Connections (Fall 2009) by Ann McGettigan

Medical news you can use

Inside this issue

4 Healthy solutions for sensitive issues Urology services help you take charge 8 Special care for tummy trouble

12 Could your leg pain be something serious? Brad Bauer, M.D. (left), and Jim Bankston, M.D., urologists at Russell Medical Center

www.russellmedcenter.com

Fall 2009

Connections Russell Medical Center

Brad Bauer, M.D.

Jim Bankston, M.D.

Improving your quality of life

any of us are guilty of not asking a quesurinary tract exist. The most common include kidney stone tion during a doctor’s visit. Whether the disease, urinary incontinence and prostate health issues. reason is because of modesty or a “this-canwait” attitude, Jim Bankston, M.D., and Brad Bauer, M.D., Kidney stones board-certified urologists at Russell Medical Center (RMC), More than 1 million kidney stone cases are diagcan help you deal with some of the most sensitive issues. nosed each year, according to the American Urological Urology is a surgical specialty focused on treating Association. While different kinds of kidney stones urinary tract disorders in men and women as well as the (caused by infection or hereditary disorders) exist, they’re male reproductive organs. “While generally made of minerals and other many patients may originally see substances that can’t dissolve naturally. Find relief! their primary care physician about Many stones cause no symptoms, but concerns, urologists have a comprehensome patients may experience sudMake an appointment with Dr. Bauer sive knowledge of urinary issues,” says den, sharp, cramping back and lower at (256) 215-3601 or Dr. Bankston Dr. Bankston. A wide variety of condiabdominal pain as well as blood in at (256) 329-8459. tions affecting different areas of the the urine, nausea and vomiting. Most Fall 2009

Our urologists address your needs

stones will pass unnoticed, but some may require medical intervention. Dr. Bauer says prevention is key in treating patients who form kidney stones since there’s a 50 percent chance another will form. “We try to find out why they form stones and what can be done to prevent them,” he says. Urinary incontinence Drs. Bauer and Bankston are also hoping to call attention to urinary incontinence, or the involuntary loss of urine. Although incontinence takes several forms, the most common types are stress and urge incontinence. In stress incontinence, a laugh, cough or sneeze may cause some urine to escape. Urge incontinence is marked by bladder contractions that create a constant feeling of fullness. Sometimes patients can’t hold urine long enough to reach a toilet. Incontinence can be treated with therapies to retrain the muscles and bladder, and if that doesn’t work, medication or surgical options may be recommended. Both doctors are excited about RMC’s pelvic floor physical therapy program available at Total Fitness at RMC, which can help women experiencing pelvic floor prolapse (when the cervix and uterus drop toward the vagina) and urinary incontinence. “There’s a world of women who have hard-to-treat urinary problems, and that’s the group that could benefit from physical therapy,” says Dr. Bankston. Prostate health The prostate plays a prominent role in a man’s urinary and sexual health. The three most common problems associated with the prostate are: Prostatitis. This condition develops when the prostate swells or becomes inflamed, usually caused by bacterial infection. Benign prostatic hyperplasia (BPH). A normal prostate can also grow many times in size when hormonal changes occur after age 40, causing BPH. Prostate cancer. Even though prostate cancer is one of the most diagnosed cancers in America, men have only an average 3 percent risk of actually dying from the disease. Tumors are often slow-growing and highly treatable. Patients sometimes experience no symptoms until the cancer has spread, so early detection is important. Drs. Bankston and Bauer offer digital rectal exam (DRE) or a prostate-specific antigen (PSA) blood test to screen for prostate conditions.

> Their roads to healthcare Jim Bankston, M.D. Medicine was an easy choice for Alabama native Dr. Bankston. “My father was a physician, and I chose to follow in his footsteps,” he says. Dr. Bankston specialized in urology because it encompassed both general medical and surgical aspects. He completed his medical degree, internship and residency at the University of Alabama at Birmingham and has been practicing for more than 30 years, many of them at RMC. Outside of the office, community members may have seen Dr. Bankston on his morning runs. “I run about 20 miles a week, generally around the neighborhood,” says Dr. Bankston. He’s completed several half marathons and the Marine Marathon in Washington, D.C. Brad Bauer, M.D. While science has always appealed to Dr. Bauer, medicine wasn’t the first thing that caught his eye. “I wanted to be a herpetologist—a biologist specializing in reptiles and amphibians,” he says. After pursuing a master’s degree in cell biology, he became interested in medicine and went on to complete his medical degree at Texas Tech University in Lubbock, Texas, and his residency at the Medical College of Wisconsin in Milwaukee, Wis. “Urology is an interesting field,” says Dr. Bauer. “I have fun with the challenges.” A native of southern Utah, he grew up helping in the family vegetable garden and enjoys gardening in the southern climate. “It’s amazing the plants you can grow in the South,” he says. “I think gardening is therapeutic. It’s just something I’ve always done.”

