May 2013 Health Matters

HEALTHMATTERS To Help People Be Healthy

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May 2013

HaysMed Surgeons Provide Cutting-Edge Care and Treatment

HAYSMED

HEALTHMATTERS 10 4 From trauma to cancer, HaysMed surgeons offer full spectrum of care

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Bariatric surgery helps transform lives h

Cosmetic work creates patient p satisfaction

Area communities grateful for expertise

WE’RE HERE TO HELP

JAY MOORE, EXECUTIVE DIRECTOR OF PRACTICE ADMINISTRATION

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esidents of western and central Kansas are fortunate to have the knowledge and talents of the surgeons and physician assistants of Southwind Surgical and Graystone Cosmetic & Reconstructive Surgery available to them.

These eight providers are unparalleled in our region in their combined years of surgical experience and expertise. From all areas of general surgery to bariatric, reconstructive and cosmetic surgery to wound care and

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endoscopic procedures, patients can have these services performed close to home by skilled providers who know and care about them.

In addition to clinics in Hays, our surgeons travel to nine other Kansas communities, covering hundreds of miles every month so patients don’t have to travel. It is comforting to know these services are available to our patients in rural Kansas without the need for them to travel to Kansas City or Denver.

A helicopter prepares to land at HaysMed to pick up a patient for transport.

THE CUTTING EDGE TRAUMA, PREVENTATIVE CARE AND TUMOR REMOVAL ARE

AMONG SURGICAL SPECIALTIES

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ince 2006, a team of general surgeons at HaysMed has strived to offer western Kansas residents the best in cutting-edge surgical technology and quality care.

From removing cancerous tumors to emergency care for traumatic injuries, the surgeons offer many procedures to meet a wide spectrum of needs in the community.

As a certified level three trauma center, HaysMed has surgeons on-call 24 hours a day to respond to emergencies.

From farming accidents and car wrecks to exotic animal bites, the surgical team strives to save lives in the most severe circumstances.

“There are unique problems with rural trauma, mainly time of transport and resources,” said Dr. Charles Schultz, a genPAGE 4

eral surgeon and director of HaysMed’s trauma program. “Whatever we can do to advance the care of those patients is important.”

HaysMed acts as a referral center for western Kansas. Hays surgeons, whenever possible, provide the needed care, but in some cases must transport patients to larger facilities.

While Hays does not have a neurosurgeon on staff, the hospital collaborates with facilities that do and make arrangements for those patients with traumatic brain injuries to be transferred. Having an in-house neurosurgeon also is a requirement for attaining a higher level of trauma center designation.

While the hospital has always had staff on-call for emergencies, HaysMed achieved level three certification from the American College of Surgeons a year ago. The process of certification involves many protocols for care and staff coordination, and in many ways, takes trauma care “to the next level,” Schultz said.

“I think it shows our commitment to

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PLAY IT SAFE

To help your family avoid traumatic injuries: • Always wear a seat belt in a moving vehicle.

• Adults and children should wear bicycle helmets when riding bikes and motorcycles.

• Ensure children’s car seats are installed and used properly.

taking care of injured patients,” he said.

“We are a referral center for western Kansas, and trauma is a very important part of care for our population. Trauma oftentimes happens to people who are young and in the prime of their lives ... and it can be devastating.”

The accreditation is renewed every three years. HaysMed is the only certified trauma center in the region.

HaysMed staff also work to educate the community about trauma prevention.

HEALTH MATTERS

A dramatic presentation to warn teens against drunk driving is hosted at area high schools, and another initiative is in the works to help prevent falls, which are a common cause of traumatic injuries.

The state of Kansas also keeps a trauma registry, which tracks the causes of traumatic injuries and helps identify trends and prevention needs.

“That’s part of the initiative, is to make people aware,” Schultz said.

PREVENTATIVE CARE

As the saying goes, an ounce of prevention can go a long way.

Prevention is considered especially important in regards to one of the most prevalent types of cancer — colon cancer.

