Inside this folder:
Consult Winter 2012 | Only Ohio State
Contents 3 Breast Cancer Program 9 Comprehensive Spine Center 15 Imaging Services 21 Men’s Sexual Health 27 GI and Gastrointestinal Surgery 31 Diabetes in Pregnancy Program 35 Urology Practice Tool 37 Plus updates on our Cranial Base Clinic, Concussion Management Program and more
4 breast cancer program
5 breast cancer program
6 breast cancer program
7 breast cancer program
8 breast cancer program
Ohio State’s
Consult Ohio State’s Comprehensive Spine Center
Collaborative Care for the Back and Neck w Multidisciplinary, interdisciplinary atmosphere w Prompt access, efficient diagnosis w Treatment ranging from therapy to interventions to surgery w Full complement of pain management techniques w Focus on returning patients to normal function as quickly as possible
Comprehensive Spine Center Medical Director: Gary Rea, MD, PhD
The Spine Center promotes patient involvement in treatment decisions. “Patients should be provided with the appropriate information, including possible outcomes, so they can make informed decisions about treatment options,” says Dr. Rea. “Our approach is not paternalistic. We want patients to be fully engaged in decision-making.”
The Comprehensive Spine Center at The Ohio State University Wexner Medical Center features spine care in a multidisciplinary atmosphere, with enhancements focused on prompt access, efficient diagnostic processes and individualized care aimed at returning patients to normal function. Specialists from the following disciplines collaborate to resolve spine-related problems with diagnostic testing, imaging, pain management, surgery and rehabilitation in a single location at our new CarePoint East facility: • Orthopaedic Spine Surgery • Neurologic Spine Surgery
With a new, more spacious location and on-site access to two non-operative neurosurgeons, three operative neurosurgeons, two orthopaedic spine surgeons, five physical medicine and rehabilitation physicians, and five anesthesia/pain specialists, patients at the Comprehensive Spine Center enjoy more immediate access to care. “We see patients quickly, direct them to the appropriate specialty care and get them on the path to improvement so they can return to work and normal functioning as soon as possible,” says Dr. Rea. In addition to providing patient evaluation, diagnosis and treatment, professionals in the Spine Center are happy to provide second opinions for patients who are considering surgery.
• Physical Medicine and Rehabilitation • Anesthesiology/Pain Medicine The care is multidisciplinary and interdisciplinary—a truly collaborative, combined approach.
Nonsurgical Treatment “A rehabilitation physician can walk down the hall and consult with a surgeon while the patient is still in the Spine Center to agree on a direction for care,” says Gary Rea, MD, PhD, a neurosurgeon and director of the Comprehensive Spine Center. “In a single visit, a patient can have diagnostic testing, receive a pain injection and see a spine surgeon. There’s no need to wait to be referred to multiple physicians. A referral to the Comprehensive Spine Center opens the door to spine-focused specialists and even integrative, nontraditional services such as medically restorative massage, aquatic therapy and acupuncture.”
Rapid Access and Treatment Plans Most Spine Center patients see nonsurgical physicians for a comprehensive evaluation. These physicians determine if patients need to see a surgeon. When surgery is necessary, many procedures can be performed within two weeks.
Nonsurgical treatment in the Spine Center involves specialists from Physical Medicine and Rehabilitation and Anesthesiology/Pain Medicine. Patients who have neck or back pain that has not responded to traditional treatment in four to six weeks are appropriate referrals. Before interventions are employed, other means of treatment are exhausted as appropriate to the patient’s condition. Physical Medicine and Rehabilitation (PM&R) physicians assess patients and develop nonsurgical treatment plans, including physical therapy, exercise and medication. PM&R specialists work closely with their Spine Center colleagues in Anesthesiology/ Pain Medicine and Orthopaedic and Neurologic Surgery. When patients do not respond to conservative measures, they may be candidates for interventions. Physicians who specialize in interventional procedures in the Spine Center are board-certified or board-eligible. They use technology advances to treat spine pain, including fluoroscopic imaging with X-ray to safely pinpoint medication injection. Digital subtraction angiography helps to ensure medication is targeted.
10 Comprehensive Spine center
“We have extensive training in interventional spine procedures and use sophisticated technology to provide the safest possible injection therapy,” says Kenneth Nguyen, DO, a physical medicine and rehabilitation and pain management specialist. “When patients are having pain medication injected in the spinal area, the experience of the physicians is important. Our six interventionalists are fellowship-trained and board-certified, which should be an absolute requirement for this type of treatment.”
fellowship training. “I wanted to practice at Ohio State upon completion of a fellowship in pain medicine at Loyola,” he says. “I wanted to be part of the resident training, research and large patient base that Ohio State afforded me. Also, the comprehensive approach at the Spine Center was of great interest. The focus is on doing what is best for each and every individual patient, not what is easy or popular. We practice evidence-based medicine with a personalized approach.”
meeting a huge demand
Surgical Treatment
Dr. Nguyen completed his residency at Ohio State, followed by a fellowship in Detroit, before returning to Ohio State. “Exciting things are happening at the Medical Center, and I wanted to be part of the growth and expansion,” says Dr. Nguyen. “The new Spine Center is meeting a huge demand for comprehensive spine care. We have the technology and expertise and high degree of collaboration among specialists to provide the best care available anywhere.”
Ohio State’s Spine Center provides the most advanced surgical interventions when surgery is determined to be appropriate for conditions including:
Nonsurgical treatment available in the Spine Center includes: • Physical therapy
Minimally invasive spine surgery with minimal tissue damage is increasingly popular, and provides patients with reconstructive back procedures with much less damage to muscles and ligaments. Several surgeons in the Spine Center are trained and experienced in these minimally invasive techniques. Jim Thoman, MD, who trained at Ohio State and then did fellowship training in minimally invasive procedures, joined the Spine Center staff in February 2012.
• Herniated cervical or lumbar disks • Cervical or lumbar stenosis • Scoliosis • Deformity correction
• Electromyography • Functional discography • Lumbar traction with electrical stimulation • Trigger point injections • Epidural steroid injections
Dr. Rea provides guidance for surgical intervention. “About 97 percent of people with spine problems do not need surgery or injections and will improve on their own,” he says. “Even if patients have herniated disks, approximately 85 percent of them will improve without surgery. We offer excellent nonsurgical treatment.”
• Intra-articular injections • Sympathetic nerve blocks • Spinal cord stimulation • Radiofrequency ablation • Cooled radiofrequency ablation
Dr. Rea advises consultation in these cases:
• Implantable intrathecal drug delivery systems
• Patients with acute neck and arm pain
• Vertebroplasty
• Patients with acute back and leg pain
Raj Swain, MD, an anesthesiologist and pain medicine specialist in the Spine Center, uses fluoroscopy to guide nerve ablation in cooled radiofrequency ablation procedures to treat lumbar spine pain. “We are one of a few facilities offering cooled radiofrequency ablation, in which the patient is under anesthesia during the ablation procedure. This procedure is performed in the hospital, with excellent patient comfort and outcomes,” he says. Dr. Swain has extensive experience with cooled radiofrequency ablation and is one of the leaders nationally using this technique.
• Patients older than 65 with pain in the back and down the legs “Surgery for a herniated disk may be a reasonable choice for patients who are miserable and who either have waited to see if it resolves over time or cannot wait due to intensity of pain,” says Dr. Rea. “One condition that tends to respond better to surgical intervention than nonsurgical treatment is lumbar stenosis,” says Dr. Rea. “Typically, these patients are older, have severe pain when walking or standing and have lost mobility.”
Like Dr. Nguyen, Dr. Swain completed a residency in anesthesiology at Ohio State and returned after his 11
Comprehensive Spine center
New Specialist Treating Complex Spinal Disorders Safdar N. Khan, MD, a recent addition to Ohio State’s Wexner Medical Center, specializes in complex adult and pediatric spine and spinal deformity surgery.
Dr. Khan treats the following conditions: • Simple and complex trauma: cervical fractures, thoracolumbar injuries
• Spinal stenosis • Spondylolisthesis • Kyphosis
• Scoliosis (adult and pediatric)
Many spinal conditions often go untreated for years, until patients become so debilitated that treatment options become limited. Adult scoliosis patients often develop arthritis, bony spurs that press on the spinal cord, as well as pain and deformity, complicating a condition that is already difficult to manage.
• Spinal deformity (adult and pediatric) • Herniated discs
• Spinal tumors • Spinal trauma
CASE ST U D Y
“I am confident that regardless of what spinal problems a patient is experiencing, we can provide treatment options that will help the patient better manage their condition,” says Safdar N. Khan, MD. “We have the ability to evaluate each patient and make sure he or she receives the best treatment, even if other physicians have been nervous about recommending additional treatments or procedures.”
A 19-year-old man came in with complaints of upper back pain and presented with untreated adolescent idiopathic scoliosis and a stiff 70 degree thoracic curve that was also hyperkyphotic (increased forward curvature) in the thoracic spine. The patient underwent successful posterior spinal fusion with instrumentation T2-L3.