Take charge of your health Both doctors agree, urology focuses on addressing quality of life. “If you get up in the middle of the night, when you get the urge to go you have to go, or if you’re the one who gets teased for stopping every 15 minutes on a road trip, we can help,” says Dr. Bauer. He also notes that in addition to treating incontinence and other urinary tract conditions, urologists also assist in preserving sexual function in men and women. “There’s no reason people can’t pursue treatments that improve their quality of life.”

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Fall 2009

Solving tummy troubles

ost of us experience occasional stomach problems. But when do those troubles warrant a trip to the doctor, and how can your doctor help? Derek K. Holcombe, M.D., boardcertified gastroenterologist at Russell Medical Center (RMC), is specially trained to diagnose and help you manage these sometimes complex conditions. Range of conditions Digestive disorders can range from heartburn and constipation to complex disorders such as celiac disease (the inability to digest gluten, a wheat protein) and Crohn’s disease (chronic intestinal inflammation). “Gastroenterologists specialize in all aspects of the digestive system, including the esophagus, stomach, intestines and colon,” says Dr. Holcombe. “I also specialize in hepatology—treating the liver, gallbladder and pancreas—so I see patients who have a wide variety of symptoms and conditions.” Key symptoms that may indicate a digestive disorder include abdominal pain, changing bowel habits, heartburn, rectal bleeding, difficulty swallowing, weight loss, nausea or vomiting.

Gastroenterologist Derek K. Holcombe, M.D., enjoys practicing medicine in a small community.

Fall 2009

advanced diagnostic technology Gastroenterologists screen for digestive disorders using diagnostic tests and techniques other physicians may not be familiar with. “We offer a variety of services in our office,” says Dr. Holcombe. “We perform our own ultrasounds and urea breath tests to diagnose Helicobacter pylori, a bacteria that causes ulcers. One procedure Dr. Holcombe offers in the office is small-bowel capsule endoscopy, a major development in gastroenterology that features a video capsule that a patient swallows. About the size of a large vitamin, the capsule contains a miniature color camera, a light, a transmitter and up to eight hours of battery life. As the capsule travels through the digestive system, it captures several images per second and sends them to a recording device worn around a patient’s waist. “Scopes used during traditional endoscopy can see the upper and lower parts of the digestive tract, but the capsule can see areas we normally can’t reach,” says Dr. Holcombe. The capsule won’t be absorbed, passes during a normal bowel movement and doesn’t need to be retrieved after the exam.

Dr. Holcombe uses specialized equipment to screen for and diagnose various conditions.

In addition to helping patients stay healthy, Dr. Holcombe and his family stay healthy with an active lifestyle.

“I specialize in all aspects of the digestive system ... so I see patients who have a wide variety of conditions.” —Derek K. Holcombe, M.D., gastroenterologist

Cancer screening and awareness Colon cancer screening is one of the most important parts of Dr. Holcombe’s practice. “Early detection is key to saving lives, and people are becoming more aware of colon cancer,” says Dr. Holcombe. “The American Cancer Society recommends men and women have a screening colonoscopy at age 50.” Colonoscopy is the most common outpatient procedure to screen for colon cancer or abnormal tissue that may develop into cancer. The procedure allows Dr. Holcombe to examine the entire colon and rectum for abnormalities. During the exam, Dr. Holcombe inserts a colonoscope—a long, flexible lighted tube with a tiny video camera on the end—into the rectum. The camera transmits images of the colon onto a screen where he carefully examines the colon’s lining. If Dr. Holcombe finds abnormal tissue, he may decide to remove it immediately or take a biopsy to test for cancer. Recovery time after the procedure is about an hour. Dr. Holcombe believes that the screening process is easy and encourages more people to get a colonoscopy. “Patients don’t need a physician’s referral to schedule an appointment,” he says. “They just need to set the appointment and stop by the office to schedule the procedure and pick up what they will need to prepare for the test. Our office offers several different bowel preparations including the ‘pill prep.’ ” Focused on health Dr. Holcombe says he chose his specialty carefully. After completing medical school at the University of South Carolina and an internship at the University of Alabama at Birmingham, he specialized in internal medicine and went on to focus on gastroenterology at the University of Memphis in Memphis, Tenn. Fifteen years after coming to RMC, he’s as busy as ever. Find relief His dedication to health extends into his To make an appointment free time, where he can with Dr. Holcombe, call be found on the tennis (256) 329-2829. court with his 14-year-

