in surgery - Manatee Memorial Hospital

manatee
HEALTH NEWS from
SUMMER 2014
HEALTHCARE SYSTEM
A
RENAISSANCE
IN SURGERY
led by da Vinci®
Trouble in your ears,
nose or throat?
Find relief at Lakewood
Ranch Medical Center
Options
in orthopedics
Individual solutions for
joint pain at Manatee
Memorial Hospital
Heart health tips from the pros
How do cardiologists care for their hearts? By
following the same advice they give patients. Here,
Jason Okuhara, DO, and Emmy Satya, MD, FACC, of
Lakewood Ranch Cardiology share their top five tips.
SEE YOUR DOCTOR.
EXERCISE.
onitor your health through
M
regular visits to your primary
care physician. Take advantage
of screenings offered for high
blood pressure, diabetes
and cholesterol.
oth Drs. Okuhara and Satya
B
advise adults to get 30 minutes
of exercise at least five days a
week, after checking with their
doctor first. “Even walking the
dog for 30 minutes is helpful,”
says Dr. Okuhara.
DON’T SMOKE.
esides risking heart disease
B
and cancer, smoking exposes
you to 4,000 chemicals including
arsenic and lead. Dr. Okuhara
advises patients to try a
smoking cessation program.
EAT BREAKFAST.
REDUCE STRESS.
ifferent people ease stress
D
in different ways, from yoga and
meditation to reading or spending
time with friends. “Whatever
your source of sanctuary,”
says Dr. Satya, “take time
for yourself.”
A healthy breakfast is a must,”
“
says Dr. Satya. “If you fast all
morning, you’re more likely to
over-eat when you sit down
to a meal.”
8340 Lakewood Ranch Blvd.
Bradenton, FL 34202
941-556-8930
FROM THE
CEO
IN TH
IS ISS
UE
IN THIS ISSUE
4
OPTIONS IN
ORTHOPEDICS
Individual solutions for
joint pain
5
Enjoy reading Health News and have a fantastic summer.
FROM EAR TUBES
TO SINUSITIS
Novel ENT treatments are
nothing to sneeze at
6
When the loggerhead turtles nested on
Bradenton Beach, we knew that summer
had officially begun. Along with the season
comes news from Manatee Healthcare System,
including the continued success and expansion
of da Vinci® robotic surgery. In the story on page
6, members of the minimally invasive surgical
team discuss the benefits of this revolutionary
technology. On page 4, the same technology in a different form is
helping to expand the choices patients have for orthopedic care.
We’re fortunate to have this capability in our hospital and we invite all
members of our community to talk to us about it. Send me a question
or request a phone call by going to www.manateememorial.com and
clicking on “Meet the CEO.” I’m happy to share how robotic systems
can make surgery more comfortable for patients – or discuss anything
else you may have on your mind.
Kevin DiLallo
Group Vice President, Universal Health Services
CEO, Manatee Healthcare System
A RENAISSANCE
IN SURGERY
A modern da Vinci® offers
smaller incisions, less pain
www.manateememorial.com
www.lakewoodranchmedicalcenter.com
Lakewood Ranch Medical Center is pleased
to welcome TEAMHealth® to our hospital. This
skilled team of physicians and practitioners is
dedicated to providing high-quality care to
both our Emergency Department and Hospitalist
Medicine programs. TEAMHealth® is an innovative
partner that brings with them a wealth of experience,
knowledge and compassion, which will enhance
the patient experience at our hospital.
In this issue, we’re highlighting minimally invasive hernia treatments
that let patients recover from surgery quicker and return to their routines
sooner. We’ve also brought ear, nose and throat specialists on staff who
care for both children and adults. We’re proud to offer well-rounded
services … all focused on providing a broad scope of quality healthcare
options for our community.
Richard Fletcher
CEO, Lakewood Ranch Medical Center
Manatee Healthcare System Health News 3
Options in ORTHOPEDICS
The multi-talented orthopedic team at Manatee Memorial Hospital’s Center for
Orthopedic and Spine Surgery offers treatments for joint pain as individual as you are.
“An X-ray may show
‘bone-on-bone,’
but a patient can do
well with injections
and exercise.”