Minimally Invasive Surgery Minimally invasive surgery for the treatment of adult scoliosis and disorders involving the cervical discs, offers great benefit to patients. Not only is the surgery less invasive, reducing the risk for infection, the recovery time is much faster and allows patients to resume a normal activity level much faster post-surgery. Cervical Total Disc Arthroplasty Dr. Khan is now evaluating patients who may be candidates for cervical total disc arthroplasty. Patients who are typically good candidates for this procedure have neck and arm pain for more than than six months and have tried other treatment options without success. This procedure is done in place of a fusion surgery and replaces discs between the vertebral bodies in the neck.
Pre-surgical: Patient with untreated adolescent idiopathic scoliosis and a stiff 70 degree thoracic curve that was also hyperkyphotic.
Post-Op: Patient’s spine following a successful posterior spinal fusion with instrumentation T2-L3.
How to refer patients... Comprehensive Spine Center | Please call 614-293-BACK We see patients at the following locations: CarePoint East 543 Taylor Ave. Columbus, OH 43203
CarePoint Lewis Center 6515 Pullman Drive Lewis Center, OH 43035
CarePoint Gahanna 920 N. Hamilton Road Gahanna, OH 43230
OSU Spine and Neurological Surgery 680 Park Ave. West, Suite 203 Mansfield, OH 44906
Our promise to you No question or concern about your patient is too small. Our policy is to accept all appropriate patients referred to the Spine Center. 12 Comprehensive Spine center
C omprehensive S pine C enter
Neurosurgery
Gary Rea, MD, PhD
J. Bradley Elder, MD
Carole Miller, MD
H. Francis Farhadi, MD, PhD
Orthopaedic Surgery
Safdar N. Khan, MD
Ronald Wisneski, MD
William J. Thoman, MD
Albert Timperman, MD
Physical Therapy
Laurie Bell, PT
Jennifer Belu, PT
Cari Hanler, PT, DPT
Nicole Vance, PT, DPT
Physical Medicine and Rehabilitation
Theresa Calimlim, MD
Francine Pulver, MD
Joseph Tu, MD
Kenneth Nguyen, DO
Steven Severyn, MD
Kenneth Nguyen, DO
Pain Medicine
Hans Miller, MD
Mike Evers, MD
Joseph Tu, MD
Anshuman Swain, MD 13
Comprehensive Spine center
The Ohio State University Wexner Medical Center Comprehensive Spine Center medicalcenter.osu.edu
Š 2012 The Ohio State University Wexner Medical Center UHOS20110222-06
Ohio State’s
Consult The Ohio State University Wexner Medical Center
Imaging Services w A leader in effective low-dose radiation for improved long-term patient safety w Deep subspecialization for the most targeted and safest imaging and the most skilled image-based interpretations and interventions w Personalized diagnostic imaging/image-guided procedure planning from the commencement of orders w Fast-turnaround structured reporting for referring physicians
Collaboration Leads to Precision Imaging Collaboration Leads to Precision Imaging
New Talent, Deep Subspecialization The radiology team at Ohio State is characterized by precision—high-level specialization and the cream of the crop in credentials.
Under new leadership, the Department of Radiology/ Imaging Signature Program at The Ohio State University Wexner Medical Center plays a central role in delivering a new level of personalized care. This model of care is largely driven by the vision of increased presence and engagement with patients and clinicians.
This depth of resources ensures the best care for patients. Imaging orders are reviewed and interpretations provided by physicians certified and subspecialty trained. “A radiologist who reads only vascular images day in and day out, for example, has a higher degree of accuracy than a general radiologist who reads a wide variety of image types, but none in large numbers” says Dr. White. “Ohio State has that level of subspecialization so patients get the best possible care.”
This transformation of the Radiology Department/Imaging Signature Program includes a high level of collaboration with referring clinicians. Case in point—a treating physician may determine that imaging of a particular organ is needed. By conferring with one of Ohio State’s subspecialty radiologists, together they may determine whether the requested imaging examination is the best one to direct the most effective care.
All our radiologists also have the ability to read patient scans from their own homes, which optimizes the speed at which patients are cared for in the middle of the night and on weekends and holidays.
“Patients do not benefit from a shotgun approach to imaging,” says new Department Chairman and Imaging Signature Program Director, Richard D. White, MD. “Today, more than ever before, a targeted patient-specific approach is essential for safety and efficiency reasons. The high degree of specialization of our radiologists and our ability to recommend, read and report with precision, distinguishes Ohio State from facilities with more general radiology capabilities.”
A total of 20 physicians were recruited in the past year to support 24/7/365 subspecialty services combined with active research and education in imaging. They include young academic radiology talents from outstanding institutions in the country, including: • Ohio State’s Wexner Medical Center (n=7) • Brigham & Women’s Hospital affiliated with the Harvard Medical School (n=3)
The New Face of Imaging at Ohio State New Department Chairman/Program Director Dr. White brings to Ohio State’s Wexner Medical Center 25-plus years of experience at leading institutions, including the University of California-San Francisco, Cleveland Clinic, and the University of Florida and Shands HealthCare.
• University of Texas MD Anderson Cancer Center (n=2) • Barrow Neurological Institute • Baylor University Medical Center • Duke University Medical Center
Not only has the face of the department/program changed literally, in terms of new faculty, but also figuratively, in terms of personality. “Radiology is an increasingly significant part of patient care and, therefore, it is increasingly important that we are responsive, accessible, approachable and patient-friendly,” says Dr. White. “Patients should understand their imaging care just as well as other aspects of their medical care. Even if patients interact primarily with technologists, be assured that our radiologists are very engaged in the process leading up to and during imaging. This ensures the orders are properly tailored to the fundamental questions about patients’ health. This is the new face of imaging at Ohio State.”
• Mt. Sinai Hospital of NYC • Northwestern Memorial Hospital • Thomas Jefferson University Hospital • Washington University Medical Center • William Beaumont Hospitals They join the 31 subspecialty radiologists, 13 imaging scientists, and multiple radiology residents and fellows already in the department to form a vibrant imaging effort.
16 imaging services
DaTscan for Pinpointing Diagnosis of Parkinsonian Syndromes
Ohio State radiologists work closely with approximately 400 radiology technologists, as well as with RNs, NPs, RAs and PAs. These team members act in complete synchronization—with these support personnel working as direct extensions of the radiologists—to achieve optimal quality, safety and patient satisfaction.
Physicians are often challenged to differentiate Parkinsonian syndromes from conditions such as essential tremors that have similar symptoms but significantly different treatment and management.
Leading the Pack in Low-Dose Radiation
DaTscan is the first FDA-approved radiopharmaceutical adjunct imaging agent to evaluate patients with suspected Parkinsonian syndromes (idiopathic Parkinson’s disease, multiple system atrophy and supranuclear palsy). This new molecular imaging agent gives Ohio State physicians an additional tool to pinpoint diagnoses and tailor treatment for conditions that traditionally can take as long as six years to diagnose.
Safety in imaging is paramount at Ohio State’s Wexner Medical Center where we have become the regional leader in low-dose radiation imaging. This accomplishment results from system-wide initiatives using optimized protocols to diminish X-ray dosage, particularly in CT. We use the lowest dose of scanning possible throughout the Ohio State system to produce high-quality images with low radiation, and continuously monitoring the safety of contrast agents used in radiology and throughout the institution.
“This new imaging tracer, used in conjunction with other tests and clinical assessment, assists physicians in directing patients to appropriate therapy earlier in their course of disease and helps prevent misdiagnosis,” says Nathan C. Hall, MD, PhD, chief of Molecular Imaging and Nuclear Medicine in the Department of Radiology.
Imaging technology managers and medical physicists collaborate to calculate personalized dosage recommendations based on the patient’s size and sex. “One-size-fits-all is not the standard of care at Ohio State,” says Dr. White. “We tailor imaging to the patient without compromising quality in any way. This is the future of personalized medicine, and just a smarter, safer way to practice.
Ohio State is the first in central Ohio to use this noninvasive technology.
17 imaging services
• State-of-the-art clinical PET-CT and SPECT-CT
“The concern with radiation is more about the cumulative effect than the individual exam effect. With our radiologists involved in cases from the time imaging orders are placed, we can help to notify ordering physicians when patients’ overall exposure might be a concern, understand the medical situation and advise if an alternative imaging procedure is appropriate and just as effective.”
• DaTscan SPECT brain imaging — Permitting striatal dopamine transporter visualization to assist in the evaluation of Parkinsonian syndromes • Tomosynthesis Digital Mammography and Volume Breast Ultrasound — Facilitating 3D imaging overcoming visualization problems with dense breast tissue • State-of-the-art interventional radiology and interventional oncology procedures
Cutting-Edge Technology, Strategic Placement
• Structured reporting by voice recognition
As part of the hospital-wide effort to reduce radiation exposure, Ohio State recently added the SOMATOM Definition™ Flash CT technology to its armamentarium of advanced CT scanners. Ohio State is the only facility in central Ohio to offer this sophisticated imaging technology. It uses only a fraction of the radiation dose that CT systems previously required to image even the tiniest anatomic detail, with scanning performed at greater speed and diagnostic yield than ever before.
