@ SURGERY BY THE NUMBERS
196,000 The estimated number of people in the U.S. who had
BARIATRIC (weight-loss)
SURGERY IN 2015, the latest year for which data is available. American Society for Metabolic and Bariatric Surgery
SPRING 2016 SUMMER 2017
Small cuts, big results HOW OUR SURGEONS USE TINY CAMERAS AND TOOLS TO MAKE SURGERIES A SUCCESS Just about any surgery done by Dr. Ram is going to involve a camera. Dr. Ram is the nickname of Prashanth Ramachandra, MD. He is the Mercy Bariatrics Clinical Director and Chair of the Surgery Department at Mercy Fitzgerald Hospital. And there’s almost no surgery he and
his team can’t perform laparoscopically. Laparoscopic Prashanth surgery is also Ramachandra, MD called minimally invasive surgery. Rather than one big — Continued on page 2
IN THIS ISSUE
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KIDNEY STONE RELIEF Find out how kidney stones are treated—and prevented.
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HOME HEALTH Care at home can help you stay independent.
CHECK IT OUT We offer a wide range of surgical services. Read more at mercyhealth.org/surgery.
Small cuts, big results — Continued from front page incision, the surgeon makes several small cuts. Through one cut he inserts a thin scope with a tiny camera attached to the end. He inserts small tools through the other cuts. Then he watches through the camera as he performs surgery with the tools. “There are very, very few times when we can’t do a surgery laparoscopically,” Dr. Ramachandra says.
A faster recovery That’s good news for patients. The tiny incisions used in this type of surgery mean less trauma and pain for the patient. “The patient spends fewer days in the hospital and gets back to work or other activities much more quickly,” Dr. Ramachandra says. The most common surgeries done this way include gallbladder removals and hernia repairs. But Dr. Ramachandra and his team also do many complex surgeries using small incisions and a camera. “We do a lot of surgeries laparoscopically that are generally not done that way at other hospitals, such as liver and major cancer resections,” he says. “We definitely have a lot of experience. And our patients do very well. We have very few complications.” So if you’re referred to Dr. Ramachandra’s team for surgery, smile. You’ll be on camera— and back in action in no time.
Questions to ask before surgery Has your doctor suggested you have laparoscopic surgery? If so, you probably have a lot of questions. Below are some you should ask your surgeon, according to Prashanth Ramachandra, MD, the Mercy Bariatrics Clinical Director and Chair of the Surgery Department at Mercy Fitzgerald Hospital. Prashanth Ramachandra, MD How many surgeries do you
1
perform laparoscopically?
2
The percentage of women in the U.S. diagnosed with early-stage (I or II) breast cancer who
58
opt to have
BREAST CONSERVING SURGERY
(also known as a lumpectomy). American Cancer Society
2
More @ Mercy Summer 2017
How many complex laparoscopic procedures do you do per month? Dr. Ramachandra says a good number is “at least 20 to 25 a month.”
3
How often do you begin a surgery laparoscopically but then convert to traditional surgery? This is called a conversion rate. It should be a low number.
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How often have you done this specific surgery? “There are some surgeries that aren’t done very often simply because the disease is rare,” Dr. Ramachandra says. “For example, gastric cancer is rare. So surgery for gastric cancer is not common. But if the surgeon is doing a large number of advanced laparoscopic surgeries, he or she can handle the rarer surgeries with ease.”
URINARY INCONTINENCE
Finding the right surgical solution From holding back a hearty laugh to avoiding favorite activities, some women limit how they live their lives because they fear they might leak urine. But women need to know this: “Urinary incontinence can be treated,” says Noah May, DO, a urologist at Mercy Fitzgerald Hospital. “You just need to ask for help.” Simple solutions—like changing bathroom habits or learning Kegel exercises to strengthen pelvic floor muscles—can often make a difference. But if those don’t work, then surgery may be the next step, Dr. May says.
When is surgery needed? The right surgical treatment depends on the type of bladder-control problem. Stress incontinence. This type of urinary incontinence is triggered
Noah May, DO
by things that put pressure on the bladder, like coughing, laughing or sneezing. Surgery may be recommended if a woman has moderate to severe leakage despite trying treatments such as Kegel exercises or if she uses multiple pads a day just to keep dry. A sling procedure is the gold standard for surgery, Dr. May says. A doctor uses a natural or synthetic material to create a supportive hammock for the urethra (urine tube). This reduces or prevents leakage. Urge incontinence (overactive bladder). Women with this condition may leak urine when they have strong urges to go. One surgical option is an implanted sacral neuromodulator stimulator—a sort of pacemaker for the bladder. The device uses electrical nerve stimulation to help calm the bladder muscles.