– Patrick Grablin, MD
Orthopedic Surgeon Patrick
Grablin, MD, uses a combination
of conservative therapy as
first-line treatment for joint
pain. This therapy can include
corticosteroid injections,
exercise, activity modification
and possibly weight loss. After
examination and testing, if
surgery offers the best solution,
Dr. Grablin performs arthroplasty
to reconstruct or replace the
diseased joint. “By using
individual pain relieving
modalities after the procedure,
length of stay in the hospital
can be decreased,” he says.
“MAKOplasty®
helps surgeons do
a better job because
it makes up for
human inconsistency.”
– John Ayres, MD
With partial knee resurfacing,
only the part of the knee with
arthritis or damaged cartilage is
operated on, and healthy parts
are left intact. Manatee Memorial
Hospital now has the capability to
carry out this procedure with the
MAKOplasty® robotic system,
which offers greater precision and
consistency, according to John
Ayres, MD, Orthopedic Surgeon.
“There are things the human eye
can’t see, but the computer – with
its superior ability to measure and
position the implant – creates a
custom fit for each patient. It’s
looking over our shoulder, making
sure,” says Dr. Ayres. “The better
the implant is aligned, the better
it will feel and function, and the
longer it will last.”
“There seems to be
less pain after this
surgery and patients
recover faster.”
– Alan Valadie, MD
Orthopedic Surgeon Alan Valadie,
MD, performs reconstructive
joint surgery at Manatee Memorial
including anterior (front) hip
replacements, which, unlike
traditional surgery performed
from the back of the hip, does
not require cutting muscle. “We
spread the muscle apart,” says
Dr. Valadie. “It can mean less pain
and patients can recover faster.
Most will go home in one or two
days.” Dr. Valadie notes surgery
is considered a last resort and
conservative treatment with
injections, anti-inflammatory
medications and exercise is
usually recommended first. ■
Meet our Orthopedic Nurse Navigator
Let Malou Kaseta, RN, BSN, introduce you to our
orthopedic services. Call 941-745-7417.
Individual results may vary. There are risks associated with any surgical procedure. Talk with your doctor about these risks to find out if robotic surgery is right for you.
4 Manatee Healthcare System Health News
From
EAR TUBES
to SINUSITIS
Newly added ear, nose and throat specialists at Lakewood Ranch Medical Center
offer innovative solutions for common problems.
The opening of Lakewood Ranch Medical Center’s
pediatric unit in 2013 was the perfect time for ear,
nose and throat specialist Chad R. Marrs, MD, to
join the staff. Dr. Marrs treats both adults and children
but has focused on growing the pediatric ENT
practice at Lakewood Ranch. “I realized with the
influx of so many people, especially young families,
into the Lakewood Ranch area, there would be a
growing need for my specialty,” says Dr. Marrs, who
treats all aspects of pediatric ENT problems and even
offers “shotless allergy drops” through his office.
Dr. Marrs also cares for a growing
population of older adults. One
of the unique surgeries he has
brought to Lakewood Ranch is the
endoscopic treatment of Zenker’s
diverticulum, which is a pouch of the
Chadd Marrs, MD
esophagus that causes swallowing
ENT Specialist
problems and can lead to aspiration
pneumonia. “This is such a great technique because
it allows patients to be treated who might not be
candidates for the older, more invasive procedure,”
says Dr. Marrs.
Sinus infections are a familiar problem to Vien
Phommachanh, MD, ENT specialist, and his patients.
He performs balloon sinuplasty, a treatment option
that has shown good results with patients who
experience repeated sinus infections despite
taking antibiotics.
“Frequent infection can cause
swelling and blockage of the
passages that drain the sinuses.
This keeps the infection from
clearing completely and can allow
the infection to persist or reoccur,”
Vien Phommachanh,
says Dr. Phommachanh. Using a fiber
MD, ENT Specialist
optic camera in a procedure similar
to angioplasty, a balloon is inserted through the nose
to stretch the sinuses and allow them to drain, thus
improving the effectiveness of antibiotics. Less
invasive than traditional sinus surgery, where the
sinuses are cut open, balloon sinuplasty requires less
recovery time, fewer restrictions afterward and allows
treatment before the condition becomes intolerable.
“In the past, we could either manage the condition
with medication or perform surgery as a last resort,”
says Dr. Phommachanh. “Balloon sinuplasty falls
somewhere in between and lets us treat patients
who are ‘borderline.’” ■
To find a doctor, call
Direct Doctors Plus®
at 941-708-8100.