“If it’s caught early, it is a very treatable disease,” said Dr. Paul Teget, a general surgeon. “If it’s caught in later stages, where it gets outside of the colon and metastasizes to other parts of the body, it’s a more difficult cancer to cure.”

Colonoscopies are minimally invasive surgical procedures that use a scope with a light and camera on one end.

Doctors are able to get a clear and detailed view of the large intestine as they search for polyps, which are abnormal cell growths.

Seventy percent of polyps are benign, meaning they would not pose a cancer risk. However, there is a 30 percent chance polyps will degenerate and become colon cancer. Polyps are removed with the scope during the colonoscopy to prevent a polyp from growing into a cancer, Teget said.

“If you get them out, you don’t have to worry about them degenerating into a cancer,” he said. Even the benign polyps can cause problems. Some can become large enough to block the colon.

People age 50 and older are encouraged to undergo routine colonoscopies once every 10 years. Patients who have a first-degree family member diagnosed with colon cancer should begin screening 10 years earlier than the age of the youngest relative who was diagnosed.

They also should get screened every five years.

HEALTH MATTERS

A model colon.

TIP

FOR HEALTH In the words of Dr. Paul Teget, “only good things come from taking fiber.”

Not only has fiber proven to help keep the digestive tract regular, it is thought to prevent diverticular disease, boost the immune system and even help lower cholesterol.

The easiest way to boost fiber intake is to purchase a daily powder supplement that can be mixed with food and drink, Teget said.

If patients have a history of significant colon polyps from past colonoscopies, they might need to be screened more frequently. Based on these guidelines, most insurance companies will cover a colonoscopy.

Recovery time following a routine colonoscopy is minimal. Patients generally are told to take the remainder of that day off work and are asked not to drive since they are sedated for the procedure.

Most patients typically are in the hospital for only a few hours, Teget said.

Patients do, however, need to prepare for the procedure in advance. Doctors instruct their patients on how to perform a “bowel prep,” which is the process of cleansing the colon before the procedure.

Preparations generally include increasing consumption of clear liquids and also might include an enema or laxatives.

“If you’re going to go have your colonoscopy, the prep is the worst part,” Teget said. “And doctors are aware it’s not

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the most fun part, but it’s very important.”

Having a clean colon ensures doctors will be able to see any polyps or other abnormalities. While many colonoscopies are done at HaysMed annually, Teget said the numbers are not high enough.

“I think the general population doesn’t understand just exactly how important screening colonoscopies are,” he said. “We could do more to help prevent cancer if people would schedule a colonoscopy.”

ADVANCED TECHNOLOGY In addition to colonoscopies, advanced technology has made it possible for a wide variety of surgical procedures to be done as subtly as possible.

Whenever feasible, HaysMed surgeons opt for a minimally invasive approach using special tools and requiring only a tiny incision.

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Dr. Babu Prasad, radiation oncologist, Dr. Brandon Cunningham, surgeon, and Dr. Anne O’Dea, medical oncologist.

“It’s less painful and there’s fewer complications,” Dr. Zurab Tsereteli, a general surgeon, said. “It minimizes long-term complications, and recovery is almost twice as fast.”

Most abdominal surgeries can be done laparoscopically including hernias, gallbladder removal, stomach procedures, small and large bowel resections, and other procedures.

The laparoscopic approach requires surgeons to complete additional training.

Not all patients, and not all procedures, are good candidates for this minimally invasive approach, he said, noting pre-surgery evaluations help doctors determine how to proceed.

BATTLING CANCER

When patients are diagnosed with breast cancer, surgery often becomes an important part of curing the disease.

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“The desired result is to have each patient achieve the best cosmetic result while not compromising our ability to cure the cancer.”

Dr. Brandon Cunningham, general surgeon Four general surgeons at HaysMed often are called on to perform lumpectomies, a procedure to remove a cancerous tumor, and mastectomies, which involve removing the entire breast.

“Surgical management is required for a definitive cure,” said Dr. Brandon Cunningham, a general surgeon.

