porte since 1995, has been performing robotic surgery since 2010, primarily in gynecological surgeries. Now, he says, robotic surgeries are being performed by general surgeons, cardiovascular surgeons and ear, nose and throat specialists.
The advantages are impressive. “Suturing is much faster and more precise,” says Shabeeb.
Emley, who has been using the da Vinci since 2005, after studying robotics in 2003, says compared to conventional surgery, there is less pain, less blood loss, decreased hospital stay and quicker return to activity. ”Feedback from patients and their relatives is more positive,” he says.
There are several training locations across the country. Each requires initial reading of material and studying a video, and spending an entire day at the facility practicing using the robotic arms and sewing stitches. When beginning to work with the da Vinci robot with patients, surgeons’ first few cases are monitored by experienced staff.
The miniaturized surgical instruments attached at the wrists help surgeons perform more precise maneuvers than would be possible with their own hands
“It’s very exciting,” says Shabeeb. “Medicine has been the beneficiary of modern technology, with MRIs, etc., and now we’re already in the third generation of robotics." Noting the recent development allowing a single-site incision and better optics. With all improvements requiring FDA approval, “The risk is pretty much the same as with open surgery." Though the risk of infection is less than with larger incisions, Shabeeb says.
“When the arms of the robot move, they pivot around a focal point, so there’s not as much pain and there’s less blood loss,” explains Taylor. “Most of the surgeries I do, which are hysterectomies, the patient can go home the next day. A sedentary worker can be back at work in two weeks.”
The da Vinci sounds great -- but there is a cost. In fact, “Cost is an issue,” says Emley. “It’s much higher than an open surgery. With open surgeries you have standard equipment that lasts. The da Vinci has parts that have to be replaced, some parts are disposable. There are also the upgrades. But the important thing is that it’s much more precise.”
And using the da Vinci, the surgeon is more ergonomically comfortable, and that may lengthen a surgeon’s career, says Emley, who adds that it’s beneficial to society to have physicians extending their careers, and for patients who experience less pain, fewer infections and more rapid recovery.
As doctors, Gaurav Kumar and Masood Ghouse are on the front lines of the war against lung cancer.
Although many patients win their battles with cancer each day, many more lose them. Last year, alone, more than 160,000 died from lung cancer—making it the leading cancer killer in both men and women in the United States.
It's an uphill battle, says Ghouse, a Porter Regional Hospital oncologist who says it can be frustrating to see funding dollars and publicity focused on other cancers, even though lung cancer causes more deaths than the next three most common cancers combined (colon, breast and prostate).
"A lot of people blame the victim," he says, noting smoking is thought to cause up to 80 to 90 percent of lung cancer cases. "There should be a stronger push for more funding and awareness so we can have more research. We need to make advancements and have better control over this in the future."
A new clinical strategy for lung cancer, however, has shown promise—identifying the presence of cancer in someone who has not demonstrated any symptoms.
About two years ago, the National Cancer Institute released results from a clinical trial in which at-risk smokers were screened with either a low dose computed tomography (CT) or standard chest x-ray. The study found that screening individuals with low dose CT scans could reduce lung cancer mortality by 20 percent compared to a chest x-ray.
Over the past year, organizations like the American Lung Association and American Cancer Society, have recommended low-dose CT screening for those who are at the highest risk—those who are current or former smokers aged 55 to 74 and who have a smoking history of at least 30 pack years, meaning a person smoked one pack a day for 30 years, two packs a day for 15 years and so on.
These findings were significant, Kumar says, because by the time a patient displays symptoms of lung cancer, the disease has likely progressed or spread.
"A lot more people used to die before the cancer would even be diagnosed," says Kumar, who is on staff at St. Mary Medical Center. "We're catching more cases now. I think our ability to catch and identify cancer is improving, and in time, in the next five to 10 years, we may see a decline in lung cancer incidents."
Several hospitals and specialist offices offer these low-dose CT scans—often for less than $100. It's a small price to pay to potentially save one's life, and may be covered by insurance companies, Ghouse says. He recommends starting first with a family physician, who can then refer the patient to a hospital that offers the service.
"More insurance companies are agreeing to pay for it because it catches cancer early," he says.
Other technology advances in the region are helping physicians catch lung cancer early, something doctors say will help patients live longer and have a better quality of life during treatment.
Now, specialists are able to minimize radiation exposure to other parts of the body and provide local radiation only to the tumor site.
Researchers also are developing ways to provide more individualized treatment for lung cancer.
"We can run the genetics on the cells and look for specific mutations," Kumar says. "Then based on those mutations, we can provide individualized care of therapy—providing specific drugs that will work better with those mutations."
Currently, survival rates for lung cancer vary depending on the type of cancer and how early it is diagnosed, but overall, the 5-year survival rate is just 15 percent.
Ghouse says he hopes these new innovations, along with several other drug therapies currently being developed, will extend the survival rate for those diagnosed with lung cancer, Ghouse says.
