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[resource] BAPTIST HEALTH SOUTH FLORIDA

SUMMER/FALL 2015

Growing Strong Working together to build a healthier community

The mystery of migraines New solution for sleep apnea

Letters

6855 Red Road, Suite 600, Coral Gables, FL 33143 • BaptistHealth.net To send comments and address changes or to unsubscribe, email MyResource@BaptistHealth.net.

Dear Baptist Health, n today’s hustle and bustle, it can be very difficult for doctors to take the time to get to know a patient. As a radiologist, Dr. Michael Silberman reads and sees people from the inside out on a daily basis. When I met him and the amazing staff at the Baptist Medical Plaza at Davie, my skewed vision of the healthcare industry completely changed. Together, he and his staff made me feel at ease the very moment we met.

I want to take a moment to thank Dr. Silberman for going above and beyond in his personal interest of my well-being. I was literally amazed to receive a phone call from him on his day off to inform me of my test results. Before this experience, I would have assumed most doctors would have waited until they were back at work to make the call. But because he realized how nervous and stressed I was, he took time out of his day to relieve me of my worries. It was music to my ears when I heard his words, “Good news… you can party now!”

You don’t have to be a radiologist to read people from the inside out. Dr. Silberman happens to be doubly blessed to have the ability to do so. Perhaps it’s his patients, for that matter, who are the blessed ones. His heart is big and kind. Baptist Health is fortunate to have him as a leader on its fine team.

Thanks to Dr. Silberman for all he has done and continues to do every day. It can be hard to find a doctor who shows so much concern for their patients. The world truly needs more doctors like him.

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Warmest regards, Robin Krauss Davie

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Letters edited for clarity and consistency.

BAPTIST HEALTH SOUTH FLORIDA Board Chair, the Rev. Dr. William W. White; President and Chief Executive Officer, Brian E. Keeley; Trustees: Jane Alonso, R.N., Sheldon Anderson, Calvin Babcock, Yerby Barker, George Cadman III, James Carr, the Rev. William Chambers III, George Corrigan, Richard Dailey, William Dickinson, Joyce Elam, Herbert Greene, M.D., Jay Hershoff, Charles Hood III, the Rev. Dr. Gary Johnson, Norman Kenyon, M.D., Rudy Kranys, the Rev. Richard Ledgister, the Rev. Wilner Maxy, Paul May, the Rev. Dr. Marcos Ramos, Aida Shafer, Ronald Shuffield, Janá Sigars-Malina, Roberta Stokes, Bill Tillett, J. Scott Weston, William Wilson III. BAPTIST HOSPITAL OF MIAMI Board Chair, Calvin Babcock; President, Baptist Hospital Medical Staff, Michael Fili, M.D.; Chief Executive Officer, Bo Boulenger.

DOCTORS HOSPITAL Board Chair, Norman Kenyon, M.D.; President, Doctors Hospital Medical Staff, Ruben Penaranda, M.D.; Chief Executive Officer, Nelson Lazo.

HOMESTEAD HOSPITAL Board Chair, the Rev. William Chambers III; President, Homestead Hospital Medical Staff, Jorge Mejia, M.D.; Chief Executive Officer, William Duquette.

MARINERS HOSPITAL Board Chair, Jay Hershoff; President, Mariners Hospital Medical Staff, Kenneth Ahonen, M.D.; Chief Executive Officer, Rick Freeburg.

SOUTH MIAMI HOSPITAL Board Chair, Yerby Barker; President, South Miami Hospital Medical Staff, Jeremy Tabak, M.D.; Chief Executive Officer, Lincoln Mendez.

WEST KENDALL BAPTIST HOSPITAL Board Chair, Aida Shafer; President, West Kendall Baptist Hospital Medical Staff, Juan-Carlos Verdeja, M.D.; Chief Executive Officer, Javier Hernández-Lichtl.

BAPTIST HEALTH MEDICAL GROUP Board Chair, Herbert Greene, M.D.; Chief Executive Officer, Bernie Fernandez Jr., M.D. BAPTIST OUTPATIENT SERVICES Board Chair, Roberta Stokes; Chief Executive Officer, Patricia Rosello.

BAPTIST HEALTH ENTERPRISES Board Chair, James Carr; Chief Executive Officer, Ana Lopez-Blazquez.

BAPTIST HEALTH SOUTH FLORIDA FOUNDATION Board Chair, William Wilson III; Chief Executive Officer, William Banchs.

DIRECTORS OF AFFILIATED BOARDS Jose Aguirrechu, Kenneth Ahonen, M.D., Yvette Aleman, Richard Alger, Cira Almeida, Anthony Alonso Jr., DMD, Jane Alonso, R.N., Dick Anderson, Sheldon Anderson, George Aronoff, Calvin Babcock, Orlando Bajos, William Baldwin, Oscar Barbara, James Barker, Yerby Barker, Rodney Barreto, Matthew Becherer, Rodney Bell, James Benenati, M.D., Mark Bennington, Robert Berrin, the Rev. Dr. Rick Blackwood, Bonnie Blaire, James Bokor, Joseph Bolton, Steven Brodie, Bette Brown, Joseph Buchanan, Daniel Buraglia, Mita Burke, Robert Burstein, George Cadman III, Barbara Calev-Moran, Willie Carpenter, James Carr, Susan Carr, Missy Carricarte, Gerald Case, Ray Castellanos, Mauricio Cayon, the Rev. William Chambers III, Barron Channer, Griselle Chernys, Neil Chrystal, Phil Conway, George Corrigan, Robert Coward, Richard Dailey, Donald Darrach, Agustin De Goytisolo, Liana De Mena, Elizabeth Diaz de Villegas, William Dickinson, Lani Kahn Drody, Joyce Elam, Tomas Erban, Justo Fanjul, Theodore Feldman, M.D., the Rev. Otto Fernandez, Pedro Fernandez, Armando Ferrer, Deborah Figaro, Michael Fili, M.D., Karel Foti, Arturo Fridman, M.D., Donald Gallo, DMD, Carlos Garcia, Ygnacio Garcia-Saladrigas, Peter Gardner, Maria Garza, Alex Gierbolini, William Gilbert Jr., Robert Gintel, Paul Gluck, M.D., Richard Gomez, Jose Antonio Gonzalez, Gretchen Goslin, Kristina Rae Gossman-Ducanes, Michael Graham, M.D., Herbert Greene, M.D., Leif Gunderson, Ghassan Haddad, M.D., Barry Halpern, M.D., Kent Hamill, Barbara Hanck, James Harris, Ilien Hechtman, William Henneberry, Alysa Herman, M.D., Luis Hernandez, Mark Hernandez, M.D., Agustin Herran, Jay Hershoff, Charlotte Hicks, Audra Hill, Charles Hood III, Sherrill Hudson, Jacque Huttoe, Abel Iglesias, Jeanne Jacobs, Lourdes Jofre-Collett, the Rev. Dr. Gary Johnson, Yvonne Turner Johnson, M.D., Lane Jones, Thomas Jones Jr., S. Lawrence Kahn III, George Kakouris, Barry Katzen, M.D., Judith Katzen, Norman Kenyon, M.D., Hank Klein, George Knox, Robert Kramer, Rudy Kranys, Charles Kropke, Samir Kulkarni, M.D., Jon Landau, Manuel Lasaga, the Rev. Richard Ledgister, Cynthia Leesfield, María Camila Leiva, Orlando Leon, M.D., James Loewenherz, M.D., Miriam Lopez, Carlos Lowell, Victoria Lowell, John Maas, Bruce Wirtz MacArthur, Stanley Margulies, M.D., Michael Marquez, Joy Martin, Charlie Martinez, Miguel Maseda, the Rev. Wilner Maxy, Paul May, Joseph McCain, DMD, Joanne McGregor-Ganus, Cheryl Anne Meads, Jorge Mejia, M.D., Fernando Mendoza, M.D., Juan Antonio Michelena, Niberto Moreno, M.D., Hans Mueller, Patricia Mull, Thomas Murphy Jr., Abe Ng, Paula Owens, Ramon Oyarzun, Martha Pantin, Arva Moore Parks, M. Johanna Paterson, Ruben Penaranda, M.D., Jorge Perez, M.D., Lillian Peters, Ann Pope, Samuel Porco Jr., DMD, Jose Portuondo, M.D., Ramon Quesada, M.D., Juan-Carlos Quintero, DMD, the Rev. Dr. Marcos Ramos, Ramón Rasco, Charlen Regan, Ian Reiss, M.D., Melinda Rich, Raymond Robinson, Ron Robison, John Rock, M.D., Domingo Rodriguez, William Rohrer, David Rosenbaum, Audrey Ross, James Russell, Darren Salinger, M.D., Steven Sapp, Joel Schenkman, M.D., Betty Anne Schilling, I.E. Schilling, Liz Schmier, Aida Shafer, Robert Shafer Jr., Emery Sheer, Joel Shepherd, Ronald Shuffield, Karent Sierra, DDS, Janá Sigars-Malina, Cale Smith, Maria Costa Smith, Albert Sotero, Patricia Stanley, Lee Stapleton, James Stewart, M.D., Roberta Stokes, Cristina Sullivan, Jeremy Tabak, M.D., Rene Taylor, George Tershakovec, M.D., Eris Thomas, Aislynn Thomas-McDonald, Patricia Thorp, Henry Tie Shue, Bill Tillett, Sats Tripathy, Ernesto Valdes, M.D., Chip Vandenberg, Otto Vega, M.D., Agustin Veitia, Frank Veloso, Juan-Carlos Verdeja, M.D., Kristine Wenzel, J. Scott Weston, Lisa Guerrant White, the Rev. Dr. William White, Vivian Williams, William Wilson III, E. Carlton Wilton Jr., Philip Wolman, Lloyd Wruble, DMD, Jack Yaffa, M.D., Marta Yee, Jerrold Young, M.D., Roark Young, Robert Zolten, M.D., Leonard Zwerling, M.D. BAPTIST HEALTH SOUTH FLORIDA EDITORIAL TEAM executive editor: Roymi V. Membiela; associate editors: Dori Alvarez, Christine Kotler; contributing editor: Patty Shillington; assistant contributing editor: KiKi Bochi; contributing writers: Kitty Dumas, Laura Pincus, Bethany Rundell, Adrienne Sylver; editorial assistant: Dorothy Stein A COLLABORATION WITH HCP/ABOARD PUBLISHING (A subsidiary of The McClatchy Company) president & publisher: Erin Zilis; chief operating officer: Giovanna Sanchez; copy editor: Sole Sastre; art director: Ethan Duran; production director: Luisa Zelaya-Morillo on the cover: Third-garder Melania de la Torre discovers the joy of uprooting carrots at Homestead Hospital’s Grow2Heal Garden. cover photo: Mabel Rodriguez