General surgeons work closely with medical and radiation oncologists, pathologists and the cosmetic surgeon to determine the best course of treatment for individual patients.

Factors such as tumor size and the aggression of the cancer help doctors decide which path to take, Cunningham said.

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When deciding between a lumpectomy and mastectomy, appearance can be another important factor, he said.

“The desired result is to have each patient achieve the best cosmetic result while not compromising our ability to cure the cancer,” he said.

“This required a multidisciplinary team approach and often we are able to give treatment such as chemotherapy or endocrine therapy prior to surgery so that breast conservation is still an option.”

Radiologists assist by providing images during lumpectomy procedures to help guide the surgeon and ensure complete removal of the cancer.

HEALTH MATTERS

Patients might need radiation or chemotherapy after a surgical procedure, but the amount of time needed to recover from surgery alone is minimal, Cunningham said. Some patients return to work less than a week after the operation.

In some cases, it is necessary to remove the entire breast. Patients sometimes even opt to have both breasts removed, which reduces the risk of recurrence by as much as 95 percent, he said.

Those who undergo a mastectomy have the option of reconstructive surgery, a process that continues for several months.

Staff also test breast cancer patients’ sentinel lymph nodes to determine if the disease has spread to the lymph nodes. If cancer is found, some patients undergo another surgery called axillary node dissection, in which the surgeon essentially removes the lymph nodes located in the armpit.

Axillary node dissection previously was considered a standard for breast cancer treatment. Recent studies, however, indicated the surgery was not always necessary and put patients at risk for developing lymphedema, or swelling of the arm.

“It can be very mild or very debilitating,” Cunningham said. “And if you can prevent a woman from having lymphedema unnecessarily, then we would do it every time.”

When choosing a breast surgeon, Cunningham said it is important for patients to research the facility they are considering and make sure they are able to provide the latest in cancer treatment.

HaysMed strives to stay on the cutting edge and offers a multidisciplinary approach to treatment, as well as a specialized breast center, he said.

“The surgeon’s very important, because you need somebody who’s going to get the tumor out,” he said. “You have to be at a place that can do the new procedures.

There’s places that can’t do sentinel node biopsies because they don’t have the ability. Then you’re going to possibly commit somebody to more surgery than they need.”

HEALING TOUCH

Outside of the operating room, the surgeons help operate HaysMed’s Wound Healing and Hyperbaric Center.

HEALTH MATTERS

Michelle Weigel, hyperbaric technician, readies a patient for hyperbaric oxygen therapy.

The specialized clinic is dedicated to the treatment of non-healing wounds, or wounds that are chronic or older than 30 days.

“We’re a referral center for all of northwest Kansas,” Dr. Anthony Hornick, a general surgeon, said. “From time to time, the outlying facilities have troublesome

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wounds that need to be addressed. We’re available and willing to assist them with these patients.”

Non-healing wounds can be caused by many underlying medical conditions, such as diabetes, insufficient blood flow or several types of ulcers.

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Weigel adjusts the setting on the hyperbaric oxygen chamber.

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When patients are diagnosed with a non-healing wound, they first are tested to help doctors determine the most effective treatment option.

Several treatment methods are available. Physicians can remove unhealthy tissue from the wound to optimize the healing process and can apply treatments such as skin substitutes, which encourage skin growth over the affected area.

If those methods fail, patients can be referred to the clinic’s hyperbaric unit, which opened in 2011. Patients spend time in hyperbaric chambers, which fill with pure oxygen under pressure. This treatment saturates the patient’s blood plasma with oxygen, which aids the healing process.

In some cases, surgery might be necessary to close the wound issue.

As HaysMed surgeons staff the wound clinic, patients have the advantage of continuity in care, Hornick said.