These high-level capabilities are enhanced by the foundational imaging technology already available, including: • 2D ultrasound • Computed and digital radiography • Fluoroscopy • Bone densitometry • Digital mammography
In addition to the Flash, Ohio State has a full complement of state-of-the-art imaging equipment. For efficiency and efficacy, equipment is strategically located where it is most likely to be needed throughout Ohio State’s healthcare campuses. Radiation safety practices of the highest level have been applied to every imaging scanner at every location, ensuring that patients are exposed to as little radiation as necessary, while not compromising diagnostic yield.
Just as importantly, Ohio State has a high level of imaging technology at its outpatient locations throughout central Ohio, not only at our main hospitals. This helps to ensure that patients have access to the best possible diagnostic and therapeutic imaging whether or not they are patients of Ohio State physicians.
Smart Scheduling , With 24/7/365 Emergency Care Ohio State’s Department of Radiology/Imaging Signature Program has undergone significant changes to improve patient access through a “Smart Scheduling” process. Scheduling coordinators work with patients to ensure they are seen quickly and their needs are met. This involves reviewing patients’ imaging requirements, finding the most appropriate and suitable equipment for their situation and providing patients with convenient scheduling options whenever possible.
Some of the advanced technologies found at the Medical Center include: • State-of-the-art clinical MRI (1.5 and 3.0 Tesla) • Preclinical ultra-high field MRI (7.0 Tesla)
“Equipment that is commonly used is offered at multiple sites on our campuses for efficiency and patient convenience,” says Dr. White. “Equipment for uncommon imaging studies is strategically placed and available to all patients who may need it.”
• Functional MRI — Measuring changes in blood flow with brain activity • Perfusion/diffusion MRI — Assessing blood flow to the brain to determine whether tissue can be salvaged after a stroke.
Radiology is onsite 24 hours a day to serve our Emergency Departments. Electronic connectivity to radiologists’ homes ensures that the right subspecialist can have on-demand access to studies regardless of the time of day or location.
• State-of-the-art low-dose clinical CT (128 Slice) • Dual-Source CT — Permitting optimal cardiac imaging, including coronary CT angiography • Multi-energy CT — Allows unique tissue characterization (e.g., uric acid in gout) 18
imaging services
Department of Radiology leadership team Richard D. White, MD, FACR, FACC, FAHA Professor of Radiology & Cardiovascular Medicine Chairman, Department of Radiology Director, Imaging Signature Program
William T. C. Yuh, MD, MSEE Professor of Radiology Vice Chair, Academic Affairs
Michael V. Knopp, MD, PhD Professor of Radiology Vice Chairman, Research and Innovation Novartis Chair of Imaging Research Director, Wright Center of Innovation in Biomedical Imaging
Joseph S. Yu, MD Professor of Radiology Vice Chairman, Education and Training
How to refer patients... Please call 614-293-4333 for patient referral.
Our promise to you We partner with referring physicians to provide diagnostic and therapeutic imaging services for your patients. We promise fast turnaround of radiology reports and timely communication with you about your patients’ cases so they can return to you promptly for ongoing care. 19 imaging services
The Ohio State University Wexner Medical Center Imaging Services medicalcenter.osu.edu
Š 2012 The Ohio State University Wexner Medical Center UHOS20110222-09
Ohio State’s
Consult The Ohio State University Wexner Medical Center
Men’s Sexual Health in the Department of Urology
w Subspecialty care from the only two fellowship-trained urologists in central Ohio w The latest in minimally invasive procedures w High-volume experience in common and rare procedures w Care for sensitive issues in a supportive environment
Ohio State’s Urology and Men’s Sexual Health Speed of Care Matters
The Ohio State University Wexner Medical Center offers new subspecialty care within Urology. With the addition of two fellowship-trained urologists—the only two in central Ohio—Ohio State’s Medical Center now offers care for unique and complex men’s sexual health issues.
Patients who have decided to seek treatment for urologic conditions will be seen quickly. Many conditions can be treated on an outpatient basis, providing patients with an added level of convenience.
Specialists Found Only at Ohio State
Trauma Care and Reconstruction
Christopher McClung, MD, is the only physician in central Ohio with fellowship training in urologic trauma and reconstruction. Gregory Lowe, MD, is the only physician in central Ohio with fellowship training in andrology and infertility.
Urologic trauma can occur from a motor vehicle accident, gunshot wound, or another injury to the urinary or genital system. Reconstruction can be necessary due to a previous surgery, injury, infection or the effects of radiation. Dr. McClung is experienced in determining how best to reconfigure the urologic system to allow the patient to return to normal functioning.
Together, these two specialists treat urologic and sexual health conditions specific to men, including: • Concealed penis • Premature ejaculation
Male Stress Incontinence
• Delayed ejaculation
Some men experience urinary stress incontinence after treatment for prostate cancer or treatment for an enlarged prostate. Treatment options for stress incontinence include:
• Enlarged prostate • Erectile dysfunction • Infertility
• Sling procedure – a piece of mesh is implanted to support the urethra
• Low testosterone
• Artificial urinary sphincter – a mechanical device, similar to a blood pressure cuff, is implanted around the urethra; the patient then presses a button to deflate the cuff when he is ready to urinate
• Male stress incontinence • Peyronie’s disease • Urethral stricture • Urologic trauma and reconstruction
Both procedures can be performed on an outpatient basis. An artificial urinary sphincter has a higher success rate for treating incontinence. Treatment options, including benefits and risks, are discussed with patients to determine their treatment goals.
• Varicoceles • Vasectomy and vasectomy reversal
Expertise and Training Are Paramount Drs. McClung and Lowe are fellowship-trained and highly subspecialized, caring for both routine and uncommon urologic conditions. They have expertise in current minimally invasive techniques and provide patients with leading-edge care.
A Side Effect Patients Don’t Have to Live With “Many patients are so relieved to have completed cancer treatment that they assume the resulting incontinence is a side effect they must tolerate,” says Dr. McClung. “This is not the case. There is no need to take a wait-and-see approach.”
“The more cases a physician does of a particular type, the greater the chances of a successful, optimal outcome,” says Dr. McClung. “This is why training and experience with less common procedures is absolutely necessary when patients are seeking care for urologic conditions.”
Patients will regain 95 percent of the urinary continence they ever will regain within one year of prostate cancer
22 Men’s sexual health
treatment. Patients who are dissatisfied with their level of continence at one year should be referred for specialty consultation so they are informed about their options and can decide which treatment is best for them.
from infection or skin breakdown that occurs from constant moisture in the area.
Sexual Health
“Being treated for male urinary incontinence can be lifechanging, and patients are very grateful,” says Dr. McClung. “Often, problems with erections accompany incontinence. We discuss treatment for both conditions. Sometimes, both treatments can be provided simultaneously.”
The Department of Urology provides care for men’s sexual health concerns including erectile dysfunction, delayed ejaculation, premature ejaculation, low testosterone, varicocele repair and Peyronie’s disease. Erectile dysfunction that does not respond to medication may be treated with nonsurgical options including injections, vacuum pumps and urethral suppositories. According to Dr. Lowe, another excellent option, depending on the patient, is surgery to place a penile prosthesis. This surgery can be performed as an outpatient procedure, and the treatment has high satisfaction rates from patients and their partners.
Urethral Stricture Patients who have a stricture from urethral scar tissue have treatment options including endoscopic incision, dilation or repair surgery. It is not advisable to have dilation or incision more than once. If this form of treatment is not successful, then surgery to repair the stricture is necessary. This treatment guideline is important because surgical repair becomes increasingly difficult with repeated procedures. One unsuccessful stricture dilation or incision is grounds for a referral for surgery.
Ohio State physicians are skilled at microscopic repair of varicoceles. This condition is present in 15 percent of men and can lead to infertility, pain or testicular atrophy. Varicoceles can also be associated with ejaculatory pain. Peyronie’s Disease For some men, sexual activity is difficult due to a curve in the erect penis. This curvature, also referred to as Peyronie’s disease, can be congenital or acquired. The curvature may cause discomfort for the patient or his partner. Other symptoms include erectile dysfunction, inability to engage in sexual intercourse and shortening of the penis.
Experience with delicate, complex urethral stricture treatment is an important consideration when selecting a surgeon. “It is not always possible to predict the course of a stricture repair surgery until it is under way,” says Dr. McClung. “In some cases, a long tissue graft is required unexpectedly, complicating surgery. Having a surgeon who is highly trained and experienced in all possible aspects of urologic surgery is beneficial. In most cases, you get one good chance to repair a stricture. The surgeon’s extra fellowship training cannot be overlooked.”