> Streamlining care With Dr. Holcombe’s practice growing, he knew he needed some experienced help. Christi G. Jackson, M.S.N., CRNP, collaborates with Dr. Holcombe to see patients quickly, assess their symptoms, schedule necessary procedures and prescribe medications. She is a certified acute care nurse practitioner. Jackson received her undergraduate degree in nursing from the University of Alabama in Huntsville and worked as a nurse while completing her master’s degree in nursing from the University of Alabama at Birmingham. After six years of working in the medical intensive care unit at Trinity Medical Center in Birmingham, Jackson and her husband, Chris, an Alexander City native, were looking for a community for their family. It was while completing her nurse practitioner training that she came to RMC and trained with Michele Goldhagen, M.D., medical director of RMC’s emergency department. “Dr. Goldhagen knew I was looking for an opportunity in Alexander City, and she introduced me to Dr. Holcombe,” says Jackson. “As a mother, my family is my first priority, and my career is extremely important as well. Dr. Holcombe and his staff embrace that and I knew this was the right place for me to do what I love: care for people.”

old daughter, Lorin. “My wife, Robin, my daughter and I like to stay active,” he says. “Lorin recently learned to water ski, and we all snow ski in the winter.” They also enjoy riding horses and have shown some of the horses they’ve raised on their farm. He’s especially pleased to practice medicine so close to home. “Being in a small community allows me to have the work-life balance that’s important to me,” he says.

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Fall 2009

Could you have PAD? Our specialist clues you in

hronic leg pain may be a sign of peripheral artery disease (PAD), the most common type of peripheral vascular disease (PVD). Basel Refai, M.D., internal medicine physician and vascular specialist at Russell Medical Center (RMC), answers questions about this often misunderstood and misdiagnosed condition: What are PVD and PAD? A: PVD is a narrowing or blockage of the vessels that carry blood to the legs, arms, stomach, kidneys or brain. PAD is the narrowing or blockage of the arteries that supply blood to these parts of the body. This condition increases risk of heart attack and stroke and, if left undiagnosed, may require amputation in some cases. As you age, you’re more likely to develop PAD, and having other conditions like high cholesterol, high blood pressure or diabetes increases your risk for it.

What are PAD’s symptoms? A: Pain, weakness or occasional numbness in the leg, thigh or back when walking that stops when resting is a key PAD symptom. The condition may be serious if a patient experiences leg cramps at rest or wakes up every night with cramps that are relieved by sitting on the edge of the bed or walking. Unfortunately PAD symptoms are often misdiagnosed as arthritis or as normal “aging” pains.

> Meet Dr. Refai Basel Refai, M.D., came to the United States as a teenager with his mother who was diagnosed with diabetes. They went to see her brother, a cardiologist in Oklahoma, and Dr. Refai decided to pursue medicine after that visit. He attended Aleppo University in Syria and completed his internship and residency at Case Western Reserve University in Cleveland, Ohio. He’s board certified in internal, vascular and endovascular medicine and is a registered vascular technologist. Dr. Refai spent time practicing in the Lake Martin area, and upon completing his fellowship in vascular medicine at the Cleveland Clinic Foundation in Cleveland, Ohio, returned to RMC to raise his family in a close-knit community. Dr. Refai enjoys reading and spending time with his wife, Noura, and their four children.

The RMC team flags potential vascular problems for further testing, which has allowed more patients to receive treatment earlier. How is PAD diagnosed and treated? A: We perform a Doppler ultrasound, a painless, noninvasive test that checks the ankle’s opening blood pressure, and compare that to the arm’s blood pressure. Computed tomography angiography can also be used to detect narrowing or blockages. Treatments available include balloons and stents to open narrow or blocked arteries, or tools that remove or break blockages. I perform these minimally invasive procedures in RMC’s cardiac catheterization lab, and patients return home the same day.