[CONTENTS]

SUMMER/FALL 2015

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Healthy Gourmet Executive Chef Stan Hodes uses fresh vegetable salsa to add flavor and nutrition to fish.

02 Just for Women

Unraveling the mystery of migraines takes detective work.

04 Perspectives

A symphony of quick action and medical skill saves a musician’s life.

06 Kid Stuff

Keeping a sense of humor is key for one young cancer patient.

08 Innovations

A new implantable device offers alternative treatment for sleep apnea.

10 Cover Story

Baptist Health is at the forefront of a new healthcare model for the 21st century, focusing on promoting healthy living and improving access to care.

16 The Second Act

Eye drops become a thing of the past for some glaucoma patients.

18 Spotlight

An arduous journey leads Nayivis Pupo, R.N., right where she belongs.

20 Making the Rounds Find out what’s happening at Baptist Health.

23 Health Stat

The importance of cervical screenings.

24 Myth vs. Fact

Donna Victor

Is running with minimalist shoes a good idea?

25 Baptist Connect Learn what’s new at BaptistHealth.net and connect with us.

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Just for Women

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Just for Women

Grateful her doctor took the time to unravel her migraine symptoms, Ximena England can now focus on her family and enjoy life.

Migraine mystery Getting to the root of these debilitating headaches takes some detective work wo years ago, former professional ballerina Ximena England was fit, active and energetic, balancing her responsibilities as a wife and working mother. Then, suddenly, something changed.

Feeling weak and lethargic, Ms. England recognized symptoms of menopause — hot flashes, night sweats, missed periods.

She also began suffering from insomnia, which led to excruciating migraines.

Crystal Harris, 30, also suffered from migraines, but her story is different.

She experienced her first migraine at age 10. Her mother took her to doctor after doctor, all of whom prescribed a variety of pain medications that worked only temporarily. Ms. Harris’ migraines would last for several days, rendering her unable to go to school or work. She was desperate for a solution. “It was like my life revolves around my migraines,” she said. “I can’t do it anymore.”

A migraine is more than just a bad headache. It is a debilitating collection of neurological symptoms that include

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intense, throbbing pain on one or both sides of the head. Symptoms may also include visual disturbances — such as flashing lights and zigzag lines — nausea, vomiting, dizziness and extreme sensitivity to light, touch, sound and smell.

Migraines affect three times as many women as men, according to the Migraine Research Foundation. Overall, about 10 percent of the population, including children, experience migraines.

There is no one-size-fits-all treatment for migraines, said Patricia Feito, M.D. a Baptist Health Primary Care doctor and a member of Baptist Health Medical Group, who treats both Ms. England and Ms. Harris.

Stress, lifestyle, diet, alcohol and caffeine consumption, tobacco use, hormonal changes, medications and life-altering events all can contribute to migraines.

Depending on the patient, treatment may include diet and exercise changes and anti-inflammatory medications, she said. Alternative treatments such as acupuncture and even Botox can help some women. Finding the right approach can be a process of trial and error.

After reviewing Ms. England’s test results, Dr. Feito diagnosed her with an extreme menopausal condition. Like Ms. England, many women experience migraines at middle age, Dr. Feito said.

“That’s when more hormonal changes are happening,” she said.

In addition to prescribing pain medications, Dr. Feito referred Ms. England, 51, to a hormone specialist. Ms. England credits Dr. Feito with carefully piecing together her medical history in search of answers. “I love her,” said Ms. England, who expects the migraines to subside now that hormone therapy is helping her sleep better.

“She’s been a very big support.”

Dr. Feito said she often has to be a bit of a detective. “I ask patients to keep a headache diary, which is much more important than anything else, because that determines how often it happens, what associated symptoms are going on, if there are any triggers that bring it on.”

In the case of Ms. Harris, who had migraines since childhood, hormones weren’t the issue. Dr. Feito set up an appointment for her to see a dietitian

Donna Victor

By Kitty Dumas

— a strategy that ultimately changed her life. Ms. Harris said she had been consuming as much as four liters of soda per day for years, in addition to fried fast food and other poor food choices. Dr. Feito encouraged her to change her diet and lifestyle, starting with just one day a week. Since January, Ms. Harris has lost 36 pounds and she recently completed a half-marathon. Her migraines have all but disappeared.

“I don’t drink soda, I drink water. I try to stay away from processed foods,” said Ms. Harris, a nurse’s aide at West Kendall Baptist Hospital. “I went from having a headache every week, to only one headache last month — and it only lasted a couple of hours.”

For women who don’t respond to medications or other forms of treatment, another option may be Botox, which blocks nerve signals to the brain and relaxes muscles. Treatment generally involves injections to the forehead, temples, back of the head, neck and shoulders. “It’s a very effective option for patients who qualify as chronic sufferers, but only after we determine no other cause for their headaches,” said Allan Herskowitz, M.D., a neurologist affiliated with Baptist Health.

“The most important thing for you to do if you have recurring migraine headaches is to see a doctor to make sure there are no physical abnormalities in the brain,” Dr. Herskowitz said. “The doctor will run tests and take down a full history of headaches before arriving at a diagnosis of migraines.”