Manatee Healthcare System Health News 5
F E AT U R E
story
A
RENAISSANCE
IN SURGERY
led by da Vinci®
Medical treatment has undergone a radical
change since robotic surgery was developed.
With today’s advanced tools and high-definition
3-D imaging providing unprecedented clarity for
surgeons, operations that used to involve long
incisions and painful recoveries have been
reduced to incisions measuring about an inch in
length with recuperation sometimes taking only
days. Manatee Memorial Hospital now offers
First in
nty
Manatee Cou
c
to offer roboti
surgery!
minimally invasive robotic surgery to help
patients in the following four key areas. ➤
“We’re using computer technology
and advanced imaging to improve
what we do for patients.”
– da Vinci® surgery team
6 Manatee Healthcare System Health News
General Surgery
There is no substitute for a skilled
surgeon in any kind of surgical
procedure. But the da Vinci® Surgical
System does compensate for
inconsistencies such as hand tremor,
which is normal in all humans. It also
enhances dexterity. “I may be making
large movements with the controls
where I’m sitting at the imaging
screen,” says Jose Estigarribia,
MD, general surgeon. “But the
movements are transformed into
micro motions inside the patient.”
The fact that the surgeons control
magnification of the visual field
adds to precision. “The images
have excellent resolution,” says Jose
Erbella, MD, general surgeon.
“So it’s easier to see and dissect
anatomic structures as well as
reconstruct blood vessels.”
One of the most remarkable
examples of what robotic surgery
can do for patients is seen with
cholecystectomy, or removal of
the gallbladder. Using minimally
invasive robotic techniques, the
entire gallbladder is removed
through one, small incision in the
belly button. “Cosmetically, the
Single-Site™ approach leaves
patients with no visible scar, which
they really like,” says Stelios Rekkas,
MD. “A single incision can also mean
less post-operative pain, a reduced
risk of wound infection and a quicker
recovery time.”
Gynecologic Oncology/
Obstetrics and Gynecology
Manatee Memorial Hospital is the
only hospital in the region with a
gynecologic oncologist on staff, and
one who is experienced at using the
da Vinci® Surgical System. Stacey
South, MD, Chief of Surgery, is able
to consider every detail about a
patient’s cancer and use the precision
afforded by technology to achieve
a positive outcome. For standard
gynecologic procedures such as
hysterectomy, or removal of the
uterus, the benefits of roboticassisted laparoscopic surgery start
with smaller incisions, often leading
to less pain and an easier recovery.
These benefits also stem from
increased dexterity and an improved
visual field. “Robotic systems have
the ability to get behind tissues,”
says Dr. South. “And the 3-D visibility
is like nothing I’ve seen to date.”
Urologic Surgery
According to the American College
of Surgeons,* more than 40 percent
of prostatectomies (removal of the
prostate gland) are now being
performed using the da Vinci®
Surgical System. It’s also being used
to perform sacrocolpopexies, which
involve application of soft, synthetic
mesh to support pelvic organs that
have slipped out of their normal
position. “The device is well suited
to these particular operations,” says
Sean Castellucci, DO. “It enhances
the surgeon’s ability to precisely
manipulate tissue and minimize
tissue trauma, and it improves
visibility of the operational field.” ■
ACS Surgery News, January 11, 2013.
*
MEET THE SURGEONS
Thoracic Surgery
Thoracic surgeries that can be
performed using robotic technology
include lung resections such as
lobectomy (removal of the lobe of
the lung), lymph node biopsies in
the center part of the chest and
removal of mediastinal tumors.
“These procedures can be
completed through small incisions
without spreading or cutting the
ribs,” says Ronald Smith Jr., MD.
“Traditional open surgery would
require an eight- to 10-inch incision
and therefore a more lengthy and
uncomfortable recovery.”
Individual results may vary. There are risks associated with any surgical procedure.
Talk with your doctor about these risks to find out if robotic surgery is right for you.