"I think in the next four to five years, the way we approach lung cancer will be more advanced," he says.
Research abounds and the data that pours out touches every corner of the system. There is speculation about how healthy people will behave with more options for insurance, but no researcher has the ability to set-up a facsimile of what the environment without pre-conditions and with mandatory requirements with confidence. Or what kind of informed or misinformed choices will come from that structure.
Medical insurances, at least in my world, kind of reminds me of choosing a cell phone plan in the old days. Remember when you used to have to predict how many minutes you thought you—and the rest of your family members—were going to talk on the phone during the next several months? Now when making my annual prognostication I tend to be incredibly optimistic or just as far gone in the opposite direction. Either way it affects cash flow adversely.
But, I have gotten better about taking care of myself and that is partly due to the contagious nature of healthy behaviors. While everyone in my life, including me, still eats way too much pizza, we eat it less often. She also pushed me to get a phone app with vegetarian recipes that are simple and convenient for dinner. She also eats too much pizza, but it doesn’t matter that much when you ride a bike nine miles to and from work unless it’s pouring rain. Everyone is more conscientious about prevention, if only because their doctors and insurance companies are forcing the issue.
And at the opposite end of the spectrum, new methods of diagnosis and treatment are hurtling forward at top speed. Chronic conditions that were once a life sentence to confinement are increasingly controllable. After targeted therapies patients resume jobs, recreational activities and normal lives, picking up where they left off. Repairs are so commonplace that even major surgery that goes on for hours is no longer something to be feared but another milestone to be passed, that causes the patient to mend unhealthy habits sooner rather than later.
Yes, dealing with health issues, diet, exercise, combinations of medications at certain intervals, remembering a complaint that may crop up from time to time, are all complicated. But none of these cause and effect relationships are impossible to learn. Not to mention having doctors and other healthcare professionals who actually listen to the answers you give to their hundred questions.
Healthcare and its consequences have become more complicated, but that’s the expectation when individuals take on more responsibility for controlling and modifying behaviors that have enlarged outcomes for us and our families.
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Bottom line, now more than ever, there is no excuse not to get screened for colon cancer, doctors say.
Colon cancer is the second leading cause of cancer-related deaths in the United States—expected to cause more than 50,000 deaths this year.
Yet colon cancer typically takes about 10 years for it to go from precancer to cancer stage—ample time for a screening to catch the cancer.
"If everybody in the country over the age of 50 got screened for colon cancer, we would cut the death rate by 60 percent," says Dr. Blase Polite, an assistant professor of medicine at the Center for Gastrointestinal Oncology at the University of Chicago.
Put another way, if everybody over 50 got screened, more than 30,000 lives would be saved each year, he says.
"This is a very preventable cancer and screening works," he says. "No debate about it."
Yet many avoid a colon cancer screening, something doctors say is essential to surviving this type of cancer because it's much more difficult to treat by the time symptoms appear. Often, doctors hear it's because patients think of a colonoscopy as a less than pleasant experience.
Polite, however, says as technology advances, more screening tests available continue to increase.
"Everything from specialized stool sample analysis where we look for DNA changes that may signal a cancer to what are called virtual colonoscopies where a CT scanner with special software is used instead of a scope to make a 3D reconstruction of the colon to look for polyps or cancer," he says.
Colonoscopies are getting more sophisticated as well, where doctors are testing using special sprays and lights to try and find precancers and cancers with higher accuracy than ever before. All of these technologies are available in the Northwest Indiana and Chicago areas at various medical practices and hospitals, he says.
"We keep improving these technologies so that hopefully one day we can do away with the preparation to clean out the colon that many patients don't like," Polite says.
In what Polite calls an era of genomic medicine, for the first time ever, doctors and researchers have sequenced the entire genome of colon cancers.
"We now know many of the gene mutations that are driving this cancer," he says. "This has already allowed us to develop many so called targeted drugs to go after these mutations and at places like the University of Chicago, we continue to test the next generation of these drugs so hopefully we will be able to cure more people with colon cancer even after it has spread to other parts of the body."
Dr. Rajeev Tummuru, a gastroenterologist at Porter Regional Hospital, says surgical treatments for colon cancer have advanced as well.
Surgeons at Porter Regional are current with the latest surgical techniques, including laparoscopic colon surgery—a surgery that involves the use of several small incisions through which a specialized camera and instruments are inserted.
"This can result in a faster recovery time without a large incision," Tummuru says.
Also available in this region now is an endoscopic ultrasound—a technique that can help surgeons and oncologists with planning treatment.
"Until now, this has not been available in the region, and patients needing this procedure have had to go to Chicago or Indianapolis," he says.
Dr. Mohamad Kassar, an oncologist at Munster Community Hospital, says one of the most exciting advancements he's seen is in colon cancer therapy.
"We used to use chemotherapy drugs, where we had one or two chemo drugs available," he says. "But now we have multiple agents of chemo drugs and biological targeted therapy."