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Perspectives

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Donna Victor

Ken Smith-Christmas is one of the lucky few who survive a ruptured aortic aneurysm.

Fit as a fiddle A symphony of quick action and medical skill saved this musician’s life

By Patty Shillington

he way Ken Smith-Christmas sees it, miracles large and small began the moment he collapsed while playing his Scottish fiddle at a talent show for snowbirds in Key Largo.

“I was sweating and sweating, and I knew something wasn’t right,” recalled

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Mr. Smith-Christmas, 65, a retired museum curator who spends winters with his wife, Linda, at their Upper Keys condo.

“I turned to the right and crumbled — but I hung on to the fiddle, an antique heirloom, and only broke one string.”

That was the small miracle.

The “stunning” miracle, as one of his

doctors described it, was that he lived to tell the story of surviving a burst aneurysm of the aorta, the primary artery that carries blood from the heart to the rest of the body. An estimated 65-85 percent of people with a ruptured abdominal aortic aneurysm die before they can get medical care.

On the way to Mariners Hospital in Tavernier, Mr. Smith-Christmas was “in and out” of awareness, but heard a paramedic’s grim remark that he couldn’t find the patient’s pulse. “I thought, this cannot be good,” Mr. Smith-Christmas said.

At first, Kenneth Ahonen, M.D., medical director of the Mariners Hospital Emergency Center, was somewhat perplexed. His patient was fainting and his blood pressure was dangerously low. “He was critical and we recognized that something serious was going on,” Dr. Ahonen said. But Mr. Smith-Christmas didn’t complain of severe, or even any, abdominal, lower back or leg pain — among the telltale signs of a rupture. A CT scan of his chest suggested a problem in his abdomen and a second scan revealed “blood free-flowing in his belly. It was clear something catastrophic had happened,” Dr. Ahonen said, “and he needed emergency surgery.”

Alerted by Dr. Ahonen, the Baptist Health Transfer Center arranged for a critical care transport team to airlift Mr. Smith-Christmas to Miami Cardiac & Vascular Institute at Baptist Hospital.

When Mr. Smith-Christmas arrived at the Institute after midnight on Feb. 23, a multidisciplinary team including physicians, stent-graft device specialists and specialized nurses was ready. The aneurysm, a weakened area in the artery

wall, was large — seven Guided by arteriogram centimeters — and indeed it images, the team deployed had ruptured. “He fell into a fabric tube reinforced that very narrow category with metal, called a stentof patients with a rupture graft, to create a new that briefly seals,” said wall for the section of the interventional radiologist aorta with the ruptured Shaun Samuels, M.D. “The aneurysm. mortality is about 10 percent Mr. Smith-Christmas Shaun Samuels, M.D. every hour. So you are racing woke up in the ICU, against the clock when you where he spent three of have that type of lethal lesion. Luckily, we his five days in the hospital. “Everybody have a program where we are prepared for was just working 150 percent, going out this type of emergency.” of their way to take good care of me,” he With no time to plan the highly said. “It was beyond amazing.” technical, minimally invasive Mr. Smith-Christmas, now a historical endovascular procedure, Dr. Samuels writer, recuperated in Key Largo for and vascular surgeon Athanassios about six weeks, working on his latest Tsoukas, M.D., began the delicate task book, before doctors gave the go-ahead of repairing the ruptured aneurysm. for him to return to Virginia.

Dr. Samuels accessed the aorta through He credits the quick action and a catheter inserted in a blood vessel expertise of Baptist Health’s medical in Mr. Smith-Christmas’ right groin. teams for giving him the chance to Dr. Tsoukas did a small “cutdown” spend future winters in Florida incision at the left groin to reach the and play his beloved fiddle. “I am blood vessels. forever grateful.”

Perspectives

NATIONAL CENTER FOR ANEURYSM THERAPY TO OPEN SOON More than two decades ago, Miami Cardiac & Vascular Institute pioneered a then-experimental endovascular procedure to repair abdominal aortic aneurysms without major surgery. Nearly 1,000 procedures later, the Institute is about to take aneurysm research and treatment to the next level when it opens the National Center for Aneurysm Therapy as part of its $100 million expansion.

Barry Katzen, M.D.

“This is something that no one in the world has,” said Barry Katzen, M.D., the Institute’s medical director and founder. “We will have physicians from many different disciplines working together to provide the most advanced care for patients with an aneurysm in the brain, kidney, aorta or elsewhere.”

Fareed Al-Mashat

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For more details about the expansion, which is scheduled for completion in 2016, visit BaptistHealth.net/Heart.

Kenneth Ahonen, M.D., medical director of the Mariners Hospital Emergency Center, was the first doctor to treat Ken Smith-Christmas.

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Kid Stuff

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Kid Stuff

The power of laughter Keeping a sense of humor helped this teen triumph over cancer ngela Ortiz will be the first to tell you there’s nothing funny about cancer. Yet she found a way to keep laughing — and still does.

Right now she is almost giddy about heading off to Harvard this fall on a full scholarship. “It’s hard to believe,” she said. Just two years ago, she was gravely ill with a tumor in her chest that was so large it was cutting off her airway. Discovered after she collapsed, the situation was life-threatening. With her ability to breathe seriously compromised, she had to have an emergency biopsy without general anesthesia. A pediatric specialist stayed by her side to distract her as she underwent surgery with only a local numbing agent at Baptist Children’s Hospital.

“It was pretty intense,” Angela said. And so was the diagnosis: Hodgkin’s lymphoma. Angela began treatment to shrink the tumor so she could undergo surgery — with full anesthesia — to implant a chemotherapy port.

“I remember waking up from that surgery, and everyone was crying. My mother was crying. My cousin was crying, my brother was crying,” she recalled. “So I said, ‘What are you crying about?’

Everyone laughed, and it was much easier after that.”

Laughter became as much a part of her healing as the chemotherapy and radiation, she said. “I could joke about how crappy I felt, but in a good way. If I wanted to be goofy, I could be goofy. As cheesy as it sounds, laughter really is the best medicine.”

Although she could have withdrawn from school during treatment, Angela was determined to continue. She had worked very hard to get into the School of Advanced Studies, a nationally recognized public program that allows high school students to earn college credits. Her cancer diagnosis came within a week of starting the program at Miami Dade College’s Homestead campus.

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“She was determined not to miss school. She was not going to let cancer define her,” said Laurie Sargent, a senior child life specialist at Baptist Children’s Hospital. Ms. Sargent, who stayed

by Angela’s side during her first procedure without anesthesia, formed a deep connection with the teen. “We were in surgery for an hour and a half. We talked about everything… You bond pretty quickly when you are in a situation like that. I knew immediately she was truly remarkable.”

When Angela’s treatment was complete, she wrote a frank yet fun pamphlet for other adolescents facing cancer. Ms. Sargent called it “a very useful tool” to help staff connect with kids. Baptist Health Foundation paid to make copies that are distributed to newly diagnosed patients.

“I wanted to reach out and let other kids know, ‘Hey, you are not alone,’ ” Angela said. In the pamphlet, she talks about losing her hair, combating boredom with Disney movies and romantic comedies, how it’s fine to cry and great to laugh.

“This is a horrible thing that happened to you, but you have to laugh about it. It makes you feel like things really can be OK,” she explained. “That has a lot of power… The way you look at things can alter everything that goes on around you.”

From the start, Angela’s maturity impressed Doured Daghistani, M.D., medical director of pediatric oncology at Baptist Children’s Hospital. He’s not surprised Angela is now interested in pursuing medicine. Many of his young patients develop an interest in becoming doctors, he said. “A few of them actually do it. I think she will be one of the few… She went through hell with chemo and not only was she able to stay in school, she was able to keep her grades up,” he said. “She went through all the emotional upheaval of having cancer — and still she got into Harvard.”

