Volume 12
Issue 5
May 2013
SYSTEMnews F or the first time in
CEO’s corner
four years, my arms and hands were almost the same size. `` Far Left: The lymphedema following breast cancer surgery caused throbbing and dramatic swelling in Jeannette Aspden’s right arm. (Her hand shows markings from the bandaging she needed to wear to help control her lymphedema).
Ralph W. Muller
CEO, University of Pennsylvania Health System
The line of descent from Benjamin Franklin to the Penn Medicine of today is a long and celebrated one. And you
before
After
can be a part of it! Another opportunity to display your innovative thinking — much as Dr. Franklin did — is now in high gear. The Your Big Idea Challenge encourages members of the Penn Medicine community to propose ideas for improving operating efficiencies and lowering costs … while of course maintaining the Penn hallmarks of excellence in patient care, research, and education. Last year’s Your Big Idea — our innovation tournament to improve the patient experience — proved so successful that we’ve brought it back in a new version this year. Nearly one-third of our workforce took part in the 2012 tournament by submitting, commenting on, or rating ideas. This year we’re aiming to climb even higher than that impressive participation rate. We’re conducting the Challenge to help ensure that we retain our strong fiscal health in increasingly difficult times. The health care industry nationwide is facing growing financial demands, and Penn Medicine is not immune from these pressures. Lower governmental payments, fewer inpatient admissions, expected cuts in medical education and research funding, and growing information technology costs for meaningful-use requirements are compelling health care organizations everywhere to take new measures to adapt. In our case, the goal is clear and basic: identify new cost-savings opportunities so that we can continue to reinvest in the future of Penn Medicine. Whether it’s performing procedures more wisely and efficiently, using less-costly supplies, or making the best use of technology — and almost anything in between — we welcome all ideas to help improve value while continuing Penn’s best-of-class standard. (continued on page 6)
A New Procedure Offers Hope to Patients with Lymphedema Seeing your knuckles may not seem like much to get excited about. But for patients such as Jeannette Aspden, knuckles represent progress — significant progress. Aspden has lymphedema — throbbing, dramatic swelling in her right arm. It developed after some of her lymph nodes were removed following breast cancer surgery four years ago. The distension got so bad that she literally could not see her knuckles or the veins in her hands for years. Forget about wearing a ring. “It’s painful, it severely hinders your ability to do everyday things, and it’s not particularly pleasant to look at,” she said. The lymphatic system circulates lymph fluid throughout the body to vacuum up and expel unneeded bacteria, viruses, and waste products. But surgeons are often forced to remove lymph nodes from the armpit area to ensure that breast cancer doesn’t spread. If the remaining nodes can’t pick up the slack, bodily detritus builds up and lymphedema may result. Bacteria can also accumulate, resulting in serious infection — which is what repeatedly happened in Aspden’s case. To address Aspden’s symptoms, Suhail Kanchwala, MD, of Plastic Surgery, performed a vascularized lymph node transfer, a new approach to treating lymphedema in the US. The complex, microvascular surgery entails relocating lymph nodes to a region where lymph nodes were removed due to previous cancer surgery. In Aspden’s case, Kanchwala transplanted lymph nodes from her abdomen to her axilla. “Our hope is that once everything is connected, the newly transplanted nodes pick up where the old nodes left off,” he said.
Regaining a Good Quality of Life
Inside Simply Because.........................2
Inside
Spoof 2013 Leaves Audience in Stitches.................2 Rubenstein to Penn Medicine@Work..............3 Step Down.................................2 Newsmakers..............................4 From Pastels to PDA’s...............2 It’s Good to Be Green................5 RoundtableFree Skin CCU at Presby Turns 50!...........5 Cancer Screening......................3 Hand Sanitzer & Shortakes...................................4 Thermometers Save Lives.......5 Awards Accolades.............6 Anotherand Title..............................5
Left: Now, months after the vascularized node transfer, the swelling not only decreased significantly, but has remained so. Much to her delight, her wedding band slides easily onto her finger.
In this country, lymphedema has been primarily managed by physical therapists. Since the disease can’t be cured, the goal has been to reduce pain and swelling while increasing limb strength. Therapists use compression bandaging (typically a sleeve that covers the entire arm and hand) and manually apply light pressure to the the lymph system, which lies just below the surface of the skin, to help drain the fluid and reduce the swelling. “The traditional physical therapy treatments can be extremely effective,” said Kanchwala. “But many patients with serious, repeated infections and severe symptoms need additional help.”
In 2011, to learn more about the procedure, Kanchwala observed Dr. Corinne Becker carry out the surgery on several patients. She has been performing the procedure in Europe and other parts of the world for years. He then went to France and participated in her clinic and other surgeries as well. “I became comfortable with the idea of performing the surgery but only in cases where patients had no other options for regaining a good quality of life,” Kanchwala recalled. “Any surgery should be a last resort, particularly lymph node transfers, which have very little history in this country and few formal studies to rely on to assess effectiveness.” A major worry is removing too many lymph nodes from the donor site. “The last thing you want to do is cause lymphedema in another limb,” he noted. “We prevent this by being extremely careful. By using special dyes, we are able to avoid nodes that drain the arm or the leg. In this way the risk of causing donor site lymphedema is negligible.”
She literally could not see her knuckles or the veins in her hands for years. Another concern is damaging nerves and blood vessels. “Before you transfer nodes to their new location, you have to scrape away scar tissue at the destination site which may be obstructing the lymphatic channels and hampering fluid circulation,” he said. “Too much scouring can destroy important tissue and cause serious damage.” Satisfied that he was fully prepared, Kanchwala performed his first lymph node transfer on the leg of a 38-year old melanoma patient. After the surgery, the patient’s leg went from being badly deformed to only moderately swollen a few weeks later. “She had achieved the kind of results we were looking for. This surgery is not intended to be a cure for lymphedema but to see such a significant improvement in our first case was very encouraging.”
(continued on page 2)
HUP Earns Comprehensive SOM Ranked #2.........................6 Stroke Center Status................ 6
1