UnityPoint Health - St. Luke's Hospital Health Beat Winter 2014

Winter 2014

St. Luke’s

B E A T 

Lifesaving training CPR and expert care saves woman’s life PAGE 6

Welcoming triplets Why a Level 2 Regional NICU matters PAGE 2

Brain tumor surgery Seizure leads to diagnosis PAGE 4

Change of heart New heart technology only at St. Luke’s PAGE 8

unitypoint.org/cedarrapids

What’s

Inside 1

Health clips

Health news you can use.

2 - 3 Welcoming triplets

Why a Coggon family chose St. Luke’s NICU for the birth of multiples.

4-5

2-3

4 - 5 Seizure leads to brain

tumor diagnosis

Coordinated care surrounds a Shellsburg woman from diagnosis, treatment to recovery.

6 - 7 Lifesaving training CPR and care from Cedar Rapids’

Heart Hospital saves a local woman’s life.

8 - 9 A change of heart

10 - 11

8-9

St. Luke’s is one of only three hospitals in the world using new heart technology.

Missed

On the

cover

the last issue?

Rebecca Graves is fully recovered after cardiac arrest.

Stories from Health Beat, Fall 2013, are available at unitypoint.org/cedarrapids

10 - 11 Levels of

rehabilitation

Integrated care aids in Shellsburg man’s long-term recovery.

ealth H St. Luke’s

12

13

Ask the expert Why should I be concerned with my kidney health?

For your health

B E A T

Health Beat magazine is produced locally by St. Luke’s Marketing Communications for the community and friends of St. Luke’s Hospital.



Vol. 19 No. 1 l Winter 2014

P.O. Box 3026 l Cedar Rapids, IA 52406-3026 319/369-7395 l unitypoint.org/cedarrapids

Timely health and medical news.

2013

Connect with St. Luke’s at unitypoint.org/cedarrapids

Health Clips Wake up and read the coffee sleeve Heart disease and stroke remain the first and third leading causes of death for men and women. UnityPoint Health – St. Luke’s Hospital wants to do its part to spread awareness of the symptoms of these two deadly diseases.

New look for LifeGuard The hospital’s goal is to provide 24/7 air LifeGuard Air Ambulance may have a new look but it continues to provide the ambulance coverage to patients and emersame exceptional care to eastern Iowans. gency response teams. The new partnership with Med-Trans makes this possible.

This fall UnityPoint Health – St. Luke’s As part of the agreement, Med-Trans will Hospital announced its 1997 Bell 407 provide all traditional aviation services helicopter was replaced with a 2013 to include: training, maintenance, pilot Bell 407. The updated helicopter is part coverage and backup aircrafts as needed of a new partnership with Med-Trans for the LifeGuard program.

Corp, which is now providing medical This is the fourth helicopter since the transportation services for LifeGuard program began. Thousands of indiAir Ambulance. viduals have been helped by St. Luke’s This partnership brings a new aircraft for LifeGuard Air Ambulance since it came LifeGuard and improved reliability. into service 32 years ago.

The hospital created coffee cup sleeves to be used at all Brewed Awakenings, Coffeesmiths and Blue Strawberry Cedar Rapids locations.

Additionally, specially created valet hangers will be placed in all valet parked cars at the hospital, St. Luke’s Medical Plaza and the PCI Medical Pavilion.

“Too many people are unaware of the signs of a heart attack and stroke,” said Jenny Houlihan, director of Acute Adult Services.

“As Cedar Rapids’ Heart Hospital we felt it was our responsibility to educate individuals on what warning signs to look for and if they have any of these symptoms to call 911 immediately.”

Learn heart attack warning signs at unitypoint.org/warningsigns.

Confused about the Health Insurance Marketplace?

UnityPoint Health – St. Luke’s Hospital has certified application counselors to walk you through the Health Insurance Marketplace enrollment process step by step at no cost.

Our counselors will help you: • Create an account • Pick a plan • Apply • Enroll

Here’s what you’ll need to bring to your appointment: • Social Security Numbers (or document numbers for legal immigrants) for every person that will be included on your application • Employer and income information for household members applying for coverage (pay stubs, W-2 form/wage and tax statements) • Policy numbers for your current health insurance plans • Employee Coverage Tool sheet completed for every job-based plan that a household member is eligible for even if they are not currently enrolled

Open enrollment ends March 31, 2014. Schedule your appointment at marketplace.unitypoint.org or call 888/275-5235.

St. Luke’s Health Beat | Winter 2014 |

1

Welcoming triplets Coggon family chooses St. Luke’s NICU for birth of multiples

W

hen Megan Johnson found out she was pregnant with triplets she was terrified she would never get to meet or hold them.

The 25-year-old Coggon woman and St. Luke’s Hospital Intensive Care Unit (ICU) nurse knew the odds were not in her favor to carry her little ones to full term, which is 40 weeks.

“My husband, Matt and I found out I was expecting again when our son, Everett, was only about 11 months old,” said Megan.

“We weren’t sure how far along I was so I had an ultrasound.

I remember being asked by the technician if we had used fertility drugs, to which I replied ‘no.’ It was at that point when I thought I saw a couple of dots on the screen and started to panic.”

The Johnsons were told there were actually three “dots” on the screen. Megan was pregnant with triplets.

“I had no idea that something like this would ever happen to us,” said Megan. “We have no family history of multiples. I was told the odds of natural triplets were one in 8,000 births. I went from being terrified to excited and then back to terrified. There are a lot of risks associated with multiples births. I desperately wanted to do everything I could to keep them safe and carry them as long as possible.”

Expert NICU care Megan and Matt set up a meeting with a neonatologist at St. Luke’s Hospital.