Donna Victor (2)

By KiKi Bochi

Angela’s mom, Aurea Hurtado, herself a breast cancer survivor, watched her daughter grow through her illness and couldn’t be prouder of the young woman who has emerged, now cancer-free.

“As a result of the experience, she is more driven, she is more compassionate. It changed her perspective on the things she can do with her life.”

As much as Angela wanted to maintain a normal life, cancer left its mark on her. “When you go through something like this, it stays with you. It becomes a part of you… Before I was an angsty teenager. I was like every other teen who complains about how hard things are — homework, school and everything else,” she said. “Now I realize what it really means for things to be hard. I can handle a lot more, and I know everything will be fine.”

As Angela Ortiz heads off to Harvard, she hopes other kids dealing with cancer will feel empowered by a pamphlet she wrote. Inset: Her mother, Aurea Hurtado, couldn’t be prouder.

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Innovations

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Innovations

The first South Florida patient to receive an implantable device for sleep apnea, Lance Vanschaik now has more energy for his 3-year-old daughter, Alexandra.

A new implantable device can lead to a better night’s sleep

By Adrienne Sylver

itting behind the wheel at a red light, Lance Vanschaik found himself in a potentially dangerous situation. The Hollywood resident, who suffers from sleep apnea that left him exhausted during the day, would often nod off in the time it took for the light to change from red to green. But thanks to a new sleep apnea treatment at South Miami Hospital, Mr. Vanschaik no longer fears the worst as he approaches an intersection; a better night’s sleep has resolved his problem.

Mr. Vanschaik, 46, is the first South Florida patient to receive the Inspire Upper Airway Stimulation device, an implant approved last year by the Food and Drug Administration. Inserted during minimally invasive surgery, Inspire offers an alternative to the more traditional continuous positive airway pressure machine, also known as CPAP, which requires users to wear a mask and hook up to an air pump that keeps the airway open as they sleep.

The Inspire device consists of three parts: a small battery similar to a pacemaker that is implanted just under the skin in the chest; a tiny electrode that leads to the hypoglossal nerve that

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controls the tongue; and a monitor placed near the ribs to sense breathing.

Using a remote control, the patient turns the device on at bedtime and off in the morning. During sleep, when the tongue begins to relax and block the airway, low-dose electrical stimulation forces it forward, reopening the airway.

“I still wake up at night,” Mr. Vanschaik said. “But there are more subtle improvements in addition to the driving. I no longer have the feeling after lunch that I’m in a comatose state.”

More than 20 million Americans suffer from sleep apnea, according to the American Sleep Apnea Association.

The disorder causes pauses in breathing during sleep, which can lead to other health problems such as heart attack and stroke, high blood pressure, diabetes, headaches, depression and an overall feeling of exhaustion. While sleep apnea

can affect anyone, risk factors include being overweight and over age 40, having a large neck size (greater than 17 inches in men and 16 inches in women), large tonsils, nasal or sinus problems and a family history.

“It’s very exciting to be able to offer patients a solution to sleep apnea that is minimally invasive and does not require putting them through major surgery,” said ear, nose and throat specialist Rolando Molina, M.D., who performed Mr. Vanschaik’s outpatient procedure.

Dr. Molina added, however, that not everyone with sleep apnea is a candidate for Inspire. “It’s only for those who have tried other treatments and failed,” he said.

The particular cause of sleep apnea also helps determine whether a patient will benefit from the new device, said lung specialist Jeremy Tabak, M.D., medical director of Baptist Sleep Center

SLEEP STUDIES Baptist Sleep Centers at Galloway, Miami Lakes, Pembroke Pines and Sunset offer overnight sleep studies, which require a doctor’s prescription. Sleep studies also are performed at Baptist, Homestead, Mariners and South Miami Hospitals. For more information, visit Sleep.BaptistHealth.net. To make an appointment, call 786-467-5240 in Miami-Dade, 954-837-1400 in Broward or 305-434-1635 in Monroe.

Donna Victor

Dream machine

at Galloway and Baptist Hospital’s Sleep Diagnostic Center. “A study done at a reputable sleep center will pinpoint whether or not you have sleep apnea,” Dr. Tabak said. “But it can’t determine what is happening within the anatomy that causes the airway to become obstructed.”

A sleep endoscopy study, done under anesthesia as an outpatient, can provide the answer. A patient whose breathing is interrupted because the tongue blocks their airway will benefit from Inspire, while one whose throat walls collapse will not. Obese patients with a BMI greater than 32 also are not candidates.

For the majority of patients, the CPAP remains the gold standard of care, both doctors confirmed. “Before Inspire, however, we gave every patient pretty much the same cookie-cutter approach to care,” Dr. Molina said. “But each person is different. It’s great to be able to offer an alternative treatment.”

Mr. Vanschaik had tried dental appliances and a CPAP machine. The dental appliances made no difference, Mr. Vanschaik said, and he felt claustrophobic and dry-mouthed with the CPAP, despite of years of adjusting settings and trying different masks.

Mr. Vanschaik said the procedure has improved his life and helps him keep up with his 3-year-old daughter. “It does affect your personality, not being able to sleep,” he said. “It affected my mood, it affected my relationships. The improvements have been subtle, but I’m feeling better — and I think I will see even more improvement.”

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BETTER HEALTH

Today, Baptist Health is at the forefront of a new model for 21st century healthcare, one that focuses just as much energy and expertise on preventing illness and promoting lifestyles that support health and happiness. In this emerging philosophy of healthcare, Baptist Health is transforming its hospitals into community gathering places that encourage and empower people to take control of their health through exercise, diet, preventive care and education.

At many locations across South Florida, Baptist Health has expanded its free wellness programs, which include everything from educational talks by physicians to exercise classes and running clubs (for details, visit BaptistHealth.net/Wellness).

To customize programs at each of its six hospital campuses, Baptist Health funded surveys to pinpoint the health challenges and needs in the surrounding neighborhoods. Armed with this important data, each hospital began developing partnerships and programs to address specific needs, such as lack of access to primary care doctors and a high rate of chronic medical conditions like diabetes.

Here is a look at three of the innovative programs — an organic garden, a free health checkup and a state-of-the-art mobile health clinic — that are inspiring individuals and changing lives.

Mabel Rodriguez

ONCE UPON A TIME, HOSPITALS WERE PLACES THAT TREATED AND CARED FOR THE SICK. AS IMPORTANT AS THAT WAS, IT WAS PRETTY MUCH ALL THEY DID.

Oliver Castillo is delighted to pull a carrot from the earth at the Grow2Heal organic garden as classmate Tru Bowers looks on.

GROWING COMMUNITY Organic garden project serves as learning lab for the community

By Laura Pincus

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n a breezy Wednesday morning, 9-year-old Deryan Deal arrives at Homestead Hospital’s Grow2Heal Garden, eager to see firsthand what is happening on the 10 acres adjacent to the hospital. Deryan, who receives speech therapy at the hospital, lives across the street and has been watching the garden grow for the past year. He can’t wait to go out onto the field.

“I want to help,” he declares.

Deryan joins a group of 50 third graders coming for a field trip from the Miami Children’s Museum Charter School. They learn about organic food, plant black-eyed peas and pull the last carrots of the season from the ground — an activity that proves to be a hit. To cap off the morning, the kids help prepare and enjoy lunch using some of the farm’s produce.

The Grow2Heal Garden is part of Homestead Hospital’s mission to improve the health and well-being of the surrounding community. Despite

Homestead’s agricultural roots, many residents lack information about healthy food choices and access to fresh produce.

“Grow2Heal is an innovative, real-life effort to teach healthy behaviors, at least nutritionally, and focus on less processed, more wholesome foods,” said Homestead Hospital CEO Bill Duquette.

The process of creating the organic garden was challenging. The site had no topsoil under the grass, so Baptist Health brought some in, dug the well and secured agricultural zoning. The hospital worked with the Dade County Farm Bureau and area farmers. And they hired Thi Squire as the garden manager, an environmentalist and organic farmer with more than 10 years experience.