How can I prevent PAD? A: Maintaining a healthy weight, staying active, not smoking, eating a healthy diet and controlling diabetes and high cholesterol can help manage PAD and lower your risk of developing the disease.

Ease leg pain!

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To make an appointment with Dr. Refai, call (256) 212-9300. Basel Refai, M.D., performs an ultrasound on a patient.

12 Fall 2009

Back on his feet RMC offers less-invasive hip surgery

t age 68, Harvey Partridge had yet to spend a night in the hospital. But all that changed in June when, while trying to remove his riding lawn mower from a utility shed, his mower rolled onto him and broke his right hip. The accident warranted a 9-1-1 call, surgery and a brief stay at Russell Medical Center (RMC). RMC’s medical staff performed X-rays to learn the extent and exact location of his injury. Mr. Partridge requested Paul Goldhagen, M.D., an orthopedic surgeon at RMC, to treat his fracture. Specialized approach Based upon Mr. Partridge’s age and activity level, Dr. Goldhagen determined he would be a good candidate for a total hip replacement using the Anterior Supine Intermuscular (ASI) technique, or anterior approach. This technique allows the surgeon to reach the hip joint from the front as opposed to the side (lateral) or the back (posterior) without cutting any muscle. This way, the most important muscles for hip function and stability are left undisturbed. This allows for a quicker recovery and less pain, and patients require minimal therapy after surgery. Fast recovery Conventional hip replacement usually requires that patients limit hip motion for six to eight weeks after surgery, which complicates normal activities like sitting in a chair, putting on shoes, climbing stairs or getting into a car. Patients who undergo anterior approach hip replacement enjoy a faster return to normal activities and can immediately bend below the waist and sit in low chairs and seats. After surgery, patients are instructed to use their hip normally, without cumbersome restrictions. “I was up using a walker right away, and when I went for a follow-up visit with Dr. Goldhagen he expected me to be using a cane, so I gave it a try,” says Mr. Partridge of his brief recovery. “It was all pretty easy.” By six weeks, he was walking without a

“Dr. Goldhagen is the ‘bone guy’ and an excellent doctor. I was very happy to have him help me out.” —Harvey Partridge, RMC patient

cane or limp and needed only one formal physical therapy session. Community care Now, just three months after surgery, Mr. Partridge is back to his normal daily activities with his wife, Myra, and keeps busy around the house. He appreciates having quality healthcare so close to home. “Dr. Goldhagen is the ‘bone guy’ and an excellent doctor. I was very happy to have him help me out,” says Mr. Partridge, who also credits the nursing staff with his quick recovery. “The nurses treated me like family. Coincidentally, I was in the National Guard with one of their fathers. You can’t find that in a big city.”

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Fall 2009 13

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Physician Referral Line (256) 329-7149

Community calendar

RMC’s fall classes and events

To register or for more information about these classes or events, call Sandra Patten, R.N., at (256) 329-7145.

Childbirth classes • Tuesdays, Oct. 6 to Nov. 3, 6–8 p.m. • RMC Community Room The cost is $60. Newborn class • Thursday, Nov. 5, 6–8 p.m. • RMC Classroom The cost is $25. CPR for infant and child • Tuesday, Nov. 10, 6–8 p.m. • RMC Community Room The cost is $25. Breastfeeding class • Thursday, Nov. 12, 6–8 p.m. • RMC Classroom The cost is $25. T.O.U.C.H. (Today our Understanding of Cancer is Hope) support group For cancer survivors and their loved ones • First Wednesday of each month, noon–1 p.m. • RMC Community Room

Dementia Support Group for Family and Caregivers • Third Monday of each month, 10–11:30 a.m. • RMC Community Room For more information, call the volunteer services department at (256) 329-7177. Diabetic support group • Thursday, Nov. 19, noon–1 p.m. • RMC Community Room

> You’re invited! The Women’s Center at RMC cordially invites you to a Breast Cancer Awareness Luncheon featuring keynote speakers Paul Ott Carruth, Sr., and his daughter, Carla Carruth Tigner, both breast cancer survivors. Thursday, November 5 Noon–1 p.m. Betty Carol Graham Technology Center Ballroom at Central Alabama Community College

Be there! For additional information and ticket requests, call Sandra Patten, R.N., at (256) 329-7145.