Treatment is most effective when started early. Many men have been told there is no treatment available. Indeed, medical treatment and surgical correction are available. Surgical correction requires subspecialized expertise and patient counseling. Dr. Lowe specializes in treatment of this condition and has had success in cases even greater than 90 degrees.
Stricture repair surgery requires an overnight hospital stay and a urinary catheter for two to four weeks, depending on the procedure.
Concealed Penis
Surgical repair options include:
Concealed penis occurs due to scarring or obesity. In obese patients, the lower abdominal skin and subabdominal fatty tissue cause the penis to become concealed in the abdomen. Patients present with an inability to stand for urination and to have sexual intercourse. Treatment involves removing fatty tissue above the penis in an abdominoplasty procedure and, more often than not, repairing the shaft of the penis with a skin graft from the thigh. Shaft repair is required when the skin has degraded
• Plication – the least invasive and easiest method • Plaque incision with grafting – a more complex procedure that requires careful patient selection • Penile prosthesis – insertion of a mechanical device to repair the curvature and assist with erections
23 Men’s sexual health
Reproductive Health
GreenLight Laser Therapy
Ohio State’s Dr. Lowe has a unique distinction of being fellowship-trained in male infertility. There are approximately a half dozen fellowships for male infertility in the United States, so many physicians are unaware of the range of treatments available. Ohio State offers many malecentered options that can dramatically improve a couple’s ability to conceive.
Patients who have an enlarged prostate or urinary frequency can benefit from treatment with GreenLight laser therapy. This minimally invasive treatment can be performed on an outpatient basis for otherwise healthy patients. Even patients who take anticoagulation medication are candidates for this procedure. GreenLight vaporization provides the effectiveness of transurethral resection of the prostate with fewer side effects. This therapy restores normal urine flow and provides long-lasting symptom relief.
Vasectomy and Vasectomy Reversal Both vasectomy and vasectomy reversal are available at Ohio State’s Wexner Medical Center. According to Dr. Lowe, training and expertise play a key role in reversing a vasectomy. “The success of a reversal procedure is very much dependent on the surgeon’s specialty training,” he says. “The suture to reconnect the vas deferens is smaller than a human hair. Outcomes of this procedure are excellent in most patients if they have a highly experienced, fellowship-trained surgeon.” “Almost all men who have had vasectomies can be good candidates for reversal. It is a misconception that vasectomy reversals do not have excellent outcomes. The best candidates, however, are those whose vasectomies were performed within the last 10 to 15 years, and those who have younger, healthy, fertile partners.” Dr. Lowe adds that studies show vasectomy reversal is more cost effective than microdissection testicular sperm extraction (TESE) and IVF, especially for men who want to have more than one child. Infertility Approximately half of fertility problems couples experience are due to male infertility. Treating male infertility is much less expensive than treatments such as in vitro fertilization (IVF). Yet, comprehensive testing for and treatment of male infertility remain underused. “There are a limited number of subspecialists trained in male infertility, so men often are not learning about or getting the treatment options available to them,” says Dr. Lowe. Dr. Lowe has expertise in microdissection TESE (testicular sperm extraction), a procedure that retrieves sperm from patients who have shown no sperm present on a testicular biopsy. The sperm is used for IVF treatment. In some cases, medical treatment can help return sperm to the ejaculate. Dr. Lowe’s expertise also includes fertility preservation, an important consideration for men having chemotherapy. These patients receive the greatest benefit when evaluated prior to treatment initiation. Given the time-sensitive nature of initiating chemotherapy, it is important to note that Dr. Lowe offers patients easy, immediate access to a fertility specialist. 24
Men’s sexual health
Department of Urology
Men’s Sexual Health Christopher McClung, MD Assistant Professor, Urologic Trauma and Reconstruction Undergraduate: Southern Nazarene University, Oklahoma City, OK Graduate: Organic Chemistry, University of Minnesota, Minneapolis Specialty Training: Loyola University Medical Center, Chicago Medical School: Jefferson Medical College, Philadelphia Fellowship: Urologic Trauma and Reconstruction, University of Washington, Seattle Dr. McClung specializes in treating: • Urologic trauma • Urethral strictures • Male incontinence • Erectile dysfunction • Concealed penis To refer a patient to Dr. McClung, call 614-293-3648.
Gregory Lowe, MD Assistant Professor, Men’s Sexual Health and Male Infertility Undergraduate: Miami University of Ohio, Oxford Medical School: Medical College of Ohio, Toledo Specialty Training: The Ohio State University, Columbus Fellowship: University of Virginia, Charlottesville Dr. Lowe specializes in treating: • Male infertility • Low sperm count • Erectile dysfunction • Disorders of orgasm • BPH • Vasectomy/vasectomy reversal • Peyronie’s disease
Complete Urology Team To make a referral to another member of our urology team, please contact us at 614-293-8155.
Robert Bahnson, MD, chair, Department of Urology Ronney Abaza, MD Frank Begun, MD Geoffrey Box, MD
To refer a patient to Dr. Lowe, call 614-293-4696.
Mary Ann Kenneson, MD Bodo Knudsen, MD Kamal Pohar, MD Ahmad Shabsigh, MD
New Videos Available for Men’s Sexual Health Drs. McClung and Lowe have recently completed a set of patient-friendly videos explaining men’s sexual health disorders and treatments available. To view these videos, please visit go.osu.edu/urology.
25 Men’s sexual health
David Sharp, MD Stephen Smith, MD
How to refer patients... Men’s Sexual Health For referrals to Dr. McClung, please call 614-293-3648. For referrals to Dr. Lowe, please call 614-293-4696. For general questions or other referral information, please call 614-293-8155.
Our promise to you We partner with referring physicians to provide specialty urology care for your patients. Our policy is to accept all patients referred to our department. If we determine that a referred patient would be better served by another specialty, we will arrange that visit for your patient. We hope you will refer patients to us when you are no longer comfortable treating them and want more specialized care. We promise to communicate with you about your patients, provide feedback about their care and refer them back to you for ongoing care.
The Ohio State University Wexner Medical Center Department of Urology www.medicalcenter.osu.edu
Š 2012 The Ohio State University Wexner Medical Center UHOS20110222-07
Ohio State’s
Consult The Ohio State University Wexner Medical Center
General and Gastrointestinal Surgery Program Leaders in innovation and minimally invasive techniques w Robotic and incisionless procedures w High-volume team w The only program in central Ohio that provides specialty surgical training in therapeutic and diagnostic endoscopy for endoscopic retrograde cholangiopancreatography (ERCP) w Easy patient access
Ohio State’s Gastrointestinal Surgery Program Gastrointestinal surgeons at The Ohio State University Wexner Medical Center are board certified, fellowship trained and entirely focused on complex gastrointestinal disease, including recurrent and complex hernias and esophageal disorders such as reflux and swallowing problems. Ohio State’s surgeons are leaders in innovation and minimally invasive surgery, including robotic and incisionless techniques that offer optimal outcomes with minimal scarring and pain.
Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James). Surgical expertise includes minimally invasive techniques for:
Ohio State was the first to:
Hernias
• use robotic techniques for esophageal surgery
While common, hernia repair necessitates specialty surgical expertise. Particularly challenging are sports and recurrent hernias. Ohio State’s gastrointestinal surgeons are a high-volume hernia team and leaders in research and in teaching others the latest techniques in hernia repair. The team’s expertise in minimally invasive surgical techniques allows hernia patients faster recovery.
• • • •
• use robotic techniques for pancreatic cancer surgery • perform incisionless surgery for gastrointestinal reflux • use minimally invasive techniques for gastric bypass surgery in central Ohio, and the first to perform laparoscopic gastric banding surgery in the state Data indicates that high-volume surgical provider teams have better outcomes. The gastrointestinal surgery team at Ohio State is a high-volume team, with few facilities in the region boasting comparable numbers.
Bariatric Ohio State’s comprehensive bariatric surgery program was the first in the state, and is the highest volume program in central Ohio. Surgeons at Ohio State perform 300 to 400 weight-loss surgeries each year, with complication rates that are superior to the national standards. Studies show that the risk of complications is lower when weight-loss surgery is performed by surgeons with expertise in the procedure.
Training programs at Ohio State instruct hundreds of surgeons from around the United States in minimally invasive surgical techniques for gastrointestinal surgical procedures.
Esophageal Disease
Most bariatric surgeries at The Ohio State University Wexner Medical Center are performed with minimally invasive techniques, including:
Ohio State’s gastrointestinal surgery team provides a full range of diagnostic and therapeutic procedures for esophageal disease, including: • • • • •
Colon cancer Stomach cancer Pancreatic cancer Esophageal cancer
• • • •
Heartburn Barrett’s esophagus Swallowing problems Reflux disease Esophageal cancer
Roux-en-Y bypass Adjustable gastric band (LAP-BAND) Sleeve gastrectomy StomaphyX (gastric bypass revision)
The bariatric program is recognized a Center of Excellence by the American Society for Metabolic and Bariatric Surgery.