Ms. Squire, 49, a native of Vietnam, arrived in Florida as a child. She adjusted easily to the tropical climate and developed an interest in agriculture and green living as an adult. When her real estate company closed, she decided she BaptistHealth.net

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of the land. “It’s great the way the hospital is using this land and making it available to the community.”

The 30,000 pounds of vegetables that the garden can produce yearly is served in the cafeteria and in patients’ meals. The healthy focus also extends to free community programs, such as information sessions on diabetes and healthy holiday celebrations. “We are giving patients actual tools to understand the link between food and good health,” Ms. Squire said. Community program attendees receive recipes and a free pantry starter kit filled with healthy ingredients.

“We are walking the talk of improving their lives.”

Deryan’s mother, Tiffany Horne, is impressed. “I never heard of any hospital anywhere that did this kind of thing,” she said. “A lot of food can be bad for you, but if you grow it yourself with fewer chemicals, it’s so much better.”

For the kids visiting the garden, it was an adventure. “I never have eaten something I have pulled from the ground,” marveled Jasmine Rassi, 8, who chomped on a carrot. “It is really cool.” n

Eric Alvarez, EMT supervisor for the mobile health clinic, serves as driver as well as healthcare provider. The nurse and doctor can be seen working in the background.

“THIS IS THE WAY TO MAKE MEANINGFUL CHANGE WITHIN OUR COMMUNITY. WE ARE TEACHING PEOPLE TO MAKE BETTER FOOD CHOICES THROUGH SMALL STEPS.” ­— Thi Squire, Grow2Heal garden manager

Donna Victor

wanted something completely different and served a stint at a produce company, where she helped build an urban farm that supplied herbs to some of Miami’s toniest restaurants. She came to Homestead Hospital because she knows the transformative power of healthy eating.

“I want people to understand the healing benefits of fresh food,” she said.

The result has been a harvest at Grow2Heal that includes greens and seasonal vegetables, such as carrots, tomatoes, zucchini and kale. Plans call for an expanded herb garden and the addition of fruit trees.

“This is the way to make meaningful change within our community,” Ms. Squire said. “We are teaching people to make better food choices through small steps. We are also giving them a connection to understand how food is grown and appreciate the environment.”

Ms. Squire works with volunteers who help tend to the garden and guide students on field trips. Volunteer Kamela Robinson, 50, grew up in Homestead and picked fruit and vegetables at local farms.

She is thrilled with the hospital’s retooling

DRIVEN TO HELP Mobile clinic brings free primary care to underserved community

By Patty Shillington

Mabel Rodriguez (2)

E From left to right: Garden manager Thi Squire demonstrates the value of fresh ingredients in meals. Third graders from Miami Children’s Museum Charter School enjoy getting close to the earth.

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very Wednesday morning, a custom-made van the size of a bus pulls up and parks in front of the South Miami Children’s Clinic.

Inside the 38-foot-long van is a medical team equipped with all the bells and whistles of a doctor’s office, including two exam rooms and a lab, as well as wheelchair access. The doctor, nurse and paramedic spend the day providing free primary care to adults in this traditionally

underserved neighborhood, where access to much-needed healthcare is limited by lack of insurance, low income and other socioeconomic factors.

Brought to the community last spring through a partnership between Baptist Health and Florida International University’s Herbert Wertheim College of Medicine, the Mobile Health Center already has made a difference for residents such as Sherale Chery. An uninsured

mother of five young children who is looking for work, Ms. Chery learned about the mobile clinic from her mother.

Both have received regular checkups and care from the mobile clinic’s doctor, Lester Carrodeguas, M.D., assistant professor at the FIU College of Medicine.

“I did blood work and had a Pap test and the doctor removed some moles from my neck,” Ms. Chery said. “He told me, if you get sick, you can come here as well.

I’m going to do that.”

The mobile clinic is one of two that visit traditionally underserved communities in Miami-Dade as part of the Green Family Foundation’s NeighborhoodHELPTM (Health Education Learning Program) at the FIU College of Medicine. This innovative initiative seeks to improve the health and well-being of vulnerable neighborhoods while creating a new and progressive model for educating the next generation of doctors, nurses, social workers, public health advocates and other professionals whose occupations intersect with healthcare.

The first step is gaining the confidence of a community often wary of outsiders.

“We listen and try to offer solutions with this interdisciplinary approach,” said Lorraine Nowakowski, R.N., program director of NeighborhoodHELP Clinical Initiatives, who serves as the mobile clinic’s nurse. “We’re trying to build trust and ensure continuity of care.”

That’s why partnerships are so crucial.

A few years ago, South Miami Hospital joined with FIU to carry out a survey of 750 households in a northern pocket of the city. “We knew there were a lot of medical problems there, but we wanted to define what they were,” said Rooney Brodie, the hospital’s director of population health.

The survey found high rates of obesity, high blood pressure and oral health problems, such as tooth loss, as well as a need for family planning. “The BaptistHealth.net

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“WE GO INTO THEIR WORLD AND SEE WHAT IT’S LIKE AND WHAT THE NEEDS ARE.”

SMALL STEPS, BIG RESULTS Healthy Hub empowers people to make better life choices

By Adrienne Sylver

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­— Lorraine Nowakowski, R.N., program director of NeighborhoodHELP Clinical Initiatives

Lester Carrodeguas, M.D., the mobile clinic’s primary care doctor, completes a patient’s paperwork in one of the two exam rooms.

quick, free evaluation at West Kendall Baptist Hospital’s Healthy Hub convinced Julio Colon he needed to do something about his health.

The 24-year-old West Kendall resident had gained 30 pounds in three years and his body mass index (BMI) landed him in the obese category. In addition, a smoking habit left him winded after one flight of stairs. When he heard about the Healthy Hub from his wife, a volunteer at the hospital, Mr. Colon was motivated to make drastic lifestyle changes.

Mr. Colon is one of hundreds who have come to the one-stop health kiosk in the hospital lobby since it opened in January. A registered nurse puts patients through a series of health screenings that include blood sugar, cholesterol, blood pressure, body fat, weight and more.

Part of the Healthy West Kendall initiative to improve the health of the community, the Healthy Hub is also a partner of the American Heart Association (AHA). Using iPads that are mounted at two stations in the Hub, patients can access the AHA’s MyLifeCheck health assessment, which asks questions about their habits, including smoking, eating, exercise and more. Those who complete MyLifeCheck receive a personal heart score and can review information on the seven steps they can take to start living a healthier life.

“The idea is to eat better, move more, stress less and know your numbers,” said cardiologist Ted Feldman, M.D., medical director of the Healthy Hub and of Baptist Health’s Center for Wellness & Prevention (or Center for Healthcare Advancement and Outcomes Research).

“Screenings are just a piece of the puzzle. In order to influence an entire community to change, access to health information and care must be improved.

The Healthy Hub is a start.”

Donna Victor

As Pedro “Joe” Greer, M.D., the FIU medical school’s associate dean for Community Engagement, has put it: “We want our students to see the relationship between health, culture and economics from day one.”

Still in its early stages, the program is already changing lives. Momina Jawad, the mother of two young children, has had no healthcare since moving to South Miami from Pakistan two years ago with her husband, a graduate student. After being referred by Dr. Carroll-Scott, who takes care of her young daughter, Ms. Jawad received a home visit from the FIU outreach team and was approved for NeighborhoodHELP and also for free care at South Miami Hospital. “I’m grateful for that kind of attention,” Ms. Jawad said of the outreach team. “They were thorough.” It was also a relief to have a full checkup at the mobile clinic and find out her health is good.

“They really took their time with me and followed up over the phone,” she said. “I love the head nurse, and the doctor is wonderful.” n

Donna Victor

community was using the Emergency Center as their primary source of primary care,” Ms. Brodie said. “There was no true source of primary care for them. Nothing met their needs.”