FYI Wound types treated at the Wound Healing and Hyperbaric Center include: • Any wound failing to improve with multiple treatments or therapies • Diabetic foot ulcers • Lower leg ulcers • Pressure ulcers • Bone infection (osteomyelitis) • Gangrene • Skin tears or lacerations • Late effects of radiation therapy • Post-operative infections • Slow or non-healing surgical wounds • Compromised skin flaps or grafts • Burns

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The most common wounds seen at the Hays facility are diabetic foot ulcers, Hornick said. Diabetes can cause poor circulation and lack of feeling in the feet.

“They’ll get a new pair of shoes, and because they don’t have feeling in their feet, they don’t realize they’re too tight,” he said. “They take the shoe off, and they have blistered toes. And they rapidly get infected.

“Or they’ll take a walk and not realize they’re hurting their feet walking too far.”

HaysMed physicians work closely with diabetic patients to educate them about the importance of wound care.

Those patients are instructed to examine their feet every day, he said.

It is important to catch diabetic foot ulcers early on, as the patient’s condition can deteriorate rapidly. Nearly half of patients who undergo amputations each year are diabetic.

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HEALTH MATTERS

Dr. Zurab Tsereteli and operating room nurse Marlis Norton, RN, prepare the tools needed for bariatric surgery.

Gaining control, losing weight

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usan Ault was desperate for a change.

Her type 2 diabetes was out of control, and she was taking up to 400 units of insulin each day in an attempt to regulate her blood sugars.

“I couldn’t get them controlled,” said Ault, who lives in the small town of Rolla in southwest Kansas. “I was eating like a bird and really trying to focus on what I was eating, and I couldn’t get the blood sugars down.”

That’s when a doctor suggested she look into bariatric surgery. After doing some research online, Ault decided to visit Dr. Zurab Tsereteli at HaysMed. She had a gastric bypass on June 26 in Hays. Since then, she’s lost 115 pounds and has not taken a single drop of insulin.

“The weight loss has been the icing on the cake,” Ault said.

“But just the feeling of not having to be on insulin anymore is an amazing feeling.”

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HaysMed bariatric surgery patient Susan Ault, before and after surgery.

BARIATRICS

HEALTH MATTERS

HaysMed offers three types of bariatric surgery: gastric bypass, lap-band and sleeve gastrectomy.

Gastric bypass is the procedure that usually results in the most weight loss. The stomach is reduced to about the size of an egg, and a portion of the upper gastrointestinal tract is bypassed.

“This is where most food and calories are absorbed,” Tsereteli said. “So by bypassing that, we are essentially causing malabsorption, so there are less calories absorbed.”

In the lap-band procedure, a small adjustable silicone band is used to create a small pouch at the top of the stomach, restricting the amount of food a patient can eat at one time.

The newest of the three procedures, sleeve gastrectomy, also involves reducing the stomach’s size. In this procedure, about two-thirds of the stomach is removed.

The procedures are done laparoscopically, a minimally invasive approach in which the surgeon uses special tools to operate through tiny incisions.

All of the procedures require significant commitment and lifestyle changes to be successful with surgery. Patients can consume only small amounts of food at a time and are taught how to ensure adequate nutrition at home.

HaysMed staff strive to offer comprehensive care, from the pre-surgery work-up to post-operative maintenance.

When a patient is preparing for surgery, requirements include evaluation from HaysMed’s on-staff dietitian and psychological evaluation. Patients meet with exercise specialists to HaysMed physicians Drs. Paul Teget and Zurab Tsereteli prepare plan for before and after surgery, and any underlying medito perform a surgery. cal problems are evaluated to ensure the patient is healthy enough for the procedure.

Since 2008, Tsereteli has been helping patients like Ault by “It’s not just surgery; how we prepare patients for surgery offering three types of bariatric surgery, which helps patients is important for the outcome,” Tsereteli said. “So we do a very battling morbid obesity to achieve their desired weight loss lengthy and meticulous work-up.” and offers other medical benefits.