Doctors can now devise treatment plans based on a biological profile of the cancer.
"We can actually obtain colon cancer profiles, and depending on the tumor characteristics, we can design an achievement plan," he says.
Doctors define a target in a higher concentration of the cancer cells, and then provide therapy that specifically targets that area.
"This way, patients do not have the classic side effects of chemotherapy, and enjoy a better quality of life during treatment," Kassar says.
Even in the most advanced types of colon cancer, where the cancer has spread to other parts of the body, doctors are seeing longer expectancy rates in patients.
"The average survival has improved dramatically in the last 10 years," Kassar says. "It used to be 6 to 8 months. Now it's 2 to 3 years."
Dr. Manoj Rao, a leading physician at Urologic Specialists of Northwest Indiana, believes being informed about urologic health can save lives. His main office is in Merrillville at 400 West 84th drive. He also has an office in Gary at the Methodist Northlake campus. He provides care and performs surgery at the following hospitals: St. Anthony's in Crown Point, St. Mary's in Hobart, Community Hospital in Munster, Pinnacle Hospital in Crown Point, and Methodist Northlake and Southlake campuses.
1. How long have you been practicing in NWI? Any concerning trends growing among your patients over the last few years?
I recently began my career with the Urologic Specialists of Northwest Indiana. I have found in my time here that the people I have cared for are very kind and the hospitals at which I work to be very supportive and dedicated to patient care. One concerning issue I have noticed is patients who attribute blood in their urine to a urinary tract infection and neglect to follow up with a urologist. This is a very concerning condition and many of these patients have underlying urological diseases such as kidney stones or cancer in the bladder or other parts of the urinary tract. I encourage any patients who see blood in their urine, especially in the absence of a urinary tract infection, to seek urological care.
2. How many cases of cancer do you treat in a year? Any particular cancer showing up more often?
Throughout the year, urological cancers are also quite common. In fact nearly 40% of all cancers encountered in men are treated by urologists. Prostate cancer is far and away the most common cancer in American men and is also the leading cause of cancer mortality. Fortunately with advances in research, we have found many men are at low risk for metastatic disease and are unlikely to die from prostate cancer. Due to this, we offer alternatives to standard treatments such as active surveillance, where we can monitor PSA levels and perform repeat biopsies to monitor the cancer over time. Our group also offers Da Vinci robotic assisted laparoscopic surgery to treat urological cancers as well as benign conditions of the prostate, kidney, and urinary tract.
3. Besides kidney or urinary tract infections what other reasons can a patient come in and see you about?
I have found many patients seeking care for men's health issues, which seem to not be talked about much in public, such as vasectomy, low testosterone, infertility or erectile dysfunction. We perform vasectomy in the office with local anesthesia and offer multiple products for testosterone replacement including longer lasting testosterone pellets. Given that in vitro fertilization is very expensive and not always covered by insurance plans, I encourage couples who are unable to conceive after one year of trying to seek urological care.
4. What are some options men have when dealing with erectile dysfunction?
For erectile dysfunction, many men are prescribed medications such as Viagra, Levitra or Cialis. Not all men are aware that other options exist for this condition. We offer treatments such as inflatable penile prostheses and other non-operative interventions for those who have a poor response to medications. The penile prosthesis surgery can be performed with a short stay in the hospital and many men and their partners find this treatment to be very favorable. I am giving seminars at Methodist Hospital's Southlake campus to further discuss men's health issues in more detail and those interested can contact my office for more information.
5. You completed your residency in Urology at Loyola University Medical Center and did rotations at Children’s Memorial Hospital and the Hines VA Hospital. How did these particular rotations (Children's and Hines) help prepare you for your career?
The experience at the Hines VA Hospital is cherished by all of our residents. With appropriate supervision, we are able to provide top notch care for all urological conditions to veterans. Our VA was one of a select few in the country with the Da Vinci robot, providing the latest in technology to our veterans who deserve the best health care available. We also spent four months at Children's Memorial Hospital, now the Lurie Children's Hospital. The majority of our pediatric urology training is with the outstanding pediatric urologists at Loyola University- Drs.Hatch and Matoka. Loyola University Medical Center's Department of Urology provided me with a wonderful, well-rounded training experience and I look forward to providing care to all patients in Northwest Indiana.
Although treatment for leukemia can be complicated and the cure success rate can vary based on a patient’s age and overall health, oncologists are hopeful that recent strides in treatment may have an impact on a countless number of patients.
There are several types of leukemia, which is defined as an abnormal proliferation of white blood cells, says Dr. Bennett Caces, a hematologist oncologist on staff at Ingalls Memorial Hospital.
The most common types of leukemia in adults are acute myeloid leukemia (AML) and chronic lymphocytic leukemia (CLL) and are treated in similar ways.
“AML is still thought to be a disease of the older population, and incidents go up as we get older,” Dr. Caces says. “The median age of diagnosis is 66 years old.”
