health! St. Anthony
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ST. AnTHony HoSPiTAL AND THE OTHER SERVICES OF FrAnCiSCAn HeALTH SySTeM
Living better with palliative care HeArT DiSeASe:
Spot the clues
Keep your bones strong
See page 15 fo r o u r
Calendar of Events Franciscan Health System • FALL 2011
Palliative care
St. Anthony Hospital’s GPS technology zooms in on prostate cancer treatment We all know how helpful it is to have a GPS handy when we’re lost on the road. But what if that same technology could outline the real-time road map to a healthier body? Radiation oncologists at the Jane Thompson Russell Cancer Care Center at St. Anthony Hospital in Gig Harbor have discovered a way to use GPS-like technology to give prostate cancer patients breakthrough benefits of tumor tracking during radiation therapy. The technology, called GPS for the Body®, allows higher doses of beam radiation to be directed at the tumor with increased accuracy—while at the same time lowering risks for exposing healthy tissue to radiation. Prostate cancer is second only to lung cancer as the leading cause of cancer-related deaths in men, according to the American Cancer Society. The prostate is a walnut-sized gland located below the bladder. “Like many of the organs in our body, the prostate gland is constantly moving,” says radiation oncologist Kenneth Bergman, MD. “With precision targeting, extremely accurate radiation can be delivered directly to the tumor while minimizing the risk of any harmful effects on normal tissues.” The Jane Thompson Russell Cancer Care Center added the innovative prostate cancer therapy in May 2011. To learn more about The Jane Thompson Russell Care Center and St. Anthony Hospital, go to www.gigharborhospital.org.
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Franciscan Health System | Fall 2011
Living better with palliative care St. Anthony Hospital to offer full range of palliative care services on the Kitsap peninsula When faced with a life-limiting illness such as heart failure or kidney disease, managing your medical care can be overwhelming. Often there are multiple specialists to visit, treatments to decipher, symptoms to manage, and strong emotions to contend with. Who can you turn to for help? The palliative care specialists at Franciscan Health System.
Patient-centered care
“Palliative medicine is about helping people live a complete and full life while living with a serious illness,” says Christine Cofer, Christine Cofer, MD, MD who oversees palliative care at St. Anthony and St. Clare hospitals.
Meeting a growing need
Franciscan is the largest provider of in-home and inpatient hospice care and palliative medicine in the Northwest. And palliative care outreach services are still growing. “People are living longer with more serious illnesses and are more challenged by gaps in the system,” says Mimi Pattison, MD, medical director of Mimi Pattison, MD Franciscan Hospice and Palliative Care. To meet the growing demand for palliative care, Franciscan has extended services to the Kitsap area. St. Anthony Hospital is now offering a full range of palliative care services, both in the hospital and throughout peninsula communities.This extends Franciscan’s palliative care reach to the entire Kitsap peninsula. “Not a lot of palliative care support was available in Kitsap County and Gig Harbor before we rolled out our palliative care services at St. Anthony Hospital,” says Linda Lepape, ARNP. The goal is to ensure that everyone who needs Linda Lepape, this care has access to it. ARNP
At the hospital and at home
Many patients first access palliative care services when in the hospital. Consultations are given at the bedside with patients and family members. These services are also available when patients are discharged home or to another setting through Franciscan Palliative Care Outreach. Palliative care nurse practitioners and a skilled team bring support and expertise to each patient, wherever they are. “Palliative care can be Georganne accessed by the patient, Trandum, RN the family or the primary care doctor—even for patients actively seeking curative treatment such as chemotherapy and/or radiation therapy,” says Georganne Trandum, RN, clinical division manager of Palliative Care Outreach.
Learn more about Franciscan palliative services by visiting www.FHShealth.org/ palliativecare.