“It’s very useful for severe urge incontinence that doesn’t respond to medicines,” Dr. May says.
Speak up Don’t feel embarrassed to talk about urinary incontinence—it’s very common. “And we have good solutions for it,” Dr. May says.
NEED A UROLOGIST? To find a Mercy urologist near you, call 1.877.GO MERCY (1.877.466.3729).
The lowdown on treating kidney stones Passing a kidney stone can be a serious pain—literally. Medicines can reduce the pain or make it easier to pass a kidney stone. And most do pass on their own without too much trouble. But sometimes a stone will get stuck and block urine flow, causing severe side or back pain. When that happens, medical help is needed to break up the stone or surgically remove it. “We can treat any type of stone a person may have,” says Noah May, DO, a urologist at Mercy Fitzgerald Hospital. “And in most cases you can go home the same day.” According to Dr. May, there
are three main ways to remove troublesome stones: Shock wave lithotripsy. Sound wave pressure is used to break stones into bits that are easy to pass. Ureteroscopy. A doctor uses a small scope to locate a stone inside the urinary tract and blast it with a laser. The pieces of stone are then removed. Percutaneous nephrolithotomy. Large stones are removed through a small incision in the back.
1 2 3
What exactly is a stone? Kidney stones typically form from
minerals (such as calcium oxalate or uric acid) in urine. Not drinking enough fluids or eating a diet rich in animal protein or salt are some things that may increase the risk of developing a stone. Once you’ve had a stone removed, your doctor can test it to find out what type it is. Then you will know what changes you need to make to your diet to help prevent future stones. mercyhealth.org
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Committed
to helping women
MAKE THE CALL To schedule your annual mammogram, call 610.237.2525. You must have a prescription from your doctor.
MEET DR. KISH, OUR NEW BREAST SURGEON It’s not every doctor who describes caring for patients as an honor. But those are the exact words Karen Kish, MD, a breast surgeon at Mercy Fitzgerald Hospital, uses. As a breast surgeon, Dr. Kish routinely treats women who need biopsies to determine if they have breast cancer, along with women who need her surgical skills to treat the disease. “And every day, these women inspire me with their strength,” she says. “It is a true honor to care for them.”
Karen Kish, MD
Dedicated to healing Helping people has always been a priority for Dr. Kish—that desire and a love of science are why she became a doctor. She earned her medical degree at Drexel University and completed her
residency at Abington Memorial Hospital. Board certified in general surgery, she arrived at Mercy Fitzgerald Hospital last October with several years of experience as a breast surgeon.
Putting women first Why breast surgery? “I just have a passion for women’s health—and helping guide women through cancer,” she says. Dr. Kish is also the mother of three young daughters, ages 5, 7 and 8. And this only deepens her commitment to caring for women. And here’s what she’d like all women to know about breast cancer: “We have more knowledge than ever before about this disease,” she says. “And that means we can offer women highly effective treatments.”
BREAST CANCER: BY THE NUMBERS
89.7 4
%
The majority of women who get breast cancer will survive five years or more after being diagnosed.
More @ Mercy Summer 2017
55–64
It’s most frequently diagnosed among women in this age range.
3-D MAMMOGRAPHY
A better view for finding breast cancer Mammograms save lives They do that by finding cancerous breast tumors when they’re still too tiny for a woman or her doctor to feel. And they can give women a potentially lifesaving head start on treatment. But mammograms aren’t perfect. They don’t find all breast cancers. That’s why Mercy Fitzgerald Hospital is now offering women an advanced form of breast imaging not yet available at all hospitals: 3-D mammography. “It helps doctors catch more cancers at an earlier stage,” says Karen Kish, MD, a Mercy Fitzgerald Hospital breast surgeon.
Better images, fewer callbacks As a woman, you won’t notice much difference between 3-D mammograms and standard 2-D ones—they feel the same. The difference is that standard mammography only takes images of the breasts from two angles. In contrast, 3-D mammography produces multiple three-dimensional images, taken from several angles. Doctors are able to see separate slices of breast tissue and spot small tumors that otherwise might be hidden, says Scott Rotenberg, MD, Section Head of Breast Imaging at Mercy Fitzgerald Hospital. Still another plus: Better imaging cuts down on the number of women called back for more tests because of a suspicious finding. Although additional testing usually reveals everything is OK, the experience makes many women understandably anxious. Given its many benefits, 3-D
mammography is a good choice for any woman. But it’s especially beneficial for women with dense breasts, Dr. Rotenberg says. Dense breasts make it harder to detect cancer in mammograms, and 3-D mammograms increase their accuracy.