This surgical team is a leader in minimally invasive treatment for reflux disease and early esophageal cancer, providing effective treatment options without incisions or surgery via endoscopic techniques.
easy access You and your patients have easy, prompt access to the gastrointestinal surgery team. Surgeons see patients at multiple locations throughout the Medical Center’s clinic network. Patients with new cancer diagnoses are seen within 48 hours.
Gastrointestinal Cancer The Ohio State gastrointestinal surgery team provides a daily clinic for patients at The Ohio State University Comprehensive 28
general and gastrointestinal surgery program
Gastrointestinal Surgery Team W. Scott Melvin, MD
Peter Muscarella II, MD
Chief, Division of General and Gastrointestinal Surgery Director, Center for Minimally Invasive Surgery Professor of Surgery
Associate Professor of Surgery Clinical Interests: gastrointestinal and hepatobiliary surgery, pancreatic cancer, pancreatitis, pancreatic cysts, laparoscopic splenectomy, incisional hernia
Clinical Interests: hepatobiliary, pancreatic and laparoscopic surgery; minimally invasive surgery; esophageal disease; GERD; Barrett’s esophagus; foregut cancers
Vimal Narula, MD Assistant Professor of Surgery
Mark Arnold, MD
Clinical Interests: minimally invasive surgery, foregut and hepatobiliary surgery, advanced therapeutic endoscopy, ERCP, natural orifice transluminal endoscopic surgery (NOTES), robotics
Professor of Surgery Chief, Division of Colon and Rectal Surgery Clinical Interests: colon and rectal surgery, colorectal cancer, radioimmunoguided surgery (RIGS), cancer imaging
Bradley Needleman, MD Director, Bariatric Surgery Program Associate Professor of Surgery
Alan Harzman, MD Assistant Professor of Surgery
Clinical Interests: minimally invasive surgery, bariatric surgery, gastrointestinal and endocrine surgery, surgical education
Clinical Interests: colorectal cancer, minimally invasive treatment of colorectal cancer, laparoscopic colon and rectal surgical procedures, rectal ultrasound
Kyle Perry, MD Assistant Professor of Surgery
Jeffrey Hazey, MD
Clinical Interests: esophageal and gastrointestinal surgery, minimally invasive gastrointestinal surgery, GERD, hernia repair
Associate Professor of Surgery Clinical Interests: minimally invasive surgery, natural orifice transluminal endoscopic surgery (NOTES), advanced endoscopy, ERCP
David Renton, MD Assistant Professor of Surgery
Syed Husain, MBBS
Clinical Interests: minimally invasive, laparoscopic and single-incision laparoscopic surgery; foregut surgery; hernia repair
Assistant Professor of Surgery Clinical Interests: minimally invasive treatment of colorectal cancer, laparoscopic surgery for diverticulitis, robotic pelvic floor repair, rectal prolapsed repair, benign anorectal disease
Richard Schlanger, MD Director, Surgical Services at University Hospital East Clinical Director, Center of Advanced Wound Management Associate Professor of Surgery
Andrei Manilchuk, MD Assistant Professor of Surgery Clinical Interests: general surgery, minimally invasive hernia repair, pancreatic cancer
Clinical Interests: general, thoracic, endocrine, breast and cancer surgery
Dean Mikami, MD Assistant Professor of Surgery Clinical Interests: minimally invasive bariatric surgery, hernia surgery and new techniques, advanced endoscopy, endolumenal therapies, surgical education
29
general and gastrointestinal surgery program
How to refer patients... Please call 614-293-3230 for patient referral. Our promise to you We partner with referring physicians to provide diagnostic and therapeutic gastrointestinal surgical services for your patients. If we determine that a referred patient would be better served by another specialty, we will arrange that visit for your patient. We hope you will refer patients to us when you are no longer comfortable treating them and want more specialized care. We promise to communicate with you about your patients, provide feedback about their care and refer them back to you for ongoing care.
The Ohio State University Wexner Medical Center General and Gastrointestinal Surgery Program medicalcenter.osu.edu
Š 2012 The Ohio State University Wexner Medical Center UHOS20110222-10
Ohio State’s
Consult The Ohio State University Wexner Medical Center
Diabetes in Pregnancy Program w Skilled team of experts dedicated to providing coordinated care w Monitoring and management to minimize the effects of diabetes on pregnancy w Leading research in gestational diabetes
Diabetes in Pregnancy Program Director: Stephen Thung, MD
Additional program features include: • Insulin pump therapy for appropriate patients • Detailed fetal ultrasound examinations to rule out abnormalities for patients with pre-existing diabetes
One of the largest programs in the United States to focus on diabetes during pregnancy
• Detailed fetal echocardiography for all insulindependent women • Diet and nutrition classes
The Ohio State University Wexner Medical Center Diabetes in Pregnancy Program, established in 1987, is an internationally recognized program. The program is led by physicians who are nationally recognized leaders and clinical researchers in the field of pregnancy complicated by diabetes.
“We are experiencing an increase in the incidence of type 2 and gestational diabetes resulting primarily from increased obesity,” explains Mark B. Landon, chair, Department of Obstetrics and Gynecology. “Type 2 diabetes is underdiagnosed, and women who appear to be at increased risk should be screened early in their pregnancies. While diabetes is one of the most common medical complications of pregnancy, we can minimize the effects of the disease on women and their babies with close monitoring and management from providers who are experienced in caring for pregnant patients.”
This comprehensive program, which assists approximately 400 patients each year, provides services including: • Pre-pregnancy consultation and planning for women with type 1 or type 2 diabetes. • Consultation and primary management during pregnancy for women with type 1 or type 2 diabetes. • Consultation and co-management during pregnancy, including coordination of care, for women with gestational diabetes mellitus. The Diabetes in Pregnancy Program is part of the Division of Maternal Fetal Medicine in the Department of Obstetrics and Gynecology. It is the region’s only program that includes nurse educators dedicated solely to the care of pregnant women. Three nurse educators work along with dietitians and the Maternal Fetal Medicine staff to provide coordinated, tailored patient care. Paramount to women with diabetes is intensive monitoring of glucose levels prior to and during pregnancy. Good glucose control reduces the risk of diabetes-associated complications for the patient and her baby. “Pregnancy is a compact period of time in which day-to-day monitoring of blood glucose levels is necessary to achieve satisfactory control,” says Stephen Thung, MD, director of the Diabetes in Pregnancy Program. “We can help most pregnant women achieve a successful pregnancy even if they have complicated diabetes. We do this by keeping open the lines of communication with patients and making timely adjustments in their insulin dosage. Our physicians and nurses review this information daily and provide immediate feedback to pregnant patients to help them maintain optimal glucose control.” 32
diabetes in pregnancy program
Edmund Funai, MD, Joins Ob/Gyn Staff
Edmund Funai, MD
Edmund Funai, MD, has joined the Department of Obstetrics and Gynecology at The Ohio State University Wexner Medical Center as vice chair of the Department and leader in Maternal Fetal Medicine and associate dean for Administration in the
College of Medicine. Dr. Funai was previously professor and associate chair for Clinical Affairs in the Department of Obstetrics, Gynecology, and Reproductive Sciences at Yale University School of Medicine. He also was section chief for the Division of Maternal-Fetal Medicine, chief of Obstetrics at Yale-New Haven Hospital and interim project director of the Epic electronic health record implementation project. Dr. Funai is a National Institutes of Healthfunded researcher who is prominently and widely published on the topics of pregnancy complications, patient safety and practice and risk management. He has been named to numerous “Best Doctors” lists, and his work on patient safety received the 2008 Award for Research Excellence from the Society for Maternal-Fetal Medicine.
Research The Diabetes in Pregnancy Program is part of the Division of Maternal Fetal Medicine at The Ohio State University Wexner Medical Center and is a participating member of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network — a part of the National Institutes of Health. This network conducts major clinical trials in obstetrics.
Dr. Funai completed his residency in obstetrics and gynecology at Lenox Hill Hospital in New York City and a fellowship in maternal fetal Medicine at the New York University School of Medicine. He received his medical degree from New York Medical College and his bachelor’s degree from the University of Notre Dame.
Dr. Landon was lead investigator of the largest prospective randomized multicenter trial to determine the benefits of treating mild gestational diabetes. The results of this trial appeared in The New England Journal of Medicine in 2009. The trial concluded that women who were treated for mild gestational diabetes were half as likely to deliver babies with excess body fat and half as likely to experience shoulder dystocia at birth. Women who were treated also had fewer cesarean deliveries and less preeclampsia or hypertensive disorders of pregnancy.
How to refer patients... We value and appreciate your referrals. To make a referral or to speak to a member of our team, please contact: 614-293-2222
“Clinical research at The Ohio State University Wexner Medical Center is aimed at investigating the effects of maternal glycemia on perinatal outcomes and assessing the benefits of medications, including newer insulin analogues on pregnancy outcomes,” says Dr. Thung.