South Miami Hospital and Baptist Health agreed to fund FIU’s Green Family Foundation (GFF) NeighborhoodHELPTM mobile clinic in the same neighborhood where they helped set up the South Miami Children’s Clinic nine years ago. The children’s clinic, run by pediatrician Tina Carroll-Scott, M.D., has cared for hundreds of uninsured and underinsured neighborhood children, whose parents also suffer from lack of access to medical care.

Dr. Carroll-Scott, along with South Miami Hospital’s Emergency Center, identified neighborhood residents who would benefit from regular preventive and primary care offered in the mobile clinic. “We’ve laid the groundwork for this to be successful; we’ve been building relationships in the community for over nine years,” Dr. Carroll-Scott said. “This is great for the community and all parties involved. And the community is very excited about it.”

An outreach team from FIU visits every household recommended, and others as well, to tell them about the program. “We go into their world and see what it’s like and what the needs are,” Ms. Nowakowski said.

Those who qualify, based largely on household income and lack of insurance, can then enroll in the program and make appointments for free primary care at the mobile van.

Some patients also will be approved for free care at South Miami Hospital to cover specialized services that the mobile clinic cannot provide. These patients will be matched with an FIU team — overseen by a physician, nurse and social worker — that includes a medical student, nursing student, social work student and public health student. The FIU team will make regular home visits to help residents learn how to improve their health and to refer them to other services they might need.

Healthy Hub nurse Marisol Penaloza, R.N., records the progress of Julio Colon, who has turned around his health with lifestyle changes and regular visits to the Healthy Hub.

While at the Healthy Hub, patients can get a free referral and an appointment with a family medicine physician with the Baptist Health Primary Care team.

Joseph Desrivieres, also of West Kendall, noticed the Healthy Hub when he stopped by the hospital to pick up some medical records. Mr. Desrivieres was surprised at his screening results, which revealed high numbers in several areas. Like Mr. Colon, he also was shocked at how his weight had crept up in recent years. Mr. Desrivieres vowed to exercise more, eat more fruits and vegetables, and make an appointment with a primary care physician.

Like Mr. Desrivieres, some people stop in once and use the results to get on the path toward healthier living. Others come back again and again to take advantage of this free resource. “The community has embraced the hub, and on most weeks we exceed our attendance projections,” said Michelle Mejia, vice president of West Kendall Baptist Hospital. “On average, 20 percent are repeat visitors, meaning that they have become

vested in their health and return to check their status or receive more education.”

Easy access encouraged Mr. Colon to return weekly to the Healthy Hub to check his progress. In three months, his weight dropped from 228 to 193 and his BMI went from 31 to 25, placing him in the lowest range of the overweight category. He lost six inches around his waist, his glucose and cholesterol levels improved, and he stopped smoking.

“I knew I had gained some weight after leaving the military, but I didn’t realize just how much until I went to the Healthy Hub,” said Mr. Colon, who continues to see his VA doctors for care. “Now, climbing the stairs is a piece of cake. My doctors told me that I have inspired them.” n

Healthy Hub is open weekdays from 10:30 a.m. to 6:30 p.m. in the lobby of West Kendall Baptist Hospital, 9555 SW 162 Ave. Services are free and no appointment is necessary. For more information, call 786-467-3030 or see the short video at BaptistHealth.net/HealthyHub. BaptistHealth.net

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The Second Act

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Buznego, M.D., who participated in the clinical trial for the device. About 15 to 20 percent of cataract patients do have glaucoma. “For people who are having cataract surgery — the most commonly performed procedure — this is a way to treat a second condition at the same time,” said Dr. Buznego, who is associated with Baptist Outpatient Services.

Maneuvering the smallest medical device ever developed requires a delicate touch.

Surgeons inject it into the eye through a 2½-millimeter incision, which is shorter than a grain of rice. “My patients are amazed when I describe the size of the stent,” said Dr. Buznego, who has performed more than 300 of these procedures.

Nestor Pous, 73, is impressed with the iStent Dr. Buznego implanted earlier this year at the Medical Arts Surgery Center at Baptist. “I treated my cataracts and I don’t have to use drops any more. I took care of two birds with one shot.”

Renewed vision The minimally invasive iStent procedure can relieve the pressure of glaucoma

By Laura Pincus

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Aarup Kubal, M.D.

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grandmother of six and a passionate stained glass artist, she recognizes the importance of keeping her vision acute. And she was particularly concerned about her eye health because her mother, who has macular degeneration, has already gone blind in one eye. “I’m kind of sensitive to what is going on with my eyes.”

Glaucoma is a complicated disease in which fluid builds up inside the eye, raising eye pressure and impairing vision.

The condition can damage the optic nerve, which sends information from the eyes to the brain, and lead to progressive, irreversible vision loss. The National Eye Institute estimates that more than three million Americans have glaucoma, but only half of those affected are aware of it. Early detection, through regular and complete eye exams, is the key to protecting vision.

Ms. Kroll is glad she opted for the iStent, which was approved by the Food and Drug Administration in 2012. Made of titanium, the almost impossibly tiny tube is placed in the eye during cataract surgery and works like a cardiovascular stent to improve fluid flow through the eye’s natural pathways, protecting the optic nerve. Once implanted, patients don’t feel the stents at all.

Carlos Buznego, M.D.

The device replaces eye drops for patients like Ms. Kroll who have mild to moderate glaucoma. More advanced cases still require traditional surgery. “We are controlling glaucoma earlier and this improves our patients’ quality of life,” said Dr. Kubal, a member of the Baptist Health Quality Network. “We don’t have to worry about patients being compliant with putting in the drops, or the cost of the prescription.

That is a benefit of the procedure.”

Ms. Kroll will continue to have regular eye checkups, but the stents have given her confidence in her future eye health and ability to avoid permanent damage from glaucoma. “I think I am set for the next 30 years.”

The iStent can only be implanted in conjunction with cataract surgery, explained ophthalmologist Carlos

KEEP YOUR EYES HEALTHY Baptist Health offers comprehensive ophthalmology services, including treatment of cataracts and glaucoma, retina and cornea procedures, and ocular plastic surgeries. For more information, contact: Baptist Eye Surgery Center 3737 North Pine Island Road, Sunrise 954-572-5888 edical Arts Surgery Center M at Baptist 8490 North Kendall Drive, Miami 786-596-2800

Donna Victor

hen Muriel Kroll was first diagnosed with mild glaucoma, a leading cause of blindness, her doctor prescribed eye drops. While the medication controlled the progression of the disease, Ms. Kroll faced a lifetime of daily eye-drop application.

Nearly 18 months later, however, Ms. Kroll is medication free — thanks to a new minor outpatient procedure. During routine surgery to remove cataracts at the Baptist Eye Surgery Center in Sunrise, ophthalmologist Aarup Kubal, M.D., implanted a microscopic stent into each of Ms. Kroll’s eyes.

“Now I don’t have to worry about putting eye drops into my eyes, and I know my pressure is controlled,” said Ms. Kroll, 69, of Pembroke Pines. An active

The Second Act

Protecting her vision is a top priority for Muriel Kroll, a passionate stained-glass artist.

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Spotlight

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Spotlight

Home, sweet home An arduous journey lands this nurse right where she belongs s a little girl in Cuba, Nayivis Pupo already knew her destiny. She wanted to be a nurse.

She had strong role models. Her father was a doctor and her mother was a nurse.

She grew up in the hospital where they worked, fascinated by the special bond between those who needed care and those who delivered it.

By the time she was 27, she had earned her nursing degree and was living her dream. Once, a Costa Rican patient who came to Cuba for care tried to tell her how restricted her world was, but she could not understand. “The mentality there is very closed,” she recalled. “You don’t think about what your future might be. You’re blind.”

And then, one day, a crack of light. “I had the opportunity to leave for another country and another life, and I took it.” She left on a tourist visa to Spain, knowing she would not return.

In Madrid, Ms. Pupo started over, working in housekeeping at a clinic. Once the owners realized her skills, they asked her to help with medical tasks such as setting up EKGs. She was surprised at the

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technology, things unavailable in Cuba.