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Women’s care now
Keep your breasts healthy for life When it comes to breast health issues, breast cancer gets all of the attention. However, there are a variety of other breast conditions that women Linda Pai, MD, can develop.These breast FACS issues can cause lumps, pain and discomfort, among many other symptoms. In fact, women are more likely to visit a breast surgeon due to benign breast conditions than breast cancer, says Linda Pai, MD, a board-certified general surgeon with Franciscan Surgical Associates, who has a special interest in breast surgery. Symptoms to know
Some of the most common non-cancerous breast diseases that women may experience include: • Fibroadenoma – a solid, rubbery but usually painless lump
• Fibrocystic breast changes – lumps, bumps and pain in the breast that worsen before each menstrual cycle • Mastitis – a breast infection that causes pain, redness and swelling in part of the breast • Breast abscess – an infection of the breast due to a blocked milk duct that causes inflammation and pain • Cysts – round or oval-shaped fluidfilled sacs within the breast that move when you touch them • Nipple discharge – leakage that is clear, milky, yellowish or bloody Why you shouldn’t wait
If you notice any of the symptoms above or any other breast changes, be sure to see your physician and have it checked out, Dr. Pai says. “The symptoms of benign breast conditions can be very similar to breast cancer, so it’s important to have a doctor perform the necessary tests to rule
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WALK-INS AT ST. ANTHONY! To learn more about mammograms at St. Anthony Hospital, call 253-530-2170.
out cancer.” Those tests may include a physical exam and health history followed by imaging such as a mammogram or an ultrasound—and an MRI if needed. Finally, a biopsy is usually performed to provide a definitive diagnosis. “Seeing your health care provider can also help you feel better. Some of these conditions are treatable with lifestyle changes, medications or in-office procedures such as fine needle aspiration to drain a cyst or abscess,” says Dr. Pai. “In some cases, such as a fibroadenoma that grows rapidly, surgery may be necessary to remove it.” Whether a lump or other kind of breast abnormality is due to one of these conditions or something more serious, like cancer, it’s important to get it checked out as soon as possible, Dr. Pai says.“There’s nothing better than early detection for treating any kind of breast disease.”
St. Anthony Emergency Department: Still breaking door-to-doc records St. Anthony Hospital’s Emergency Department has once again earned the #1 patient satisfaction rating among community hospitals nationwide. Our patients appreciate the emergency department’s excellent care and short wait times. Thanks to an innovative triage method, most patients are seen by a doctor or physician assistant within 11 minutes!
We’re here for you! When seconds count, the St. Anthony Hospital Emergency Department is here for you. To learn more about our services or health talks, go to www.gigharborhospital.org. www.FHShealth.org
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The healing garden
The healing power of nature Peace and serenity in St. Anthony’s healing garden Hospitals have used natural landscaping, gardens and fresh air as components of healing for centuries. The Daniel A. Snuffin Healing Garden at St. Anthony Hospital was created to continue this tradition and provide patients, visitors and staff with a place of healing and peace. Over the years, healing gardens have become less common.Yet studies show that nearly all visitors to a healing garden feel a significant positive change of mood during and after their visit, contributing to their overall recovery or sense of well-being. A special place in Gig Harbor
The healing garden at St. Anthony is considered the heart and spirit of the
hospital. The garden can be viewed from every public space, and it is the perfect place to meditate, relax and promote natural healing. The garden features a boardwalk, Zen garden and a lively pond that is spanned by two arch bridges. Rock boulders from Baker, Oregon, line the cascading ponds, and water lilies are abundant in the three pools. Situated on the ground floor adjacent to the St. Anthony Café, the healing garden is a lovely place to enjoy lunch or a latte as you take in the tranquil surroundings or the sweeping views of the native forest beyond.
Walk of Art enhances health and well-being The St. Anthony Walk of Art features one-of-a-kind artworks that support and enhance the hospital’s overall healing environment. The original paintings, sculptures and other unique pieces promote the health of the mind, body and spirit. This art collection, funded by the Franciscan Foundation’s Campaign for St. Anthony, is featured throughout the hospital, and includes pieces that capture the spirit of the Northwest. “Art creates the beauty that can reduce anxiety and inspire hope,” says Ginny Scalzo, art consultant for St. Anthony Hospital. “The possibilities for healing are multiplied when this happens.” Ten local artists were commissioned to create original pieces in bronze, basalt, cast glass, oil-on-canvas and other media, creating an art collection unique to St. Anthony Hospital. In addition, a number of other donated pieces complete the exhibit. Take a virtual tour of this art collection by visiting www.gigharborhospital.org and clicking the “Walk of Art” link. Or, better yet, enjoy a self-guided tour before enjoying a meal at the St. Anthony Café.
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lunch 10% orEither dinner at the off St. Anthony Café Franciscan Health System | Fall 2011
ST. AnTHony HoSPiTAL offers delicious cuisine morning, noon and night, seven days a week, for hospital patients, visitors and employees alike. With fresh, heart-healthy food and a daily “blue plate” special, the St. Anthony Café is Gig Harbor’s best kept secret! Check out this week’s menu at www.gigharborhospital.org.