Ohio State’s Maternal Fetal Medicine Diabetes in Pregnancy Program Martha Morehouse Medical Plaza 2050 Kenny Rd. | 5th floor 33
diabetes in pregnancy program
Dedicated Nurse educators
Diabetes in Pregnancy Program Faculty Stephen Thung, MD
Barbara Martin, RN, BSN, CDE
Associate Director of Maternal Fetal Medicine Director, Diabetes in Pregnancy Program Associate Professor of Obstetrics and Gynecology Residency: New York University/Bellevue Hospital Fellowship: Northwestern University Medical School Medical School: New York University School of Medicine
Catherine Varga, RN, BSN
Mark B. Landon, MD Chair, Department of Obstetrics and Gynecology; Richard L. Meiling Professor of Obstetrics and Gynecology Fellowship/Residency: Hospital of the University of Pennsylvania Medical School: Cornell University Medical College
Lisa Buccilla, RN
Steven G. Gabbe, MD Chief Executive Officer, The Ohio State University Wexner Medical Center Senior Vice President, Health Sciences, The Ohio State University Wexner Medical Center Fellowship/Residency: Boston Hospital for Women, Harvard Medical School Medical School: Cornell University Medical College
Š 2012 The Ohio State University Wexner Medical Center UHOS20110222-08
Ohio State’s
Consult Practice Tools
Starting the Conversation—How to Talk with Patients About Urologic Problems Urologic Specialty Care Referral Guidelines
Starting the Conversation—How to Talk with Patients About Urologic Problems Does your male patient need urologic help?
“We, as physicians, tend not to focus on the emotional aspects of men’s health,” says Dr. Lowe. “Urological health matters can significantly affect men’s lives in terms of relationship satisfaction, self-esteem and socialization. We do them a disservice when we leave these questions unasked.
Men often delay seeking care for urologic conditions for many years due to fear or embarrassment about their condition. Yet the treatment for their conditions may be straightforward and can significantly improve their quality of life.
“We strive to provide a safe and welcoming environment to discuss these sensitive issues. Patients are always given the time they need during appointments to ask questions and establish a treatment plan for their specific conditions.”
Primary care physicians can enhance their patients’ lives— physically and emotionally—by routinely inquiring about urologic and sexual health: • Do you have difficulty urinating? • Do you have difficulty holding urine? • Do you get up several times during the night to go to the bathroom? • Do you have blood in your urine? • Do you have difficulty with erections? • Do you have any difficulties in your sexual life? • How would you rate your sex drive? • Do you have any pain in your abdomen, groin or genital area?
How to refer patients... Men’s Sexual Health For referrals to Dr. McClung, please call 614-293-3648. For referrals to Dr. Lowe, please call 614-293-4696.
“We strive to provide a safe and welcoming environment to discuss these sensitive issues.” — Gregory Lowe, MD
For general questions or other referral information, please call 614-293-8155. 35 Urology practice tool
Urologic Specialty Care Referral Guidelines Ohio State Treatment Recommendations Erectile Dysfunction
Male Infertility
Initial recommendations
When to refer for specialty care
• Trial of phosphodiesterase inhibitor (Cialis, Levitra, Viagra) - Use at full strength; cut dosage in half if whole pill works - Inform patient about need for sexual stimulation and waiting at least 30 minutes after taking
• Patient needs chemotherapy or radiation therapy • Patient has low semen count, abnormal motility or morphology on semen analysis
• Patient has low testosterone (below 300 ng/dl) or • Consider checking total testosterone levels and HGBA1c abnormal FSH (greater than 7.6) - Especially in patients with low sex drive, low testoster- • Patient and partner are considering in vitro fertilization or one levels can lead to erectile dysfunction assisted reproduction • Consider cardiac workup if there is no identifiable cause • Patient has a palpable varicocele or small testicles on exam of erectile dysfunction - Coronary events may be predicted by erectile dysfunction Enlarged Prostate/BPH
When to refer for specialty care
Most common symptoms
• Patient has penile curvature of Peyronie’s disease • Patient reports poor response to medical treatments • Patient has contraindications to medical treatments
• • • • • • • • •
Special treatments available • Vacuum erection device or Viberect (a device to help rehabilitate the penis) • Penile injection therapy • Intraurethral suppository
Weak stream Sense of incomplete emptying Pain with urination Frequency of urination Nocturia Urgency Incontinence Intermittent stream Straining to urinate
• Penile prosthesis When to refer for specialty care - Surgical options and penile injection therapy have very • Patient has recurrent hematuria high patient and partner satisfaction rates - Most men overcome the anxiety of injection into the • Patient’s symptoms do not improve with Flomax, penis; this is not typically painful Uroxatral, Proscar, Avodart or Rapaflo Urethral Stricture
• Patient’s symptoms worsen on medication or patient experiences adverse side effects from medication
When to refer for specialty care
• Patient is interested in discontinuing medications
Consider definitive treatment with a specialist soon after diagnosis of urethral strictures rather than having patients undergo repeated procedures to dilate or incise strictures.
• Patient is interested in exploring surgery
• Patient has persistent dysuria, recurrent UTI, pain with urination or urinary retention - These conditions are more common in patients with history of trauma, prior surgery or catheterization
• GreenLight laser therapy—vaporization of prostate
Special treatments available
• Transurethral resection of the prostate (TURP) • Holmium laser enucleation of the prostate (HoLEP)
• Patient has a previous stricture; increases likelihood of recurrence 36 urology practice tool
Ohio State’s
Consult New Lupus Clinic Provides Comprehensive, Ongoing Care Expertise in a Single Location
Benefits at a Glance: • Cutting-edge treatments not available elsewhere • Multidisciplinary care in one location • Rapid access to specialists who cover all the organ systems potentially involved in immunologic systemic diseases
LU P U S C L I N I C T E A M
Wael Jarjour, MD
Samir Parikh, MD
Stacy Ardoin, MD
Ohio State’s Lupus Clinic has been in operation for the past year, and allows patients to see a variety of specialists in one location. These experts cover all organ systems involved with lupus and provide specialized training for rheumatology and nephrology fellows in treating autoimmune disorders. A single location gives expert physicians the opportunity to confer together on complex patients and obtain consultation from colleagues so the proper workups and treatments are implemented quickly. The clinic moved to CarePoint East (543 Taylor Avenue) during the summer of 2011 to allow for an easily accessed building with free parking offered on site. The Clinic was started by Brad Rovin, MD, director of Ohio State’s Division of Nephrology and Wael Jarjour, MD, director of Rheumatology and Immunology. Patients diagnosed with lupus often present with kidney involvement, or develop kidney problems over time. “It is important for us to diagnose and treat kidney disease in lupus as promptly as possible to try and prevent permanent damage to the kidneys, or to stabilize damage once it occurs,” adds Dr. Rovin. Research-Driven Treatment
Lee Hebert, MD
Brad Rovin, MD
Ongoing basic, clinical, and translational research offers lupus patients access to the latest treatments. Dr. Rovin’s current studies include looking at mechanisms of inflammation in the kidney, and urine biomarkers of disease activity and kidney pathology. Dr. Jarjour is examining gender differentials in lupus and how estrogen impacts the immune response. “We are exploring some of the mechanisms that make women continued on page 5
Contents...
Cranial Base Surgery Program ...................................... 2
Imaging Accreditation Update ..................................... 5
New Heart and Lung Failure Treatment ..................... 3
Maintaining CME Credits with Ohio State ................. 6
Concussion Management Program .............................. 4
Announcing Our New Name . ....................................... 7
Cranial Base Surgery Team Treats the Most Complex and Hard-to-Reach Tumors At a Glance: • Access to the only program of its kind in the area — fewer than 10 exist in the entire country • World-renowned surgical expertise for rare and difficult-to-treat tumors
pre-op: Preoperative MRI showing large cranio-vertebral junction meningioma compressing the brain stem and the upper cervical cord
• This team also treats fractures, trauma and other cranial base procedures
post-op: Postoperative MRI showing complete removal of the meningioma
Physicians in the Comprehensive Cranial Base Surgery Program treat complex tumors that can often be difficult to reach surgically. The Program was originated with the recruitment of internationally renowned leaders in the field: otolaryngologist Ricardo Carrau, MD, FACS, and neurological surgeon Daniel Prevedello, MD. Working together, Drs. Prevedello and Carrau played a leading role in revolutionizing the surgical treatment of skull-base tumors. “By recruiting these two highly-qualified and experienced surgeons, we are able to provide patients with the knowledge and expertise to treat the most difficult tumors,” says Mario Ammirati, MD, director of the Skull Base Surgery Program in the Department of Neurological Surgery. “It is very important to customize each patient’s treatment based on their specific situation —and every situation is different.”