Stelios Rekkas, MD
General Surgery
Stacey South, MD
OB/GYN, Gynecologic
Oncology Surgery
Jose Estigarribia, MD
General Surgery
Ronald Smith Jr., MD
Thoracic Surgery
Jose Erbella, MD
General Surgery
Sean Castellucci, DO
Urologic Surgery
Manatee Healthcare System Health News 7
THE
beat GOES ON …
IN MANATEE COUNTY
Patients no longer have to be
transferred for advanced cardiac care.
Ventricular arrhythmias, or when the heart beats too slow, too fast or irregularly, can have their origin
in anything from blocked arteries to stress. Manatee Memorial Hospital offers a new diagnostic tool
and treatments that were previously unavailable in our community to give patients with life threatening
arrhythmias effective alternatives – right here.
eliminates a-fib triggers
SUBCUTANEOUS
DEFIBRILLATOR
reduces complications
LINQ™ INSERTABLE
CARDIAC MONITOR
Medication is used
first to control atrial
fibrillation, or an
ablation can be
performed, which
Daniel E. Friedman, uses radiofrequency
MD
energy to scar a
very small area of
heart tissue. Once
scarred, it can no
longer produce the
erroneous electrical
signals that caused
Jagan Akella, MD
the arrhythmia.
“Patients don’t have to accept
a-fib,” says Daniel E. Friedman, MD,
cardiologist/electrophysiologist.
“Ablation is an effective treatment
that will help with symptoms if not
cure them.” The procedure involves
inserting a catheter through an
artery in the groin. “We use the
3-D mapping system to help us
guide the ablation process,” says
Jagan Akella, MD, cardiologist/
electrophysiologist. “Patients are
usually discharged the next day.”
In order to shock
the heart back
to its natural beat, the
wires in traditional
defibrillators are
Joseph Pace, MD
placed into the
heart itself. The new Boston
Scientific S-ICD® subcutaneous
defibrillator, an implantable device
that sits just below the skin, leaves
the heart and blood vessels
untouched. “The wire is tunneled
across the bottom of the sternum
and up the left side of the body,”
says Joseph Pace, MD, cardiologist/
electrophysiologist. “The procedure
is less invasive and you don’t
expose patients to radiation
in order to position wires in
the heart.”
Now doctors can
more thoroughly
diagnose patients
with cardiac
problems that
Jeffrey Rothfeld, MD
cause loss of
consciousness, or those with strokes
that have no apparent cause. The
Medtronic LINQ Insertable Cardiac
Monitor tells the doctor whether
the patient’s heart is beating too
fast or too slow. “The LINQ is
inserted under the skin through a
tiny incision and monitors the heart
about 46 minutes at a time,” says
Jeffrey Rothfeld, MD, cardiologist/
electrophysiologist. “With
monitoring during episodes, we
learn what the problem is and
can decide the best way to
treat it.” ■
ABLATION FOR ATRIAL
FIBRILLATION
8 Manatee Healthcare System Health News
contributes to a better diagnosis
For more information, visit
the Manatee Heart and
Vascular Center online at
www.manateememorial.com.
A closer look at one of the most common
surgeries in the United States
Lakewood Ranch Medical Center provides
comprehensive management of all types of hernias.
A hernia is a defect or tear in a layer of the abdominal wall called the fascia. Made of ligamentlike tissue, the fascia gives strength and support to the abdomen. Years of use or an acute injury
can result in a hole in the fascia, or a hernia. Once a hernia is present, the organs that live behind
it can protrude through, creating a bulge, pain or even injury to these organs, namely the intestine.
If an intestine gets stuck, life-threatening complications such as strangulation, where the hernia
cuts off the blood supply to the bowel, can occur.
Hernias can be present in the groin (inguinal), belly
button (umbilical) or across the entire abdomen
due to prior surgery. While some patients need
open procedures, others may have a hernia small
enough that a tiny incision – sometimes done
without general anesthesia – is the best choice.
Laparoscopic surgeries usually take under an hour
and are done on an outpatient basis.
“The standard of care for hernia surgery includes
a mesh patch, which takes away the tension that
used to be created by pulling the torn edges of a
hernia together,” says David Napoliello, MD, FACS,
a board-certified surgeon, fellowship trained at the
Mayo Clinic in advanced minimally invasive surgery.
“This ‘tension-free method’ has revolutionized
hernia repairs over the past 20 years. Having the
ability to apply the mesh laparoscopically limits the
size of the incisions as well as discomfort.”