Doctors say one of the major advances in leukemia research is understanding the composition of the disease, which makes it easier to determine a course of treatment. Looking at genetic markers helps classify the treatment into three categories that gauge treatment successes.
“Before, we would lump all AML patients into a category with three or four subcategories,” Dr. Caces says. “Now we can categorize them as AML, but give them a good prognosis, intermediate and poor prognosis. This is important, because it helps physicians proceed with treatment.”
For leukemia patients, the first step in treatment is induction chemotherapy, which is designed to help bring patients into remission.
For most AML patients, Dr. Caces says, the only cure will come from a stem cell transplant, either from a donor relative or someone on the donor registry. The transplant follows chemotherapy, if chemotherapy has brought a patient into remission.
Dr. Caces says there is still room for improvement in the leukemia survival rates, but recent developments have given researchers, patients and oncologists hope that there might be new treatment options on the horizon.
Chemotherapy has worked for decades because it kills cancer by attacking any cells in the body that divide quickly, Dr. Caces says. That’s why a chemotherapy patient loses their hair or gets diarrhea, because the hair and the lining of the gut have cells that divide rapidly.
But a new form of therapy—called targeted therapies—rely on chemical agents to target something specific on the cancer cell, which will help leave the normal, non-cancerous cells intact.
Dr. Alan Tan, an oncologist with Premier Hematology Oncology Associates who is also a staff physician at St. Margaret Health, says chronic leukemia (CLL) patients are benefiting from a targeted therapy drug called ibrutinib.
“It’s the closest thing to a miracle drug that we’ve seen in the last decade or so,” Dr. Tan says. “It’s not just a generic killer, it targets the pathway of the cancer.”
Patients who were not otherwise responding to traditional chemotherapy treatments or are not eligible for transplants have seen an increased success rate when using this drug, he says.
Right now, treating leukemia with targeted therapies is being used in trial studies and in larger cancer centers, both oncologists says.
“Right now, they’re being used together with chemotherapy,” Dr. Caces says. “Chemo is still a good part of treatment, overall. But some patients with AML, especially the elderly, could not ever tolerate a strong regimen of chemo, but they can get the targeted therapy on its own.”
Dr. Caces says it is important for people to be willing to participate in clinical trials, not only because it could help with their own treatment, but it could also help improve treatment options for future generations.
“Ultimately, the more we study these things, the more chances we have for improving the outcomes,” he says. “For these clinical trials to move forward, we need people willing to participate in the studies.”
Dr. Tan agreed, and says that trials randomize patients to determine who gets standard care and who gets additional experimental drugs.
“There more people we enroll into clinical trials, the more it benefits everyone else,” he says. “Especially with leukemia that is difficult to treat, and there is nothing else to offer as far as a good, curative therapy.”
For the Halpern family, multiple sclerosis is a disease that has affected the entire family, not just its matriarch, Donna.
Donna Halpern was diagnosed with MS while she was in her late 20s, when it began as problems with her vision and her knees, says her husband, Fred Halpern.
Fred Halpern, who owns Albert’s Jewelers, says after his wife was first diagnosed, she was able to lead a fairly normal life, and could golf, do housework, and keep up with the family.
But over the next 35 years, Donna Halpern, now 66, has undergone numerous treatments to stave off its progression through her nervous system.
After a fall, it affected her back to the point she now needs to get around in a wheelchair.
“It’s affected her bladder, her knees, her vision, her hearing. Over time, it has taken a lot of her motor skills away,” Fred Halpern says. “It’s a terrible disease.”
Dr. Mridula Prasad, medical director for the Methodist Hospital MS Center, says multiple sclerosis is a chronic, often disabling disease that attacks the central nervous system, which includes the brain, spinal cord and optic nerves.
It presents with symptoms of fatigue, numbness, temporary loss of vision in one eye, difficulty walking or balance issues, stiffness or muscle spasms, and bowel and bladder problems.
Treatment has evolved over the years, and while there is no cure, Dr. Prasad says the symptoms can be managed and there are new medications and treatments available.
“Before, symptoms were managed, but now we have disease modifying medications,” she says. “Dependent of the person and symptoms, more and more new medications are now available to manage and slow the progression of MS. With the push for research, many more new treatments are expected.”
And while there is nothing anyone can do to prevent MS, it is important to catch the disease early to help prevent disabilities.
“The treatments are to maintain quality of life and control symptoms,” she says.
Fred Halpern says he has made sure his wife has all the resources possible to fight the disease.
“She gets drugs, infusions, whatever it takes to hopefully slow down the disease,” he says. “My girl has been through a lot of misery with this disease.”
She also does aqua therapy in a pool, either here or in their Florida home during the winter.
Through it all, however, she has faced the disease with a positive attitude and a strength and fortitude of character, he says.
“She thinks there are people who have things worse than she has,” he says. “She has a good outlook, always looks on the sunny side of the street. She wants to live for her children and grandchildren.”