Unmatched Expertise
Unique Surgical Options
Team Approach
Dr. Carrau helped develop a way to perform surgery at the base of the skull. The technique utilizes the same kind of endoscope used to treat sinus conditions. He previously worked as part of a team at the University of Pittsburgh, where he was on staff prior to coming to Ohio State. Skullbase neoplasms include pituitary gland tumors, meningiomas, chordomas, sarcomas and sinus and olfactory endothelium tumors. Most are diagnosed at an advanced stage, when they press on adjacent structures or obstruct respiration.
Core members of the team are housed in one location. Patients can see their head and neck surgeon, neurological surgeon, reconstructive surgeon, and nurse practitioner, as well as endocrinologists, ophthalmologists, speech and swallowing therapists, and prosthetic experts if needed. “The team approach makes it possible for each patient’s case to receive the review of a variety of physicians all specializing in different, but very specific areas,” says Dr. Carrau. “We have weekly meetings to discuss every patient and determine the best treatment plan for each one.” A concierge service is available to arrange housing and other services for out-of-town and international patients.
Dr. Carrau estimates that fewer than 10 centers in the United States provide comprehensive care for skull base tumors. “One of the advantages here at The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute is that everyone on the skull base team—surgeons, nurses, therapists and support staff—is trained in both the traditional and endoscopic approaches,” he notes. In addition to expertise in open and endoscopic procedures, we have recently incorporated robotic surgery in our armamentarium. Through an international cooperation with surgeons from Rosario, Argentina, our team has pioneered reconstructive techniques that are now used throughout the world.”
Drs. Ammirati, Prevedello and Carrau now work as a team with Bradley Otto, MD, an otolaryngologist and endoscopic skull base surgeon, and Matthew Old, MD, a head and neck and skull base surgeon. While most endoscopic skull-base procedures are for tumors, the physicians also treat conditions such as fractures and trauma to the skull base, some problems with the spine, malformations, compression of nerves, bone problems and even decompression of the optic nerve channel.
Get started For more information or to refer a patient, please call 800-293-5066.
38
A New Treatment for Heart and Lung Failure Benefits at a Glance:
Benefits for Patients
• Offered in central Ohio only at Ohio State
Often, when patients are placed on a ventilator due to other health issues, their lungs can become damaged by the high pressures and levels of oxygen required to support their needs. Having the ability to give the patients time for their bodies to recover, while allowing their heart or lungs to rest, provides better patient outcomes and a better quality of life for the patient after leaving the hospital.
• A better alternative for many heart/lung failure patients • Short-term support for patients with failing heart, lungs or both
Extracorporeal Membrane Oxygenation (ECMO), provides short-term support for patients with failing heart, lungs or both heart and lungs—similar to how dialysis can take the place of failing kidneys. Most patients use ECMO for three days and up to two weeks, although some circumstances allow for longer use. “Ohio State is one of 150 centers across the United States and the only one in central Ohio that can provide this treatment option to some of our sickest adult patients,” says Michael Firstenberg, MD, a cardiac surgeon and director of the ECMO program. Patients are very sick and experiencing either cardiac or respiratory failure when ECMO is started.
“I’ve seen patients as young as 18 who were otherwise healthy, but contracted Influenza H1N1 or viral meningitis and were able to receive ECMO treatment to help their bodies recover more quickly. We have even had patients with severe lung injuries after trauma recover after several days of ECMO,” says Dr. Firstenberg. Most patients requiring this therapy have acute lung injury (such as severe bacterial or viral pneumonia). However, support can be provided to patients with acute cardiac failure from problems such as massive myocardial infarctions, myocarditis, and even difficulties in recovery after heart surgery. “With newer technology,” adds Dr. Firstenberg, “we even have the ability to transport patients on ECMO from other hospitals.”
How it Works When patients are experiencing respiratory failure, ECMO treatment serves several important functions: 1. Large cannulas are placed, typically in the femoral vessels, to drain the venous blood
Get started To refer a patient to the ECMO program, please call 614-293-ROSS (7677).
2. Carbon dioxide is cleared out of the blood 3. The blood is oxygenated 4. The oxygenated blood is then actively pumped back into the patient
Case Study:
Before ECMO
The X-rays are from a 29-year-old, female patient who was very healthy, other than a history of asthma. After being diagnosed with meningitis, the patient required mechanical ventilation. She began to experience adult respiratory distress syndrome and supporting her on the ventilator was becoming more difficult, making ECMO a suitable option. The patient remained on ECMO for eight days and was discharged home with her family several days later. This outcome was in part accomplished by timely recognition of her acute lung injury. Delaying therapy clearly results in less desirable outcomes, because lung and other organ injury can be irreversible.
POST ECMO
39
Concussion Management Program Provides Rapid Care At a Glance: • All concussion patients seen within 24-48 hours of referral • Evaluations to determine return-to-play status • Research trials advancing clinical care of concussion
Ohio State’s Sports Medicine Program offers concussion patients comprehensive care to help them resume normal athletic activities in a safe and timely manner. The multidisciplinary team includes physicians, neuropsychologists and athletic trainers who specialize in treating athletes at all levels. All concussion patients can be seen by one of our physicians within 24-48 hours for evaluation and treatment.
Research Ongoing research studies provide clinicians with a wider range of treatment options than may be available elsewhere. The care team knows which studies are enrolling patients and which patients would benefit from participating in specific clinical trials. “The discoveries made through our research studies translate directly into patient care and improve treatment options and outcomes for our patients,” Dr. Best notes.
Sometimes patients put off going to the doctor, even if they think they may have sustained a concussion. Any patient who experiences the symptoms of a concussion five to seven days after the initial injury should be evaluated by a concussion specialist.
OSU Sports Medicine conducts research on concussion in various areas. Clinical trials are underway to follow and promote recovery in concussed patients. Newly concussed patients may qualify for a study to follow brain function during recovery by using a computer program developed by the Ohio State Psychology department. For patients with post-concussion syndrome, social media and gaming are used in a study to evaluate its effect on recovery.
Standardized Criteria and Care “Paul Gubanich, MD, MPH, and Kelsey Logan, MD, MPH, have been an integral part of standardizing the care patients receive for a concussion here at Ohio State,” says Thomas Best, MD, PhD, co-director of OSU Sports Medicine. “Regardless of which of the five sports medicine offices a patient visits at Ohio State, the evaluation will be the same and will be provided by physicians who all have the same level of expertise. No two concussions are alike, so even though we evaluate patients using the same criteria, each patient’s care plan is unique and specific to that individual’s situation and symptoms,” says Dr. Best.
Five offices offer Concussion Management: OSU Sports Medicine at Morehouse OSU Sports Medicine at Stoneridge OSU Sports Medicine at CarePoint Gahanna OSU Sports Medicine at CarePoint Lewis Center OSU Sports Medicine at CarePoint East Physicians on our Concussion Management team include: • Paul Gubanich, MD, MPH • Thomas Best, MD, PhD • Kelsey Logan, MD, MPH • James Borchers, MD, MPH • Michael Jonesco, DO • Luis Salazar, MD
Return-to-Play Decision Making “Knowing when an athlete is safely ready to get back to sports may be the most challenging task we have,” says Dr. Best. Because each patient’s situation is so unique, it is important to make sure evaluation is done by physicians who have expertise in treating concussions. “We work with a variety of governing bodies on the state and national level, along with organizations such as the American College of Sports Medicine, to help develop and implement standards for concussion management,” says Dr. Best.
Get started To refer a patient to Ohio State’s Concussion Management Program, please call 614-293-3600.
40
New Lupus Clinic | continued from page 1
more susceptible to lupus and how knowledge of these mechanisms can affect our ability to improve treatment options in lupus,” says Dr. Jarjour.
• Send us a patient for a one-time consultation, and the patient can return to you for follow-up care • Send us complex cases that you feel require a greater depth of resources or a multidisciplinary approach to managing autoimmune diseases
Lupus patients are offered participation in a number of clinical trials that seek to improve the efficacy and outcomes of systemic lupus and lupus nephritis using medications with lower toxicity than presently available. If you have a patient who might benefit from involvement in a research study for lupus, or would like to see what studies are currently available, please visit http://ccts.osu.edu/ studysearch and use keyword search “lupus.”
• If you suspect an immune-mediated process, but are unsure what type of autoimmune disorder a patient has, our team can help make that determination and work with you to develop a comprehensive treatment plan for the patient.
Get started To refer a patient to the Lupus Clinic, please call 614-293-4837. For urgent lupus consults, please call Shelley McNutt at 614-688-6677.
How We Work With You Patients living with lupus have complex health issues that evolve over time. Our team is equipped to partner with you in the following ways:
Imaging Facilities Earn ACR Gold Seal Accreditation Positron Emission Tomography (PET) services have been accredited for more than five years. The Medical Center’s MRI facilities received ACR accreditation more than six years ago, and all newly installed systems are in the process of being accredited.