Still, she said, “The basics were the same.”

When she arrived in the United States a few years later, she had to start over a second time. She took a job in a bakery, working for tips. That was followed by more than two years at a blood bank, where her pay depended on how many people gave blood. She needed a steadier income.

She was drawn to the only place she had ever felt truly at home — a hospital.

In 2003, she took a job in environmental services at Doctors Hospital, dreaming that she might one day be a nurse again. “When you are an immigrant in a country, you have to do whatever it takes,” she said. “I spent three years mopping floors at Doctors Hospital.

There’s nothing wrong with that. It is honorable work. But I had my bachelor’s degree in nursing. I wanted to do more.”

After working all day, she studied at home to improve her English for the nursing board certification test. The language was her biggest obstacle. Without it, passing the board test would be impossible — but she refused to give up.

“I know she struggled a lot,” said Maria Cabrera, R.N., the patient care manager at Doctors Hospital’s operating room and Ms. Pupo’s current supervisor.

“She started from the bottom and worked her way up.”

Ms. Pupo was happy working at the hospital in any capacity, but she craved more contact with patients and medicine.

It took a while, but she finally convinced an Intensive Care Unit supervisor to give her a chance as a clinical partner, a nurse’s aide. “I didn’t speak English that well, but I knew what I was doing,” she said.

She worked there for six months until she passed her boards. “My skills opened the doors for me.”

Finally she could add the letters R.N. after her name. Nayivis Pupo, Registered Nurse. But that wasn’t enough. Now, she wanted to work in the operating room, which required an additional nine months of training. She welcomed the opportunity.

Through all of this, she was the sole supporter for her three children while her husband was awaiting his exit visa.

A surgeon, he waited more than five

Donna Victor

By KiKi Bochi

years for permission to join his family in Miami a year ago. He missed the early years of his three sons, now 6 and 4 (twins). Currently, he is studying to take his medical boards, following the road forged by his wife.

At 41, Ms. Pupo is grateful to be living in the United States. But she is even more appreciative that she was able to find her way back to nursing and earn a position as team leader in the operating room. “If I

died and was born again, I would again go into nursing,” she said. “I think everyone has a destiny, and for me, nursing was in the stars.”

Ms. Pupo’s love for her work can be seen every day in her eagerness to help others, said Norma Sabates, R.N., the director of surgical services. “Every day she does something special for someone,” she said. “It’s truly a special commitment she has to nursing.”

Nayivis Pupo, R.N., has found her home as a team leader in the operating room of Doctors Hospital.

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Making the Rounds

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from the Centers for Medicare & Medicaid Services, patients can be confident they are making informed decisions about where to be treated.”

Making the rounds

Bienvenido, Dominican Republic Residents of the Dominican Republic are getting to know the meaning of the pineapple, Baptist Health’s

Continually improving Primary care physicians. Cardiologists.

Neurologists. Oncologists. Fertility specialists. There are nearly 1,000 physicians who are part of Baptist Health Quality Network. For patients, that means more streamlined care with better communication among caregivers, improved coordination of care and fewer hospital re-admissions. In addition, it often means lower costs because clinically integrated networks can work together to contract discounted rates with health insurance companies.

“We are focusing our efforts on chronic disease management and looking at population health, which is the health outcome of groups of people,” said Jonathan Fialkow, M.D., Baptist Health Quality Network executive medical director and a practicing cardiologist.

“The commitment our physicians have toward their patients and their families has enabled us to launch initiatives that improve patient satisfaction and quality.”

One new project, for example, is a communications platform that allows clinicians to safely share private patient information via a secure text. Pictures,

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videos, files and voice memos can be added to the message, quickly bringing specialists up to speed on a patient.

If you’re looking for a physician, go to the “Find A Doctor” tab at BaptistHealth.net. Baptist Health Quality Network physicians have a green pineapple icon next to their name.

On the honor roll

Baptist Health hospitals led the pack in patient satisfaction and patient safety, according to recent ratings from a government organization and an industry group.

The Centers for Medicare & Medicaid Services introduced a new star rating system to help patients compare hospitals. Mariners Hospital in the Upper Keys was the only hospital in Miami-Dade, Broward and Monroe to earn the highest rating — five stars — based on patient experience surveys. All four hospitals in Miami-Dade that earned four stars are part of Baptist Health: Baptist Hospital, Homestead Hospital, South Miami Hospital and West Kendall Baptist Hospital. The average rating for

a Miami-Dade facility was 2.5 stars.

The surveys measure 11 factors, including how well doctors and nurses communicate, how well patients’ pain is addressed and whether patients would recommend the hospital to others.

In the Leapfrog Group’s latest Hospital Safety Scores, four Baptist Health hospitals (Baptist, Doctors, Homestead and West Kendall Baptist) received an A grade for protecting patients from preventable medical errors, injuries and infections at the hospital. South Miami Hospital received a B score and Mariners Hospital is not eligible to participate because of its designation as a rural, critical-access hospital.

The healthcare industry watchdog group also honored Baptist, Doctors and Homestead Hospitals with a new “Straight A’s” gold badge for achieving a perfect score since the survey was launched in June 2012.

“Our scores signify our commitment to patients and their safety,” said Brian E. Keeley, Baptist Health president and CEO. “And when combined with our star rankings in patient satisfaction

Baptist Health International began in 1994, scheduling medical tests and appointments, helping with travel arrangements and transportation, and coordinating insurance benefits for patients abroad. In recent years, the program has expanded to offer a 24-hour call center, a medical second-opinion service and medical education conferences throughout the Caribbean and Latin America.

Gort Productions

Baptist Health news and updates

well-known logo in South Florida, with the opening of Baptist Health International’s newest office in Santo Domingo. The office offers videoconferencing, telemedicine and an in-country representative to assist Dominican patients with consultations and to help educate local nurses, international hospital personnel and medical students.

Making the Rounds

Smiles to last a lifetime If Justin Barracks was nervous before undergoing surgery recently, the brave little boy didn’t show it as he made friends with Yvonne Barbato, R.N. Justin was one of 20 children and young adults who received free reconstructive surgery during Baptist Children’s Hospital’s Day of Smiles. Doctors from various specialties, along with nurses, technologists and other staff, provided their time and expertise to perform free facial and other reconstructive procedures for children whose families are unable to pay. “It only takes a little bit of our time, but it impacts these children and their families for a lifetime,” said Joel Levin, M.D., chief of plastic surgery at Baptist Hospital. By day’s end, doctors had repaired cleft lips and palates, performed nose and scar revisions and reconstructed ears.

“These surgeries help make such a difference to these children and bring tremendous satisfaction to everyone involved,” said Randall Lee, chief operating officer of Baptist Children’s Hospital. In addition to Dr. Levin, other doctors who donated their services included Andres Bustillo-Lopez, M.D., Guilherme Dabus, M.D., Johnny Franco, M.D., Felix Freshwater, M.D., Rafael Gottenger, M.D., Joshua Lampert, M.D., Fred Pedroletti, DMD, Jose Rodriguez-Feliz, M.D., Jhonny Salomon, M.D., George Varkarakis M.D., Jill Waibel, M.D., Thomas Zaydon, M.D., Piotr Krasuski, M.D., Luis De La Cruz, M.D., and Daniel Zaitman, M.D.

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Healthy Gourmet

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Health Stat

Citrus Vegetable Salsa Courtesy of Executive Chef Stan Hodes

Healthy seafood is easy and delicious

By KiKi Bochi

re you one of those people who quickly walk past the fish section at the grocery, even though you’d like to include more seafood in your diet? Don’t worry, you’re not alone. “The average person has a lot of questions about fish — fresh versus frozen, wild versus farmed. And what about mercury? They wonder if fish is really healthy at the end of the day,” said Stan Hodes, executive chef at Baptist Hospital.

Partly because of the confusion, more than half of Americans seldom eat fish.