Follow-up care is also critical. Patients “Diabetes, sleep apnea, high blood are typically hospitalized for a few days pressure, dyslipidemia, infertility — a lot Free seminars are available the first after the procedure. Follow-up examinaof different conditions can be associated Tuesday of every month for patients tions are scheduled regularly once they with morbid obesity,” Tsereteli said, notinterested in bariatric surgery. For return home. ing there are approximately 200 medical more information, visit The care model used at HaysMed is esconditions linked to obesity. www.haysmed.com/bariatrics. sentially the same used at larger surgery The long-term weight loss associated centers, but patients have the added with the surgery alleviates other sympadvantage of more personalized care. toms. Some patients, such as Ault, are “It’s more accessible care and also one-to-one patient care,” able to stop or reduce the amount of insulin they need to reguhe said. “We know our patients, and we take care of them.” late diabetes. Others are able to quit taking medications for That support has made a significant difference for Doug high blood pressure or sleep though the night without sleep Malay, who underwent bariatric surgery in late May. apnea symptoms.

Malay, a resident of WaKeeney, has lost nearly 150 pounds Patients with a body mass index score of 40 and above autoand reduced the number of medications he takes from 17 to matically qualify for a procedure. Surgery also can be done for four. patients who have a BMI of at least 35 and are suffering from a His success, he said, is largely due to the care he has reco-morbid condition. ceived from HaysMed staff. He appreciates being in close Bariatric surgery involves reducing the size of the patient’s proximity to his surgeon and knows staff members are only a stomach, meaning they do not need to eat as much after phone call away whenever he has questions or concerns. surgery.

“There are wonderful people in this office and they support “We offer them this type of surgery when they fail to lose you,” he said. “With all the support systems, it makes it hard to weight with other means, like exercising, dieting and medicafail.” tions,” Tsereteli said.

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FYI

HEALTH MATTERS

BARIATRICS

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Dr. Kirk Potter and Jannelle Savickas, physician’s assistant, tend to a patient in the Graystone Cosmetic and Reconstructive Surgery Clinic.

Creating satisfaction

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r. Kirk Potter joined HaysMed’s staff in 2008, becoming the first plastic and reconstructive surgeon based in northwest Kansas. His clinic, Graystone Cosmetic & Reconstructive Surgery, offers patients a wide array of surgical and non-surgical treatments to help enhance patients’ lives.

One of the most popular services offered at Graystone is breast reconstruction surgery, which is offered to patients who have had a breast surgically removed, most often due to cancer.

Breast reconstruction is the process PAGE 12

of surgically forming a new breast, either by using synthetic breast implants or transferring tissue from elsewhere in the body.

The procedure can be started immediately after the mastectomy or at a later time.

There are two types of breast implants available: saline water and silicon gel. Both have been approved for use by the U.S. Food and Drug Administration and do not pose a safety threat, Potter said. Silicon gel is more expensive, but it tends to have a more natural feel, he said.

COSMETICS

Patients also have the option of nipple reconstruction and “tattooing,” which is the process of using permanent ink to make the nipple and areola the correct color.

Patients also have the option of undergoing a procedure, such as surgical reduction or augmentation, on the other breast to ensure symmetry.

For breast cancer patients, the entire procedure is covered by insurance, Potter said.

United States law mandates all insurance companies must offer reconstruction to breast cancer patients.

HEALTH MATTERS

Abdominoplasty/Tummy Tuck The tummy tuck procedure (abdominoplasty) is a powerful and popular procedure performed at Graystone Cosmetic & Reconstructive Surgery. It is designed to remove unwanted skin and tissue from the abdomen and tighten abdominal muscles.

The end result is a flatter, smoother stomach and a more attractive figure. In some cases, abdominoplasty is performed in conjunction with liposuction and various body lifting procedures for

a more comprehensive treatment.

Potter works with each tummy tuck patient to determine the best way to achieve his or her goals.

Abdominoplasty can be performed under general or local anesthesia, depending on the patient.

The tummy tuck procedure begins with an incision along the patient’s bikini line. The navel is cut away from the abdominal skin and reattached after the skin has been repositioned.

After moving and suturing the abdominal muscles to make them tighter, the abdominal skin is stretched downward, and excess skin is trimmed away, creating a new hole for the navel.