But, he says, he knows many families aren’t as lucky as he is, and don’t have the best resources at their fingertips. Which is why the family, and his business, have been heavily involved in raising money for the National MS Society.
Each year he holds an auction at his store, Albert’s Jewelers, to raise money for MS research. He also participates in numerous other fundraisers, and donates personally, as well. Last year, he donated between $150,000 and $200,000 between all his fund-raising efforts.
“The help and support we get is unbelievable,” he says. “We have amazing teamwork, and companionship, everyone wants to do good and raise money for research.”
This November, Fred Halpern and his son, Josh, are going to Colorado for a National MS Society Volunteer Hall of Fame banquet, where they have been nominated for an award for their fundraising and awareness efforts.
“I would love to see a cure. I don’t know that it would ever help my wife, but it will help someone, some day,” he says. “We’re trying.”
Patient A with cancer goes to a chemotherapy appointment, where a nurse gets an IV running with drugs that will kill cancer cells but also make the patient feel sick for awhile.
Patient B with cancer goes to the kitchen at home, takes a pill with some water, and goes about the business of the day.
What makes their treatment routines so different from each other?
Patient A has an acute and likely curable kind of cancer. Patient B has a cancer determined to be incurable yet manageable with medication for an extended period of time—a chronic cancer.
“Some cancers can kill quickly, and others grow so slowly that an elderly patient may very well die of old age and not from the cancer,” says Dr. Bharat Barai, medical director of Methodist Hospital Oncology Institute in Merrillville. “We always try to cure; in cases where we can’t cure, the next best thing is to try to convert it into a chronic disease.”
Barai likens treating a chronic cancer to treating diabetes or high blood pressure: The condition exists but is controlled as much as possible with medication.
Quality of life is an important factor in choosing treatment, says Dr. Erwin Robin, on staff at Community Hospital in Munster and St. Mary Medical Center in Hobart. “If the disease is curable, like testicular cancer, we use aggressive treatments. We probably won’t take short-term quality of life into consideration because we don’t want to compromise the curability of the disease.
“But there are many types of malignancies that we know from day one they won’t be cured; we hope for remission. If you know the patient will be around, for example eight years with a chronic malignancy, we want that to be a good quality of life time.”
Traditional treatments include chemotherapy, radiation, bone marrow transplants, and surgery, says Barai. But for a chronic cancer, treatment can be as simple as taking a pill every day, or radiation followed by medication.
Both Robin and Barai emphasize there are many cancers today that can be cured, including certain kinds of leukemias, breast cancer, colon cancer, and lung cancer. “Cancers that without treatment can kill in months, we have turned into chronic cancers,” says Barai. “Turning a cancer into a chronic cancer is not possible in every case, but more and more people are alive through treating as a chronic disease.”
For patients with a chronic, non-curable disease, says Robin, “We try to keep them in remission for as long as possible, and while they’re in remission there is always the hope that a new thing will be discovered to turn it into a curable disease. I always like to tell patients that hopefully they’ll discover a cure. “In a research project at Community Hospitals I witnessed a breakthrough … using Receptin along with chemotherapy for Stage I and Stage II breast cancers. With Receptin there was an increase in cures by twenty percent.” In a patient with leukemia, pills were prescribed and “within a month or two I sent him to a research facility. He was there a month and came back to me with a normal blood count. Several months later he was in complete remission” and survived for several years after that..
Barai agrees there have been significant advances, with “much better survival for colon cancer and lung cancer, and now 85 percent of women diagnosed with breast cancer in 2013 should be living 5 years from now and beyond.”
That’s a beacon of hope for patients with chronic cancers as well. And the patient’s outlook can affect the how well treatments work in the meantime.
“A patient who is going to fight for life and keep a cheerful outlook; in most cases the quality of life will be 95 percent of normal,” says Barai. “But if the patient thinks about that other 5 percent, it can affect how they (take care of themselves).”
“The attitude of the patient most definitely has an effect,” says Robin, who adds that patients with a positive outlook are more likely to be doing things that help overall health, such as making sure they have proper dietary intake. Definitely, a patient with a positive attitude is more likely to respond to treatment better.
Committing to Weightloss: Bariatric surgery is not just about an easy fix, it's about a lifestyle change
For many, bariatric or weight loss surgery isn’t a cosmetic choice but a medical necessity.
“Our culture with so many fast food options and hurried schedules as well as lack of time to cook, feeds into the continuing and rapid rise of overweight Americans,” says General and Bariatric Surgeon, Dr. Paul Stanish, M.D., F.A.C.S., who is the Medical Director for the Healthy 4 Life program at Community Hospital in Munster and St. Mary Medical Center in Hobart.
According to Dr. Larry Brewerton, PhD, a professor of psychology at Indiana University Northwest who also has a part time private clinical practice, though our ancestors ate just enough to survive with a little to keep going in the winter when food was scarcer, now our eating patterns have definitely changed and not for the best.
“Food is too readily available,” he says. “Soda used to be a treat, when I was growing up nobody drank it every day.”