Medical specialties
Fight inflammation—
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There is growing concern about the debilitating impact of chronic inflammation—now thought to be the root cause of degenerative disorders like arthritis, obesity, heart disease and cancer. But what exactly is inflammation and why is it so devastating?
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Normally, inflammation is our body’s protection system. When we have an injury or exposure to a foreign microorganism, our body responds to the threat with inflammation and destroys the alien cells and then returns to normal. Chronic inflammation takes place when the inflammation doesn’t turn off and instead of protecting our bodies, continues to attack. Scientists think chronic inflammation inside the body plays a role in the development of conditions like heart disease, diabetes and cancer. Why inflammation matters
Cancer often arises at sites of inflammation in the body. A study in the Archives of Internal Medicine found that women with higher white blood cell counts— a sign of inflammation—had a greater risk of developing cancer of the breast, colon, lung, and uterine lining. Inflammation also tends to accompany heart disease. It arises when tiny cholesterol particles enter the blood vessel lining, causing an inflammatory response, explains Y.G. “Joseph” Chami, MD, FACC, Y.G. “Joseph” cardiologist at Franciscan Chami, MD, FACC
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Cardiology Associates. “Higher levels of inflammatory blood markers have been associated with more unstable angina and heart attacks,” he says.
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Tracking inflammation
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One sign of inflammation is higherthan-normal levels of C-reactive protein, or CRP, made by the liver. A simple blood test can detect the increase. “I will sometimes use the test in children to check for the Wajahat Khan, presence of infection,” MD says Wajahat Khan, MD, internist at Gig Harbor Medical Clinic. Some cardiologists may recommend a CRP test as a way of gauging a patient’s risk for more damaging heart episodes, including heart attack. “We have found a correlation between unstable plaque lining the walls of the arteries—the kind more likely to produce a heart attack. However, we do not recommend testing healthy adults without obvious heart disease risks,” says Dr. Chami. If high CRP levels are found, treatment for heart disease might include dietary changes and medication. “I typically recommend a Mediterraneanstyle diet, which cuts down on saturated and trans fats and increases omega-3
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Our health care experts have the answers you’re looking for. Call a Franciscan doctor at 888-825-3227 today!
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fats from fish, as well as statin drugs,” says Dr. Chami. “Statins not only help reduce cholesterol, they also help stabilize plaque, so it is less likely to burst and cause a life-threatening blockage.”
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How can you reduce inflammation?
These smart changes help reduce risk factors such as artery-clogging cholesterol, which increases the risk of heart disease. Dr. Khan recommends that his patients eat more fruits and vegetables. “Our Western diet is too high in starch and bad fats. Avoiding these foods helps reduce these damaging dietary elements,” adds Dr. Chami. Reducing inflammation-producing foods is critical because obesity is linked to inflammation. “Exercising, not smoking and not drinking excessive alcohol can help reduce inflammation as well,” Dr. Khan adds. These smart changes help reduce risk factors such as artery-clogging cholesterol, which increases the risk of heart disease.
“Our Western diet is too high in starch and bad fats. Avoiding these foods helps reduce these damaging dietary elements.” — Dr. Chami. www.FHShealth.org
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Osteoporosis
Fend off fragility fractures
Understand your osteoporosis risk to maintain health and quality of life You may view fragility fractures—when bones break because they cannot withstand body weight during a normal daily activity—as a Patrick later-life concern. Not so, Vaughan, MD says orthopedic surgeon Patrick Vaughan, MD, of Tacoma Orthopaedic Surgeons. “Fractures have their roots in weakened bones, known as osteoporosis. And since bone mass peaks in your 20s, if you’re 35 or older, it’s time to start thinking about preventing this potentially debilitating condition.” Fortunately, with smart prevention and the help of Franciscan Medical Group physicians, you can stay one step ahead of fractures and live a more active, healthier life, whether you’re 29 or 90. Are you at high risk for osteoporosis?