That’s unfortunate, since fish is a highquality source of protein and omega 3 fatty acids, which may improve brain and cardiovascular health. “Fish is a great

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Baptist Hospital Executive Chef Stan Hodes says using a vegetable topping with fish adds flavor and nutrition.

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choice,” Chef Hodes said. Plus, it is easy to prepare by grilling, baking, steaming or pan frying with cooking spray — and you can pair it with endless toppings that add interest and flavor (see recipe).

If you have access to locally caught fresh fish, that’s usually best, Chef Hodes said. Make sure you purchase from a reputable market, and look for firm flesh that springs back when pressed. If it smells “fishy,” make another selection; it probably has been in the cooler too long.

Don’t eliminate frozen fish. Much of today’s fish is flash frozen at sea within hours of being caught. When thawed, it is almost indistinguishable from fresh, according to food experts.

Wild fish is generally preferable, Chef Hodes said, but it can be pricey. Don’t be discouraged; farm-raised fish is a great value, and with advances in aquaculture, it is a good option, he said.

With all the health benefits of fish, the Food and Drug Administration (FDA) is encouraging even pregnant women and children to eat three servings weekly of fish lower in mercury. The guidelines caution against fish associated with high mercury levels: tilefish, shark, swordfish and king mackerel. In addition, the FDA suggests limiting consumption of white (albacore) tuna to six ounces a week. Better choices?

Shrimp, pollock, salmon, canned light tuna, tilapia, catfish and cod.

Method: 1. Combine tomatoes, corn, jicama, red pepper, mango, red onion and scallions in a large bowl.

2. In a small bowl, whisk together cilantro, serrano peppers, lime juice, orange juice, oil and salt. Pour over vegetables and toss to coat. Refrigerate at least 2-3 hours (or overnight) to allow the vegetables to absorb the vinaigrette.

3. A llow about half the salsa to return to room temperature as you cook your fish.

Serve fish with salsa on top or on the side. Save any remaining salsa for use over grilled chicken, in another other recipe, or to enjoy right out of the bowl.

Timely testing Ignoring Pap screen guidelines puts women at risk for cervical cancer

By Bethany Rundell

ith all the discussion about how the latest screening methods for cancer are saving lives, it may come as a surprise that many women aren’t getting their recommended Pap test to detect cervical cancer.

A recent Centers for Disease Control & Prevention report found that eight million women under the age of 65 have not had a Pap smear in five years. The report further noted that more than half of new cervical cancer cases occur in women who have never been screened or who haven’t been screened in five years.

These statistics indicate that, without preventive care, many women are putting themselves at an unnecessary risk for advanced cervical cancer.

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NUTRITION FACTS Serving size: ½ cup of salsa with 6 ounces baked white fish Calories: 257; Total fat: 8.3 g; Saturated fat: 1.7 g; Cholesterol: 83 mg; Sodium: 183 mg; Carbohydrates: 14.6 g; Sugars: 4.6 g; Protein: 33.6 g

Elise McCormack-Granja, M.D.

“Our understanding of the main cause of cervical cancer and how the disease progresses has changed the frequency and the way we test,” said Elise McCormackGranja, M.D., a Baptist Health Medical Group physician with Baptist Health Primary Care. “But we still want women to get their Pap smears, following the recommended schedule.”

That schedule changed in 2012 as a result of new recommendations from the U.S. Preventive Services Task Force, the American Cancer Society and the American College of Obstetricians and Gynecologists. Instead of the previously recommended annual Pap tests, the new guidelines suggested women between 21 and 65 with no history of cervical cancer and with two consecutive normal Pap tests could wait three years before their next screening. In addition, experts agreed that 30- to 65-year-old women who had two consecutive normal Pap results and tested negative for high-risk strains of the human papillomavirus, or HPV, could wait five years for their next Pap test.

Because the updated recommendations call for less-frequent screening, some women may have gotten the impression that Pap testing is not important. But that is not the case, Dr. McCormack-

© Photo Credit TK

Fishing for answers

Ingredients: › 2 cups each of halved grape tomatoes, fresh corn kernels and diced and peeled jicama (an edible root that resembles a turnip) › 1 cup diced red pepper › ½ cup each diced mango, finely diced red onion and sliced scallions › ¼ cup chopped fresh cilantro › 2 small serrano peppers, seeded and minced › ⅓ cup fresh lime juice › ¼ cup orange juice › ¼ cup olive oil › ½ teaspoon sea salt Salsa makes 8 servings

Granja said. The new recommendations simply reflect a better understanding of how cervical cancer develops.

“These guidelines follow the discovery that two strains of HPV — HPV-16 and HPV-18 — were present in women with cervical cancer,” Dr. McCormack-Granja said. “They also take into consideration that precancerous cells take years to turn into invasive cervical cancer, and the immune systems of some women, and adolescents especially, clears HPV infections before they cause precancerous lesions.”

Dr. McCormack-Granja, who performs Pap tests as a primary care physician, encourages women to get vaccinated against HPV before they turn 26, when the vaccine is most effective, to further reduce their risk of developing cervical cancer.

“We know more about preventing and detecting cervical cancer than many other cancers,” she said. “It’s so important that women who have not had a Pap recently do so. Patients play a key role in preventing cervical cancer from becoming deadly. ”

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In the Know

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Myth

In the Know

INFORMATION AT YOUR FINGERTIPS

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PINEAPP Find the closest locations to you and shortest wait times at Baptist Health Emergency and Urgent Care Centers. Download PineApp for free in the iTunes Store and Google Play for Android.

By Bethany Rundell

Is running with ‘minimalist’ shoes a good idea?

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Christopher Hodgkins, M.D.

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performance and reducing the risk of injury. But foot and ankle specialists say those claims don’t apply to everyone, and a new study by the American Academy of Orthopaedic Surgeons agrees.

“There’s really no consensus on whether barefoot running or running with minimalist shoes improves running efficiency or if it causes more injuries,” said Christopher Hodgkins, M.D., a Baptist Health Medical Group orthopedic surgeon with Miami Orthopedics & Sports Medicine Institute. “Yet we do know that losing the protective effect of the shoe can lead to heel, knee and hip problems.”

Dr. Hodgkins, who specializes in foot and ankle conditions, noted that most runners strike the ground with their heels first, so the soles of common running shoes are designed to absorb that impact.

“To prevent injury when that supportive, elevated heel is no longer there, barefoot or minimalist runners need to adapt their running style to first strike the ground with the balls of their feet,” Dr. Hodgkins said. That doesn’t always happen. As the study showed, experienced runners, especially those age 30 or older, tend to maintain that heel-first strike pattern, which could lead to injury.

Baptist Health connect Adolescent runners, on the other hand, more easily adopt a forefront strike pattern when running barefoot or in minimalist running shoes, according to the study.

Dr. Hodgkins suggests runners stick with the shoe they are used to. “I would not recommend trying to change your running style to accommodate your shoes,” he said. “Since there’s no conclusive evidence that wearing minimalist shoes or running barefoot improves your running, why take a risk?”

Dr. Hodgkins does recommend that runners who are serious about improving the efficiency of their stride and minimizing the risk of injury consult with a shoe specialist at a reputable running store. That can be wiser than purchasing an off-the-shelf shoe or following a trend that may not support their running style.

“Running has a high risk of injury associated with it,” he said. “If you begin experimenting with shoes and you don’t know what you’re doing, you could suffer serious injuries.”

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hey resemble those novelty toe socks that look like gloves for your feet. But minimalist running shoes are not reserved for fun-loving wearers of silly socks. Instead, a growing number of runners who take their sport seriously are donning the odd-looking footwear and hitting the streets for long distances.

The theory is that wearing minimalist shoes — or no shoes at all — allows people to run the way nature intended.

Without the padding and support of modern running shoes, the minimalist footwear aims to alter how runners’ feet hit the ground. Supporters maintain that the minimalist approach can create a more “natural” stride, improving

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