Not so in the era of Big Gulps, all-you-can-eat-buffets and supersized meals – an overload of unhealthy calories that translates into an obesity epidemic. Current estimates indicate that nearly one-third of the adult American population or about 60 million people. Those with clinically severe obesity, generally considered to be 100 pounds above a person’s ideal weight, are at a high risk of developing such life threatening medical conditions as heart disease, high blood pressure and diabetes. Annually, there are more than 300,000 excess deaths in the U.S. due to obesity and the resulting healthcare costs amount to approximately $100 billion.
According to Stanish, several studies show that bariatric surgery can reverse the Type 2 diabetes better than just medication. Other medical pluses, besides significant weight loss, include improvement in cardiovascular risk factors along with a reduction in mortality ranging from 23 percent to 40 percent.
“There are basic criteria that insurance companies look for in determining if a patient is a candidate for bariatric surgery,” says Lori Granich, Bariatric Dietitian at the Midwest Bariatric Institute in Dyer. “The most popular parameters are having a BMI greater than 40 or having a BMI over 35 with two co-morbidities such as hypertension, diabetes or sleep apnea. Patients have typically failed previous attempts at weight loss. Patient’s eligibility will also depend on meetings with the surgeon, nursing staff, psychologist and dietitian.”
Healthy 4 Life’s website features an easy to use tool for measuring body mass index (BMI). Plug in your height and weight (no fibbing please) and the site can calculate your BMI.
The surgery first became available in the 1950s but has vastly improved since then.
“Most bariatric surgeries these days are minimally invasive or laparoscopic and can be categorized into restrictive or malabsorptive procedures,” says Granich RD. “A restrictive procedure, such as the lap-band or sleeve gastrectomy, reduces the size of the stomach to decrease the amount of food it can hold. Malabsorptive procedures, such as the Roux-En-Y Gastric Bypass, restricts food intake while limiting absorption of calories. This results in large amounts of weight loss.”
But it isn’t a free pass to a future of endless desserts and no weight gain (sigh!). Indeed Stanish says that after surgery if big time sweet eaters don’t cut back it significantly, the undigested sugar in their intestines can make them sick and cause something unpleasantly known as dumping syndrome.
“Bariatric surgery should be taken as a last resort,” says Kim Kramer, a wellness dietitian at Ingalls Hospital and the Illinois Dietetic Association’s media spokeswoman. “It is not a quick fix, it’s very hard work. People should try every other option before making this choice whether it’s going on a weight loss plan or adding more exercise to your day.”
Stanish says that when they first started their weight loss program, it was surgical.
“Then we recognized we needed a non-surgical program,” he says. “So now usually when patients come to us we say we’re going to get to the surgery later, let’s work on this first so by the time we get them into surgery the patient is probably 15 to 20 pounds lighter and in much better shape for the surgery. But even with surgery, if patients don’t make the therapeutic changes in their way of life, they will gain some of it back. These changes include healthy eating and an increase in physical activity.”
Besides their pre-surgery program, Healthy 4 Life also provides customized weight loss options with ongoing medical and personal support as patients adjust to their new – and healthy -- life habits. This includes their Weight No More support group designed for on-going participation enabling patients to continue practicing the skills necessary for a lifetime of continued health and weight management.
“Our Therapeutic Lifestyle Changes (TLC) teaches patients about eating the right foods and increasing physical activity," says Stanish, adding that he avoids the dreaded “e” word – exercise.
“Bariatric surgery is a life-changing procedure,” says Granich. “It is imperative that patients are willing to commit to the lifestyle changes needed for post-operative success. Some insurance companies implement a time frame up to six months for medically supervised weight loss before they will approve surgery. The surgeon may require additional testing based on the patients past medical history or age. A medically supervised program will help patients change their eating habits, quit smoking, lose weight and start exercising before surgery. When these changes are made preoperatively, patients adapt better to life after surgery.”
Kramer, who conducts preparatory classes for people considering the surgery as well as weight management programs, says that the life changes include smaller portions, at times not being able to eat solids and fluids together and a commitment to exercise and healthy eating.
“We offer healthy cooking demonstrations and discuss general nutrition,” she says. “We prepare people for what to expect after surgery. A lot of times people take vitamins afterwards based on what surgeries they’re having.”
In order to get ready for surgery, Kramer says people need to start exercising before surgery.
“Bariatric surgery is a huge step,” says Brewerton. “For those who are considering it, they should talk to someone who has had the surgery and find out would they do it again if they had the choice and why or why not.”
Besides the physical component, weight loss surgery also has a psychological aspect too.
“Many people use food when they’re feeling badly, sad, angry or anxious,” says Brewer. “It becomes a way of dealing with their feelings.”
But ultimately, stuffing ourselves harms our health and, if we gain too much weight, our self-esteem, sometimes increasing the feeling we’re trying to stymie through food.