Our accredited breast care program 3-D mammography is just part of Mercy Fitzgerald’s breast care program, which earned accreditation from the National Accreditation Program for Breast Centers (NAPBC). Receiving care at an NAPBCaccredited center ensures that patients have access to a full continuum of care from early diagnosis to survivorship; a multidisciplinary team to coordinate the best treatment options; and clinical trials. The NAPBC-accredited program also expands responsibilities for Mercy Fitzgerald’s Oncology Nurse Navigator, Joy Hepkins, BSN, RN, OCN. Joy assists any woman with abnormal mammogram results— answering questions, easing fears and coordinating care. Previously, she only assisted women with an actual diagnosis. “Most women are pleased when a nurse navigator is present at a mammogram or follows up with them for the biopsy after a diagnostic mammogram,” Joy says. “They feel that you stand as an advocate— someone who has knowledge and experience and can better explain, guide and prepare them, while reassuring and giving support. And not just for that time, but ongoing
WE MAKE IT EASY TO GET A MAMMOGRAM Every Wednesday, Thursday and Friday from 8:00 a.m. – 4:00 p.m., Mercy Fitzgerald Hospital offers walk-in screening mammograms for women 35 years and older. No appointment is necessary. All you need is a signed prescription from your doctor, along with your insurance card and photo ID.
into the continuum of care.” Mercy Fitzgerald is also designated as a Breast Imaging Center of Excellence by the American College of Radiology for digital mammography, breast ultrasound, stereotactic biopsy and breast MRI.
4 steps for a better mammogram Time for a mammogram? Whether this is your first test—or you’re a veteran of the screening—remembering these four steps will help everything go smoothly: Schedule smart. Arrange a time when your breasts aren’t typically tender or swollen. If you haven’t gone through menopause yet, that’s usually the week after your period. Skip the deodorant. It can show up on mammograms as white spots. Show up prepared. If you’ve had a mammogram elsewhere, bring the past images with you. That way the old images can be compared to the new ones. Share information. Tell your mammogram technician if you have any breast changes or problems or a history of breast cancer.
1 2 3 4
Source: American Cancer Society
mercyhealth.org
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Make the most of your medications
HOME HEALTH
When you need a little help at home When you’re ready to leave the hospital but you’re not quite ready to be on your own at home, Mercy Home Health has got your back. Maybe you’ve had knee surgery and need help learning how to get in and out of the shower. Or you’ve left the hospital with a new list of medicines that you’re not sure how or when to take. Whatever the reason, you just need a little medical help so you can stay at home. “That’s our goal—to help patients remain independent in their homes,” says Jayne Green, MSN, RN, Regional Director of Mercy Home Health. Sometimes that means: •• Sending a nurse to someone’s home several times a week to care for a wound •• Having a nurse teach someone how to use a catheter or check a surgical drain •• Providing home health aides to help someone with personal care
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More @ Mercy Summer 2017
Family members can also be coached to help care for their loved ones at home. “For instance, our nurses can teach them about the patient’s incision and how to look for signs of infection,” Jayne says. Mercy Home Health does a full checkup on each patient referred for services. “Then we develop a plan of care so we can manage the patient in their home,” Jayne says. Most people are referred to Mercy Home Health by the hospital, their doctor or a nursing facility. Ask your doctor if you think you need our home health services, or simply give us a call to chat about how our services might benefit you or a family member.
EXPERTS IN HOME CARE Call us at 1.888.690.2551 to learn more about Mercy Home Health.
Sometimes, getting and staying healthy means taking medicine. But that medicine may do more harm than good if you don’t take it just as your doctor orders. Keep in mind a few basic rules that can help you get the most out of your medicine, says Catherine Zaccario, RN, a nurse with Mercy Home Health. “Don’t skip doses,” she says. “Don’t take more or less than what your doctor prescribes. And don’t stop taking the medicine without talking to your doctor first.” That’s for starters. In addition, if it’s hard for you to take your medicine as needed, these tips may help: •• Take your medicine at the same time each day. Make it part of your routine—for example, you might take meds when you brush your teeth in the morning. •• Use a pill organizer to sort your medicines by day of the week or time of day to take them. Or use a pill chart or calendar to keep track each time you take a dose. •• Ask your doctor what to do if you accidentally miss a dose. •• Talk to your doctor if you are having trouble paying for your medications. There may be options to help make them more affordable.