Dr. Napoliello adds that as hernia surgery
continues to evolve, patient comfort is accelerated.
“Lightweight meshes and biologic meshes made
from skin grafts are the latest developments,”
he says. “Dissolvable fasteners also help reduce
potential post-op pain, as they have less risk of
nerve injury by entrapments.”
Because the hallmarks of a minimally invasive
approach are smaller incisions, less pain and
a quicker recovery, it’s an excellent option for
many hernia patients. “I am conservative in
my surgery choices and recovery,” says
Dr. Napoliello. “I recommend my patients
avoid physical strain for four weeks.
Data shows, however, that within a
week’s time, most people feel like
themselves again.” ■
An advanced level of surgical care
David Napoliello, MD, FACS, who has been serving the
communities of Sarasota and Manatee counties for 14 years,
focuses on laparoscopic and minimally invasive surgery with
a special interest in hernias. His background includes a Mayo
Clinic fellowship and emergency surgical experience at a
Level I trauma center. Last year, Dr. Napoliello was awarded the
opportunity to present his work at World Congress of Surgery
in Helsinki, Finland.
Manatee Healthcare System Health News 9
ASK THE
doctor
Are we
at risk for
West Nile
virus?
Why is West Nile
virus dangerous?
What are the symptoms
of West Nile virus?
West Nile is transmitted
through the bite of a
mosquito that has become
infected by feeding on
infected birds. In serious
cases, West Nile can cause
encephalitis (inflammation
of the brain) or meningitis
(inflammation of the lining
of the brain and
spinal cord).
About 75 percent of people
infected don’t develop any
symptoms. About one in five
people will develop a fever
along with body aches, joint
pain, vomiting, diarrhea or
a rash. These people often
recover completely, but can
experience fatigue for months.
Less than 1 percent will develop
a severe neurologic illness such
as encephalitis or meningitis,
and about 10 percent of these
people will die.* ■
Where and when
do most cases occur?
With mangroves and tidal
marshes prime mosquito
breeding grounds, Florida
has its share of unwelcome
bugs. Family medicine
physician Ronald Grubb,
DO, with Manatee Primary
Care Associates, and
Reed Holland, DO, internal
medicine physician with
Lakewood Ranch Medical
Group, give us the buzz on
mosquito-borne West Nile.
The disease has been
detected in all states
except Alaska and Hawaii,
and outbreaks have been
occurring every year since
West Nile’s appearance in
the United States in 1999.
Most people are infected
from June through
September.
How is the
disease diagnosed
and treated?
Only a blood test can
determine if you’ve been
infected with West Nile
virus. A human vaccine
for the disease may be
available in the future.
Centers for Disease Control and Prevention
*
Bite back with the four ‘D’s’
DRAIN. Mosquitoes lay their
eggs on standing water, so
eliminate it where you see it.
DEET. Apply insect repellent
containing DEET, picaradin,
IR3535® or oil of lemon eucalyptus
according to label instructions.
DAWN AND DUSK. Mosquitoes
are more likely to bite in the
morning and early evening.
DRESS. Wear clothing that
reduces skin exposure when
outside, such as long pants
and long-sleeved shirts.
10 Manatee Healthcare System Health News
AWARDS AND
recognitions
The first 27 graduates of Manatee Memorial Hospital’s Graduate
Medical Education Program were honored by (from left), Manatee
Healthcare System CEO, Kevin DiLallo, and program directors
Larry Wickless, DO, Residency Program Director for Internal
Medicine; Ronald Grubb, DO, Residency Program Director for
Family Medicine; Catherine Cooper, DO, Director of Medical
Education and Program Director of the Transitional Internship;
and former Internal Medicine Program Director, John Peters, DO.
Jack MacArthur (center) was honored as the 2013-2014
LWRMC Volunteer of the Year at Lakewood Ranch
Medical Center. Pictured with Jack are Richard Fletcher,
CEO and Lisa Kirkland, Manager of Marketing
and Volunteers.
Lakewood Ranch Medical Center’s CEO Richard Fletcher (back
row, third from left) and staff accept the Excellence in Reducing
Healthcare Infections Award from the Florida Medical Quality
Improvement Organization.