Brewerton suggests learning to express our feelings by talking to a therapist or joining a supportive weight lose group like Weight Watchers is one way to handle negative emotions in a positive way.
“Stress management is also important so that we don’t eat as a stress reliever,” says Kramer. “There’s a lot of emotion in why we eat what we do.”
Geriatrics. Palliative care. Hospice. For many people, each term denotes helplessness and hopelessness. But those are the very things healthcare workers and volunteers are dedicated to helping people avoid.
Geriatrics does indeed deal with the challenges of the aged and aging. The operative behaviors and illnesses and works to alleviate them.
Palliative care, explains Amy Warren, hospice coordinator at IU Health La Porte, is for helping patients manage life-threatening illness in the greatest comfort possible.
"(When illness is terminal), palliative care can eventually be a bridge program to hospice,” says Warren.
IU Health La Porte hospice administrator Virginia Davis emphasizes, “Patients go into hospice for quality of life." She said that can have its own rewards for patients, families, and hospice workers.
Helping families cope
All three disciplines can overlap. For instance, when patients are coping with a terminal illness, he or she may need assistance.
“In geriatrics, if someone’s ability to make decisions is affected by severe depression, they need help managing the depression," says Carol Schaaf, director of the Geriatric Behavioral Health Unit at Methodist Hospital’s Northlake Campus in Gary. The hospital’s 55-bed unit addresses a variety of psychological problems.
Many people worry that a loved one with dementia can’t be cured.
“We try to eliminate behaviors that limit their ability to stay in the home," says Schaaf. "There is rage and fear in the soul of someone with dementia. What you think is a further deterioration is actually like a very young child’s inability to tell you what’s wrong, and so has to act out by crying or getting angry. Connecting long-term memory with present-day stimuli such as familiar, pleasant smells can alleviate anxiety as the patient feels connected to the here and now."
When hospice referrals are unable to be managed in the home it’s usually because of their behavior and not because of their disease, says Shaaf. At Methodist there is a 12-bed geriatric unit. "(The unit) is very nice, compact (and secure). Because the patient is constantly under observation, we can figure out behaviors to help them integrate back into their living environment."
“Geriatrics is the next frontier,” says Schaaf. “So many people are living longer and they’re much more functional.”
Schaaf says schools may be getting more focused on courses in geriatrics. The pay varies according to the level of education. A registered nurse can earn $22 to $35 an hour; with a master’s or doctorate in nursing, it’s much more, says Schaaf. A technician might make $15 an hour.
Heading into hospice
“People think when they hear ‘hospice’ that they’re in their last days, but hospice is about quality of life and not being in the hospital,” says Warren.
“We’ve had a patient who elected hospice early enough that they could travel to visit relatives, with their oxygen and medications, and for management we connected them to the hospice in the area where they’re going,” says Davis.
But facing reality comes first. “When a person goes into hospice, they’re facing end of life. They stop trying chemo or radiation because they realize it’s not going to help. Sometimes the family wants them to keep trying; our chaplain plays a big role then,” says Davis. Warren adds, “So many of our patients are sick and tired of being sick and tired. They want to be home with their families.”
Hospice leaves decisions about care for the patient up to the family.
“The hospice patient and/or family decides the plan of care. We ask, ‘What do you need?’ and give them choices,” says Patty Warring, clinical nurse specialist at VNA Porter County Hospice and Palliative Care, affiliated with Porter Regional Hospital in Valparaiso, Ind. Again, reality has to come first, says Warring, “I can’t tell you how many people come to us and no one has told them they’re dying. I’m not blaming anyone. In this country, we don’t talk about it. It’s the elephant in the room. Yet usually the patient knows.”
If no one talks about it, “You may never have the chance to say things like ‘I love you,’ or, ‘I’m sorry.’ That’s why we encourage hospice earlier, so that people can tie up the loose ends of their lives and find closure,” Warren says, and adds, “People need to know that even though you will miss them immensely, you’re going to be okay. It’s so true that some will die when their person has left for home or to get coffee,” thinking to spare them the trauma.
The team is extensive and essential. “Hospice and palliative care includes RNs, a social worker (with a master’s in social work), chaplain, volunteers, home hospice aides, dietician, bereavement counselor, physician and volunteer coordinator. All have training for working with families and patients with end-of-life issues,” explains Davis.
Tuesday meetings are for debriefing; the staff helps each other get through the deaths. “Our social workers are a very tight-knit group, so we know to go to others for support. Everybody’s here for each other -- that’s part of the greatness of our staff,” says Warren
Warring at VNA says her team has been “phenomenal. I think people in hospice have a kindred spirit.”
Choosing to cope with grief
Everyone in the team is educated about grief, says Davis -- the sadness, sense of loss, and anxiety patients and families have at the end of life. So who chooses geriatrics, palliative care or hospice?
Warren speaks with conviction. “It’s a calling, to help people to be comfortable. It’s a gift to be able to go into a patient’s home; to help them be able to die a peaceful death in the home if possible; to give them and their family the sense that their life is complete.”