Finally, the skin is stretched into place, where it will heal during recovery.

Depending on how much tissue is removed, some patients could spend the night in the hospital after surgery.

Stitches will be removed after approximately a week.

Most patients are able to return to work after no more than two weeks, but it could take a month or more to feel completely normal again and see the full benefits of the abdominoplasty.

Tummy tuck patients need to wear special compression garments under their clothes to promote healing and prevent complications, such as blood clots, that could arise during recovery.

Dermatology The clinic also helps patients who are concerned about potentially cancerous spots on their skin.

Often the first step is to biopsy the affected area to determine whether cancer is present. When cancer is found, it is necessary to remove the lesion.

Excision procedures sometimes can be done in the patient clinic. If a large area of the body is affected, it often becomes necessary for the patient to undergo more extensive surgery.

“If it’s a delicate area such as an eyelid, nose, lips or ears, sometimes different labs or grafts need to be performed,” Potter said.

Potter works closely with HaysMed’s oncologists to help the patient obtain any follow-up treatments that are needed after surgery. Those options include radiation therapy.

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Breast reduction is another procedure that can offer patients several health benefits. Women with large breasts often experience symptoms such as chronic pain in the neck, back and shoulders, or rashes on the chest.

Those complaints can be alleviated by surgically reducing the size of the breasts.

“This is a surgery that has a very high rate of satisfaction,” Potter said. “They decrease the weight and are able to do things they used to not be able to do, secondary to the pain.”

Operating room staff at Phillips County Hospital include David Grey, CRNA; Angie Babcock, RN scrub technician; Jodie Bretz, RN operating room nurse; Connie Reese, CNA scrub technician; Dr. Charles Schultz, MD; Dave Engel, hospital administrator; Kelly Bohl, RN operating room manager; and Kim Reynolds, CNA.

Surgeons hit the road to fill needs

HEALTH MATTERS

They also perform some outpatient surgeries, such as colonoscopies, EGDs and various lesion removals. When the equipment is available, surgeons offer laparoscopic procedures, such as hernia repairs and cholecystectomies (gallbladder removal).

There even have been cases when emergency procedures have been performed during outreach clinic hours, he said.

“Occasionally, I’ve been in an outreach clinic and somebody will come in with acute appendicitis, and I happen to be there,” Schultz said. “That happens once in a while, but it’s pretty rare.”

Most of the time, surgeons partner with local community hospitals and use their operating room staff for the procedures.

More extensive procedures and open surgeries still need to be performed in Hays, Schultz said, noting some patients with underlying health issues also are sent to HaysMed.

OUTREACH

“If somebody has a need for a specialist, they’re right there available for us,” he said. “A lot of these people already have relationships with cardiologists and other doctors, so that works out really well.”

HaysMed staff strives to keep constant communication with outlying communities to identify any medical needs, Schultz said. When a need is identified, efforts begin to establish a new outreach location.

Sometimes staff at a community hospital reaches out to HaysMed for help.

That was the case when Phillips County Hospital in Phillipsburg lost its longtime general surgeon last year.

It was important for patients to still have surgery services available in Phillips County, said hospital CEO Dave Engel.

“Part of it is we’re dealing with individuals who need services, and they have some traveling restrictions or just don’t feel comfortable going to a larger area,” Engel said. “It’s a service that’s definitely needed.”

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hile many patients travel to HaysMed for surgical services, Hays physicians also go to them.

Outreach clinics in nine surrounding communities enable western Kansas residents to access health care close to home, said Dr. Charles Schultz, a general surgeon.

“We have an elderly population in western Kansas. It’s hard for people to travel, and they appreciate us coming to them,” he said. “It’s fun, because the people really appreciate it.”

Schultz has been doing outreach clinics since he began practicing medicine in Hays 22 years ago.

Several Hays surgeons participate in the outreach program, traveling to each hospital monthly. Some hospitals are able to offer surgeons three weeks each month.

During outreach clinics, doctors maintain office hours and visit with new and returning patients.

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