Exercise and rest A PRESCRIPTION FOR LIVING WELL WITH HEART FAILURE When you’re living with heart failure, it’s good for you to move— but sometimes you need to take it easy too. The right mix of physical activity and rest may help you live better with the condition. It may give you more energy and reduce some of your symptoms. And regular exercise may even help your heart work better.
Make a safe move
WE CAN HELP Interested in how Mercy Home Health can help you or a loved one? Call 1.888.690.2551 or visit mercyhomehealth.org.
“Exercise is safe for most people with heart failure, but you should ask your doctor or nurse what types and amounts are right for you,” says Mindy Hillerman, a physical therapist with Mercy Home Health. When you are ready to be active, start slowly—even five minutes a day is fine until you can do more. Also try these tips: •• Choose activities you enjoy. Walking is a heart-healthy exercise, and it’s easy to get started.
You can do it!
when you feel most energetic, such as in the morning. •• Ask a friend or loved one to join you. You can encourage each other to stick with an activity.
Rest well While it’s important to stay active, it’s also important to rest when you need it. “Fatigue is a common problem for people with heart failure,” Mindy says. Here are some suggestions for fighting fatigue: •• Plan your day so that you alternate periods of being active with periods of rest. •• Put your feet up for a few minutes every few hours. •• If you struggle to sleep at night, avoid naps and large meals close to bedtime.
Be aware too that the sooner you bring up a concern, often the easier it is to treat. “Why let months go by when you could be getting help right now?” Dr. Raziano asks.
NO TOPIC IS TABOO WHEN TALKING TO YOUR DOCTOR It may not be easy to talk to your doctor about a health concern that seems sensitive or even embarrassing—say a sexual problem, a bowel issue or your alcohol use. But it’s crucial that you have the conversation. That’s because your doctor can’t treat a problem he or she doesn’t know exists. And it’s why no topic— no matter how private—should be off limits. It might help to know that doctors genuinely care about their patients’ well-being. “If something is bothering you, we sincerely want to help,” says Donna Raziano, MD, Chief Medical Officer of Mercy Home Health.
•• Pick a regular time to exercise
Getting comfortable
And while it’s your role to share information, it’s your doctor’s role to be nonjudgmental. Plus, doctors see many patients with many different problems. “So while you may feel that your symptom or concern is unique, your doctor has heard it before—and chances are, often,” Dr. Raziano says.
Opening up about a sensitive subject may be easier if you see your doctor for regular checkups—and not just when you’re sick. That way you may feel more relaxed discussing private things. But if you’re still hesitant, bringing up your concern may be as simple as saying, “Doctor, there’s something that’s bothering me.” Once those words are out, you may find the rest of the conversation flows naturally. You’ve opened a door, and that’s frequently the hardest step. mercyhealth.org
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MFH
INGUINAL HERNIAS
When and how AND
they’re treated
About 2 percent of all people will develop a type of hernia in their groin called an inguinal hernia. Men are 25 times more likely to have one than women. An inguinal hernia happens when tissue—often part of the small intestine—bulges through a weak spot in the lower wall of the abdomen. Leon E. Clarke, MD, a general surgeon at Mercy Fitzgerald Hospital, answers questions about this most common type of hernia. What causes an inguinal hernia? Answer: Some people are born with a weakness in the abdominal wall that develops into an inguinal hernia. But one can also occur
Q
later in life as the muscles of the abdominal wall weaken.
Q
What are the symptoms?
Answer: There may not be any. But when they occur, they usually include a lump in the groin area and a tugging or pulling feeling. That discomfort often gets worse with coughing, lifting or straining. But it goes away with rest. Sometimes part of the intestine may get trapped within the hernia and cause sudden pain that doesn’t go away, redness, nausea and vomiting. These are signs of a potentially life-threatening problem that needs emergency treatment. Call your doctor or 911 immediately if you experience them.
Leon E. Clarke, MD
How are hernias typically treated? Answer: Small hernias with no symptoms may not need any treatment—just close monitoring. But surgery is usually advisable for larger hernias or ones that cause symptoms. During surgery, doctors push back the bulging tissue and strengthen the abdominal wall. Surgery is often done using several small incisions—rather than one large cut—which speeds healing and eases pain.
Q
NEED A DOCTOR? You can search by specialty, name or location at mercyhealth.org/find-a-doctor.
MORE @ MERCY is published as a community service for the friends and patrons of Mercy Health System. Information in MORE @ MERCY comes from a wide range 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 and illustrations. If you would like to stop receiving this publication, please email IAtMercy@mercyhealth.org. 2017 © Coffey Communications, Inc. All rights reserved.