“It takes a special kind of person," says Schaaf. "You need to have willingness and heart to work with those emotional challenges. Our staff is compassionate, but is also able to see hope, and treat patients as if they were our own family members.”
“In one of my internship rotations the average age was 82,” recalls Dr. Kristine Teodori at Franciscan St. Anthony Health in Crown Point, Ind. “That experience told me I wanted to work in geriatrics. I love what I do. It’s difficult, we have people who pass and we get close to their families. I am blessed to be a part of that.”
Teodori takes an extensive patient history. “People tell me about their marriage, serving their country in the war, their lives. It’s important to recognize them for that.”
For some, working in geriatrics and hospice is what they've truly wanted to do.
“It’s been such a blessing in my life, it’s where I belong,” says Warring. “As a hospital nurse in oncology, I began to look at what we do at the end of life and thought, there must be a better way (than to continue treatment when it becomes futile). When we moved to this area, my Realtor told me about VNA, and VNA hired me 18 years ago as a visiting home nurse for hospice. It was the hand of God in my life.”
Looking to the future
“Hospice is a growing field. Not as fast as we would want, but the need is there, with baby boomers aging,” says Warring. “The numbers alone make it a growing field,” says Teodori, “yet It’s still underserved.”
Entry-level salary can be anywhere from $10 to $20 an hour; says Davis, depending on education and training.
To specialize, typically someone graduates medical school, does a residency in either internal medicine or practice, and then a geriatric fellowship, which can take one to two years.
“Having someone you’ve cared for years is emotionally trying, yet it’s not as hard as trying to work with the red tape of medicine,” says Teodori. “With the HIPAA privacy laws I’ll have children of patients who want information, but when you have patients who are still able to make their own decisions, the children still want to make decisions and have their questions answered."
“Once people have had experience with hospice, they recommend it to others,” says Warring.
IU Northwest students put healthcare skills to work in community: Interdisciplinary educational approach a win-win for students, area residents
Thanks to a unique working relationship among Indiana University Northwest’s various College of Health and Human Services disciplines, both students and residents of surrounding communities are reaping the benefits of the schools’ innovative cross-disciplinary curriculum.
In the real world, professionals from across disciplines collaborate frequently in order to do their jobs effectively and provide the best care possible for those they serve. Similarly, through the Interprofessional Education Program (IPE), students in the fields of nursing, social work, dental education, public affairs and medicine collaborate in order to work effectively together in order to serve the needs of their respective clients and communities.
Dr. Patrick Bankston, Ph.D., assistant dean and director of the IUSM-NW, and dean of the College of Health and Human Services at IU Northwest, said the program was designed to provide team-based learning and outreach exercises that promote better understanding and communication between healthcare practitioners. Surprisingly, he said, this kind of basic information is missing from the curriculums of many professional schools.
“Most often what is learned about the other professions is anecdotal,” Bankston said. “The result is that members of the healthcare team have at best a rudimentary understanding, and at worst a misunderstanding, of what other members bring to the table. This in turn leads to failures of communication, mistakes with patients and less respectful relationships between team members.
“At IU Northwest and IUSM-NW,” Bankston said, “we want to work collaboratively to attack this basic problem at its roots. The students need to know what their colleagues are trained to do well if they are going to respect each other as vital members of the healthcare team.”
One successful example of interdisciplinary collaboration is the Healthy Path program, currently in its second year.
Last fall, students across disciplines worked together to set up “health-check” stations along the walking track at Gleason Golf Course just west of campus. Student nurses took community members’ blood pressure, checked height and weight, and performed other wellness checks, while other CHHS students and even community health groups provided useful health information to passers-by.
The event was well-received, and students will again be working to bring this much-needed service to Gleason walking path again this fall, possibly with more screenings offered.
“The program gives students valuable experience working with the public and with each other, while also providing a welcome service to the many local community members who exercise at the Gleason course,” said IU Northwest Clinical Assistant Professor Karen Bertram, who is an advisor to the Healthy Path program.
After a successful first year with Healthy Path, the schools are now looking to expand their outreach and experiential learning initiatives.
During the Fall 2013 semester, medical students will attend a seminar to educate them on the nursing profession and what nurses contribute to the healthcare team. Linda Delunas, Ph.D., director of the School of Nursing, will describe the nursing education program and curriculum, nursing student clinical experiences, different clinical venues in which nurses function and what special expertise they bring to the healthcare experience for patients and the healthcare team.
The nursing seminar is just one of many reciprocal talks that will be happening across the university’s health units over the next two years, Bankston said. Students will hear similar talks about the professions of physician, social worker, health administrator, dental hygienist, health information management professional, radiological technologist.
“The Interprofessional Education idea all came from the idea of healthcare errors and how they are largely avoidable and are due to miscommunication of one sort or another,” Bankston said. “So programs like these help to educate the students about each other’s roles in the healthcare process, and they help to educate the community, too.”