“Osteoporosis means “bones with holes,” and it is reaching epidemic proportions among American women,” says orthopedic surgeon John Bargren, MD, who practices at The Orthopaedic Center in Tacoma. Being female and older increases your risk of developing osteoporosis— John Bargren, though men can develop MD it, too. Other risks include being underweight or Caucasian, drinking excessive alcohol or coffee, and smoking. “Primary care physicians start testing an otherwise healthy woman for osteoporosis between ages 60 and 65 using the DEXA scan,” says internal medicine physician, Jesus Casino, MD, with St. Anthony 10
Franciscan Health System | Fall 2011
Family Medicine in Gig Harbor. “This painless imaging test compares the density of bones in a woman’s hip and lower spine against composite scores of healthy women in their 20s—the lower the score, the weaker the bones.” A score of -2.5 or lower indicates osteoporosis, while -1.0 to -2.5 indicates a less severe bone weakening called osteopenia. Both diagnoses warrant attention, with lifestyle change the usual course of treatment for osteopenia. However, the lower the score, the more likely it is that a physician will recommend both lifestyle change and some form of medication therapy in an effort to minimize the long-term risk of fracture. Jesus Casino, MD The real and present danger of fractures
“Fragility fractures usually occur in the hip or spine, though wrists and shoulders can also sustain these troubling injuries,” states Dr. Bargren.“Spine fractures may contribute to height loss and spine rounding. Hip fractures require rehabilitation and are more likely to result in loss of independence.” With the rise in osteoporosis rates, hip fractures are becoming more common, averaging more than 500,000 each year. That number is projected to increase to 750,000 in 10 years. Both men and women have a one in five chance of sustaining fragility fractures before age 65. However, after 65, the risk for women increases to a one in two chance. The reason for this change? Menopause. Once estrogen production falls, bone density decreases dramatically. Fortunately, there are preventive measures you can take to help protect your bones.
Start—or keep—exercising
“Walk for 30 minutes at least three times weekly as a minimum. This kind of weight-bearing exercise is critical to increasing bone mass,” says Dr. Bargren. “Other beneficial activities include hiking, jogging, dancing and aerobics— anything that pits your bones against the force of gravity.” Bone up at mealtime
The Institute of Medicine recommends supplementing with calcium (1,000 mg for premenopausal women and 1,2001,500 for postmenopausal women) and vitamin D (400-800 international units, or IUs, daily). “Taking vitamin D is critical in the Pacific Northwest, where sunshine is at a premium,” notes orthopedic surgeon Joshua Johnston, MD, with Franciscan Orthopedic & Sports Medicine Associates in Lakewood. A healthy diet can also help your body get the minor minerals it needs for bone-building such as magnesium, manganese and iron. Practice balance
According to the Centers for Disease Control and Prevention (CDC), injuries from home-related falls result in an average of 21 million medical visits and 20,000 deaths each year. Falls are the leading cause of injury among adults aged 65 years and older in the United States. However, patients in their 80s and 90s who exercise regularly have improved balance, resulting in fewer falls. Balance exercises help build strength in leg muscles, which help to Joshua improve balance. Johnston, MD
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“If your balance isn’t what it used to be, start slowly,” recommends Dr. Johnston. “Stand near a support structure, such as a wall or a table so you can catch yourself if necessary. Stand on one leg for five seconds and then do the same with the other leg every day. After a week, repeat the exercises but try to increase the time to 10 seconds. Ultimately you should set a goal of 15 or 20 seconds each day. It may not seem like much, but you’ll feel steadier and better able to adapt to a sudden incline or decline while walking.”
Get screened
Most primary care physicians start screening for osteoporosis between the ages of 60 to 65. But your doctor may recommend that you be screened as early as age 50 if you have any of the following: • family or personal history of osteoporotic fractures • loss of height, which can indicate spine strength issues • history of steroid or injectable birth control use • smoke or drink excessive alcohol or coffee
Quit smoking
“Many patients in their 30s think the only risk to smoking is lung cancer. They are surprised to learn that smoking leads to greater risk for back pain, osteoporosis and results in longer recovery time to heal after injuries,” says Dr.Vaughan. For fractures, longer recoveries can mean more time off your feet, which negatively impacts long-term mobility, heart health, and increases the risk of infection.
If you are female, white and underweight, and fall into any of the categories above, early screening is critical. Understand treatment risks
No medication therapy is without risks. In the past, estrogen therapy was used to help prevent bone loss. This may still be an option for some women but can slightly increase the risk of breast cancer.
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Got questions? Franciscan Health System physicians have the answers. Find your physician today by calling 888-825-3227 or go to www.SouthSoundDoctors.org.