Manatee Memorial Hospital received the American Heart
Association/American Stroke Association’s Get With The
Guidelines®-Stroke Gold Plus Quality Achievement Award
for 2013. Pictured with team members is Kevin DiLallo, CEO
of Manatee Healthcare System.
Winners of the 2014 C.A.R.E.S. Awards at Manatee Memorial
Hospital, recently honored, are from left to right: Ralph
Gonzalez, MD; LaVern Dunbar, ECHO (S-Supportive); Patti
Lippert, Nursing Resources, (R-Respected); Tracey Warner,
Emergency Department (C-Concerned); Stacey South, MD;
Karen Vaadi, ECHO (S-Supportive); Jeremy Eminhizer (not
pictured), Physical Medicine (E-Enthusiastic), accepted
by Dean Steffenhagen, Director of Physical Medicine;
Tran Martin, Patient Access (A-Amiable); pictured with
Kevin DiLallo, CEO of Manatee Healthcare System, far right.
The Wound Care and Hyperbaric Treatment Program at Manatee
Memorial Hospital received the Center of Excellence Award from
Healogics™, Inc., for the third year in a row.
Manatee Healthcare System Health News 11
PRSRT STD
U.S. POSTAGE
PAID
PERMIT NO. 322
PONTIAC, IL
Manatee Memorial Hospital
206 Second Street East
Bradenton, FL 34208
Application
Please choose the membership for which you are applying:
One Year: ❏ Single: $15.00
Lifetime: ❏ Single: $45.00
“Senior”
means privilege!
❏ Couple $25.00
❏ Couple $70.00
Name______________________________________________________
DOB_______________________________________________________
Name (second applicant)____________________________________
DOB_______________________________________________________
Address____________________________________________________
City/State/Zip______________________________________________
Telephone__________________________________________________
E-mail______________________________________________________
The Senior Advantage Program of Manatee Healthcare System
is all about you. If you’re age 50 or older, Manatee Memorial
Hospital and Lakewood Ranch Medical Center offer services
designed to enhance your health and well-being.
We are happy to continue our partnership with the Senior
Enrichment Center at Renaissance on 9th, operated by Meals on
Wheels Plus of Manatee, enabling us to offer you more seminars
and events to enjoy during the year.
We have added a “What’s Happening” recorded announcement line
for Senior Advantage members to keep you up-to-date on seminars,
screenings, social activities and events. Just call 941-745-7308!
What’s more … if you’re a patient at Manatee Memorial Hospital or
Lakewood Ranch Medical Center, your Senior Advantage benefits
include the possible waiver of the Part A Medicare deductible for
members age 65 and older.
For more information,
please call 941-745-7548.
How did you hear about us?____________________________________
Please make your check payable to
“Senior Advantage” and mail to:
Senior Advantage Office
206 Second Street East
Bradenton, FL 34208
Connect
WITH US!
www.manateememorial.com
www.lakewoodranchmedicalcenter.com
HEALTH NEWS FROM MANATEE HEALTHCARE SYSTEM
Kevin DiLallo, Group
Vice President, Universal
Health Services, Inc.,
CEO of Manatee
Healthcare System
Richard Fletcher, CEO,
Lakewood Ranch
Medical Center
Vernon DeSear, Vice President,
Manatee Healthcare System
Betty Chambliss, Director,
Advertising and Community
Relations, Manatee
Healthcare System
Lisa Kirkland, Manager of
Marketing and Volunteer
Services, Lakewood Ranch
Medical Center
Ted West, Official Hospital
Photographer
Information in Health News comes from a wide variety of medical experts. If you have any concerns or
questions about specific content that may affect your health, please contact your healthcare provider.
Models may be used in photos or illustrations. Any opinions expressed by an author whose article
appears in this publication are solely the opinions of the author and not necessarily reflect the views of
Manatee Healthcare System, Manatee Memorial Hospital, Lakewood Ranch Medical Center or Universal
Health Services, Inc. Physicians mentioned in this publication are independent practitioners who are
not employees or agents of Manatee Healthcare System. The hospital shall not be liable for actions or
treatments provided by physicians. ©2014. All rights reserved. Printed in the U.S.A.
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remove your name and address from our mailing list, please contact Manatee Healthcare System’s Marketing Department at 941-745-7545; the Direct Marketing Association, Farmingdale, NY; or log on to http://www.dmachoice.org.