Several facilities at Ohio State have been awarded first-time accreditations after a recent review by the American College of Radiology (ACR). Awarded for the first time to Ohio State’s Wexner Medical Center is a threeyear term of accreditation in computed tomography (CT) and nuclear medicine. The MRI system at the Stefanie Spielman Comprehensive Breast Center is also in the process of being accredited in the newly established Breast MRI program by the ACR. Furthermore, the Breast Center has received the distinguished Breast Imaging Center of Excellence award for achieving accreditation in all breast-specific imaging modalities: mammography, breast ultrasound and stereotactic breast biopsy.
“Our team has worked tirelessly to meet the stringent quality and safety standards of an ACR-accredited facility, even before it was required. We’re proud to represent the quality and expertise expected by an academic medical center of Ohio State’s caliber,” says Richard D. White, MD, who chairs the Department of Radiology and directs the Imaging Signature Program at Ohio State’s Medical Center. For a complete list of ACR accredited facilities at Ohio State, please visit medicalcenter.osu.edu.
James Cancer Hospital Earns Top Ranking For the third consecutive year and the fourth time in five years, The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute has been named among the safest and most effective hospitals in the country, according to a national ranking from the Leapfrog Group. The James is among 65 hospitals from a field of almost 1,200 to be named 2011 Leapfrog Top Hospitals based upon a rating system that provides an up-to-the-minute assessment of a hospital’s quality and safety. The James is among 52 adult, three rural and 10 children’s hospitals on the list, and one of only two freestanding cancer hospitals to be honored. In Ohio, three adult and two children’s hospitals made the list. 41
Maintaining CME Credit is Simple with Ohio State’s Center for Continuing Medical Education As a physician, it may seem difficult to find time for opportunities to earn continuing medical education (CME) credits, but Ohio State’s Center for Continuing Medical Education (OSU CCME) makes it very simple for you to receive and track your credits. In addition to a wide range of live CME conferences, OSU CCME also offers numerous online educational opportunities. A listing of all upcoming and current offerings can be found at ccme.osu.edu under “CME Activities.” All credits awarded by attending a conference, or completing an online post-test or questionnaire, are automatically recorded into your OSU CCME account. If you do not have an account but register for a conference, an account is automatically created for you using your email address, so your credits will not be lost, and you can track your credits through the OSU CCME website. A record of your CCME credits is maintained for a minimum of six years. You can print out your CME certificates individually or in a summary report at your convenience.
Since it can be difficult to schedule time away from the office, OSU CCME also provides educational activities available online 24 hours a day, seven days a week for your convenience: w Point of Care If you perform a Web search for patient treatment options or other care-related information, you are eligible for 0.5 AMA PRA Category 1 Credit(s)™. You must complete the CCME’s Point of Care questionnaire to receive credit. A maximum of 20 AMA PRA Category 1 Credit(s)™ per year may be obtained per physician. There is no charge for completing the questionnaire. w MedNet21 Programs MedNet21 is the CCME’s webcast series, accessible online 24/7. This on-demand series offers more than 120 programs at any time, covering today’s hottest medical topics. Each webcast includes a PowerPoint presentation, associated PDF handout and a post-test. While there are 120 programs available online, approximately 80 programs are viewable in Real Player only. Starting with the 2011 – 2012 season, the webcasts have been formatted for Windows Media Player. Webcasts are all free to view. If your hospital is a MedNet21 subscriber, your access to the post-tests is also free! If you’re not affiliated with a subscribing hospital, there is a $25 fee to take the post-test and receive the CME credit. Each posttest completed entitles you to 1 AMA PRA Category 1 Credit(s)™. Individual subscriptions are also available.
Get started To access our educational offerings and receive notices of future CME opportunities, sign up for a free account with the instructions below. For questions or to see if you have an existing CCME account, please call 614-293-3576. 1. Go to ccme.osu.edu 2. Select the red “Sign Up” button 3. Complete the registration page and click Submit 42
Gain Electronic Medical Record Access to Your Patients at Ohio State’s Wexner Medical Center Now there is a fast, convenient way for you to access your patient records during and after their care at Ohio State’s Wexner Medical Center. Our DocLink 2.0 provides you with access to comprehensive medical chart information on your patients, including:
To request a DocLink 2.0 account, please contact one of the numbers below. Bill Cox: 614-293-2824 Karen Mitchell: 614-293-4352
• Full visit histories and treatment plans
DocLink Help Desk: 614-293-3861, option 2
• Complete chart detail, results review, allergies, histories and problem list • The ability to communicate electronically with the Ohio State attending physicians involved in your patients’ care.
Announcing Our New Name: The Ohio State University Wexner Medical Center The Ohio State University Board of Trustees voted in February to name The Ohio State University Medical Center in honor of university alumnus Leslie H. Wexner in recognition of his three decades of leadership and service to the university. The medical center will now be known as The Ohio State University Wexner Medical Center.
vision for our academic Medical Center, and that is to be a world-class institution, period.”
“Les has been among Ohio State’s most dedicated leaders and most passionate supporters for many decades, and someone who continues to make an indelible impact on our community,” said President E. Gordon Gee. “His generous contributions, both in time and resources, have been wholly transformational, but his most valuable gift has been his extraordinary leadership. He has a firm and unequivocal
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Mr. Wexner’s philanthropic connection to Ohio State began three years after he graduated, when he made a $5 donation to the university. For more than 30 years, Mr. Wexner and his affiliates have donated more than $200 million to the university, as well as hundreds of millions more that Mr. Wexner has directly helped to raise. Last year, Mr. Wexner, his wife Abigail, and the Limited Brands Foundation’s $100 million gift to the Medical Center, the James Cancer Hospital and the Wexner Center for the Arts was the largest single donation in Ohio State’s history.
Connect with Resources from Ohio State’s Wexner Medical Center
Our Regional Outreach team is here to assist you in accessing the resources, education and patient referral information you need most from Ohio State’s Wexner Medical Center. Call your regional outreach coordinator at any time for information such as: • Help with the referral process • Requests for visits/calls with Ohio State physicians • Requests for patient materials • Access to CME and clinical research opportunities
Franklin County 614-366-6680 East/Southeast Ohio Karen Mitchell | 614-293-4352 North/West Ohio Bill Cox | 614-293-2824
Your Resources Referring Physicians medicalcenter.osu.edu/referringphysicians Referring physician information, links, downloads and forms, patient education materials, maps and directions The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute The James Line: 614-293-5066 cancer.osu.edu Patient referral center, clinical trials and research information, patient education materials Continuing Medical Education ccme.osu.edu Continuing Medical Education programs, including Category I CME offerings online through Ohio State’s MedNet21, traditional lecture series and Grand Rounds Physician-to-Physician Consultation Line 800-293-5123, option 1 Consult with an Ohio State’s Wexner Medical Center physician, discuss specific patient-related cases, appointment referral, transfer a patient © 2012 The Ohio State University Wexner Medical Center UHOS20110222-05
Physician Relations 800-293-4326 or mdrelations@osumc.edu Physician Relations supports the needs of community physicians and their staff as they interact with Ohio State’s Wexner Medical Center Ohio State’s Regional Outreach Program Franklin County..................................................614-366-6680 East/Southeast Ohio, Karen Mitchell..........614-293-4352 North/West Ohio, Bill Cox..............................614-293-2824 Outreach provides access to Ohio State’s Wexner Medical Center services, specialty physicians, continuing medical education and other Medical Center programs Physician Directories To request a copy of our physician directory or to request updated sections for your existing directory, please call your Regional Outreach Coordinator (above). Physician Referral Guide To request a copy of the Physician Referral Guide, call your Regional Outreach Coordinator or visit medicalcenter.osu. edu/referringphysicians to access an online version.
Physician Resources
Contact
DocLink doclink.osumc.edu
Online tool for secure access to your patient’s medical records during and after their care at Ohio State.
Ohio State’s Wexner Medical Center medicalcenter.osu.edu
Referring physician information, patient education materials, maps and directions
The Arthur G. James Cancer Hospital and www.cancer.osu.edu Richard J. Solove Research Institute
Patient referral center, clinical trials and information, patient education materials
Ohio State’s Wexner Medical Center ccme.osu.edu Center for Continuing Medical Education
Web site featuring Continuing Medical Education programs including: Category I CME offerings online through OSU MedNet21, traditional lecture series and Grand Rounds
1-800-293-5123; option 1 Physician-to-Physician Consultation Line
Consult with an OSU Medical Center physician, discuss specific patient-related cases, appointment referral, transfer a patient
Physician Relations 1-800-293-4326 or mdrelations@osumc.edu
Physician Relations supports the needs of community physicians and their staff as they interact with Ohio State’s Wexner Medical Center
Franklin County: 614-366-6680 Ohio State’s Regional Outreach Program East/Southeast Ohio: 614-293-4352 North/West Ohio: 614-293-2824
Outreach provides referring physicians with access to Ohio State’s Wexner Medical Center services specialty physicians, continuing medical education and other medical center programs
www.medicalcenter.osu.edu/referringphysicians