Other medicinal therapies include bisphosphonates. They can increase bone mass but also carry a risk of gastrointestinal problems. Prolonged use of bisphosphonates may also increase the risk of fractures in some women, however further research is needed to confirm and understand why. Take medications as directed
The most important thing to do to avoid gastrointestinal issues is to take the medications as directed. You should take medication first thing in the morning, before eating, sitting up with a full glass of water. Remain sitting up straight for at least half an hour after taking the medicine and don’t eat for at least an hour. It is important to drink a whole glass of water because this particular type of pill can get stuck in the esophagus and cause irritation. IV medications and nasal sprays are new options for patients who can’t tolerate the pills. www.FHShealth.org
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Ankle replacement
Walking on air Get active again with total ankle replacement surgery Most people know someone who has had a knee or hip replaced— but an ankle? Thanks to advanced technology, total ankle replacement (TAR) has become an appealing alternative to traditional ankle fusion surgery. For active senior WD Page, it was exactly the surgery he needed to keep him moving pain-free. A full-time missionary known to the Russian orphans he ministers Byron Hutchinson, as “Grandpa Dub,” WD had been experiencing ankle pain for a DPM couple of years. “Walking was very painful, and I had a continual limp. It certainly slowed me down.” WD was referred to Byron Hutchinson, DPM, who specializes in reconstructive foot and ankle surgery at his clinic, Franciscan Foot & Ankle Specialists. What had begun with an ankle fracture had developed into end-stage osteoarthritis. Such severe arthritis is the result of the progressive wearing down of the cartilage cushion that lines the ankle joint, ultimately resulting in bone-on-bone Peter Krumins, grinding of the joint surface. While it’s a fairly common condition, MD Dr. Hutchinson thought an uncommon solution might work best.
WD Page’s total ankle replacement was a success!
new hope for arthritic ankles
Upon examination, WD was deemed a good candidate for TAR surgery. And since TAR’s average recovery time is two to two-and-a-half months compared to a staggering four to nine months for ankle fusion surgery, WD agreed it was the best option for him. “Ankle replacements have been around for over 40 years,” says Dr. Hutchinson. “What we’ve learned about biomechanics from hip and knee replacements has revolutionized this generation of ankle replacement.” The procedure involves replacing the arthritic ankle with an implant composed of two or three parts that glide easily against each other. “Total ankle replacement surgery gives the ankle near normal motion,” says Peter Krumins, MD, orthopedic surgeon with Gig Harbor Orthopaedic Surgeons. “And because it places less stress on other joints, it reduces the risk of those joints becoming arthritic in the future.” Fusion surgery is still recommended for younger patients with osteoarthritis, those with severe deformity of the leg and patients with diabetes. After surgery,WD spent just four days at St. Francis Hospital, and began to move his ankle six days later. “The hardest part was waiting for the doctor to tell me I could put weight on my foot again,” he remembers. But after eight weeks, he was up and walking. “That ankle is absolutely performing the way it’s supposed to and doesn’t cause any problems whatsoever,” says WD, happy to be back to his missionary work. “The pain is gone, and I’m back at full speed again.”
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TruST THe eXPerTS Dr. Hutchinson and Dr. Krumins are two of only a few surgeons in the South Sound regularly performing total ankle replacement surgery. To learn more, call Franciscan Foot & Ankle Specialists at 206-242-6553 or Gig Harbor Orthopaedic Surgeons at 253-853-8810.
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www.FHShealth.org
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health! Franciscan
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St. Francis Hospital 34515 Ninth Ave S, Federal Way, WA 98003 St. Joseph Medical Center 1717 South J St, Tacoma, WA 98405 St. Clare Hospital 11315 Bridgeport Way SW, Lakewood, WA 98499 St. Elizabeth Hospital 1455 Battersby Ave, Enumclaw, WA 98022 St. Anthony Hospital 11567 Canterwood Blvd NW, Gig Harbor, WA 98332 Franciscan Medical Group 1313 Broadway Plaza, Suite 200, Tacoma, WA 98402 CEO, Franciscan Health System Joe Wilczek Interim President, St. Anthony Hospital Laurie Brown Managing Editor Joan B. Artman Franciscan Health System is part of Catholic Health Initiatives, which has health care facilities throughout the United States. ©2011, Franciscan Health System. All rights reserved. For questions or comments, or if you’d like to be removed from the health! mailing list, please contact us at 253-382-3850, (fax) 253-382-3877, www.FHShealth.org or write to: Editor, Franciscan health!, Franciscan Health System, Marketing & Communications, PO Box 2197, Tacoma, WA 98401-2197.
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