“I was 23 weeks along when we met the neonatologist,” recalled Megan. “I wanted to know if my babies were born too early, what could be done to save them.”

“Everyone at St. Luke’s NICU cares for our babies like they are their own.”

Megan Johnson, Coggon

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“Our first goal is to understand a family’s specific concerns,” said Dr. Andrew Nordine, St. Luke’s NICU medical director. “When they come to us like Megan and Matt, families often want to know about our NICU’s capabilities and our outcomes.”

“We had a tour of the NICU and the operating room,” said Megan. “Triplets are usually delivered by

The serious problem of premature birth C-section. I was so impressed by it all.

Talking with the neonatologist gave us a sense of comfort. We learned some pertinent NICU statistics and all of it put the nurse in me at ease.”

Once Megan’s babies hit 27 weeks gestation she started to feel more confident her babies were going to be okay.

“For the longest time I didn’t want to put up the cribs,” recalled Megan. “I just thought if something happens and the babies don’t come home with us – it would be devastating. I didn’t think I could come home and look at that room with the empty cribs. It was my worst fear.”

“We have the most capable NICU in Linn County and a history of outstanding outcomes,” said Dr. Nordine. “Of course we have state-of-the art technology, facilities and board-certified specialists in neonatal medicine. But, more importantly, we incorporate them into teams of experienced nurse practitioners, nurses, respiratory therapists, pharmacists, and developmental specialists entirely focused on meeting the needs of our patients and their families with the highest-quality care possible.”

Ironically Megan was 32 weeks along when she gave her initial interview for this article. She had planned a Dec. 16, 2013, C-section where she would have been 36 weeks along – a safer time to deliver the triplets. But the babies had other plans.

Nurses checked the baby’s heart rates and everything was fine. Then a doctor was called to check and see if Megan was dilated.

“He said ‘you are six or seven centimeters dilated (10 is fully dilated) and you are going to have these babies today,’” recalled Megan. “I frantically called my husband and told him to get here fast.”

Matt arrived just as Megan was being rolled into the operating room (OR). She learned the NICU team was standing by to care for the triplets. A wave of relief rolled over her.

“There was a sense of urgency going into the OR,” said Megan. “Everyone was calm but I later learned one of the baby’s heart rate had lowered and its placenta had partially detached. When I was moved to the OR table my water broke causing the placenta to fully detach. That meant the baby wouldn’t have any blood supply and therefore no oxygen. I am thankful for their tremendous care and fast work to deliver my babies.”

And oh, baby, did they come fast. Each born one minute apart the Johnsons were proud to welcome: Journey Lynn, 4lbs, 14ozs, 17 ¼ inches; Jaelyn Emery, 4lbs, 3ozs, 16 ½ inches and Easton Michael, 4lbs, 4ozs, 16 ¾ inches all arriving just after 12:34 a.m. on November 24.

Triplet birthday

Journey and Jaelyn came out crying and Easton initially needed some extra stimulation. All three babies were quickly transferred to the NICU.

“They didn’t want to wait until Dec. 16 to make their grand entrance,” joked Megan.

“I was working a four-hour shift at the hospital on November 23 when the Braxton Hicks contractions started to intensify. I decided to visit St. Luke’s Birth Care Center to get checked out just to play it safe.”

“Matt went with the babies and I went to recovery,” said Megan. “A little later I was able to see the triplets. It was wonderful.

They all looked so good. The NICU team is fantastic. I’ve always heard great things about St. Luke’s NICU but now I know firsthand how exceptional the care is.”

Every year, more than half a million babies are born too soon in the U.S. Our country’s premature birth rate has risen by 36 percent over the last 25 years.

That’s serious cause for concern.

March of Dimes is addressing this crisis and helping families have full-term, healthy babies by funding lifesaving research.

Preterm labor occurs before 37 weeks of pregnancy. Here are some warning signs: • Contractions every 10 minutes or more often • Change in vaginal discharge • Pelvic pressure • Low, dull backache • Cramps that feel like your period • Abdominal cramps with or without diarrhea If you think you’re having preterm labor, call your healthcare provider immediately.

“The main goals right now are to keep the triplets healthy, wean them from their incubators, and support their transition from feeding by tube to feeding by mouth,” said Dr. Nordine. “These are all normal things that most premature babies have to do. They were all well-developed and don’t need long-term breathing support. They are growing well and look terrific.”

“I know there will be stress and sleepless nights in our future but I am so thankful for their health,” said Megan. “Everyone at St. Luke’s NICU cares for our babies like they are their own.”

We invite you to start your family at St. Luke’s. Tour our private birth suites to see the difference our family-centered care makes. Register online or call 319/369-8129 to schedule a personal tour.

St. Luke’s Health Beat | Winter 2014 |

3

Seizure leads to brain tumor diagnosis Coordinated care surrounds patient from diagnosis, treatment to recovery

D

arlene O’Brian was enjoying the trip of a lifetime when, seemingly out of the blue, she had a seizure. The 73-year-old Shellsburg woman had never had one before. Darlene was wrapping up the week-long trip to Ireland with her husband, Larry, daughter, Denise and son-in-law, Brian, when she had the seizure. The year was 2011.

A computed tomography or CT scan uses X-rays to create pictures of certain areas of the body. An MRI (magnetic resonance imaging) is a way to take pictures of sections of the body using a magnetic field and pulses of radio wave energy.

“Darlene mentioned she had a seizure in Ireland,” said Hoffmann. “She wondered if the episode was caused by her blood sugar. I told her I did not think it was related to her diabetes and suggested she get a CT scan.”

“I had to tell Darlene over the phone that the doctors saw something,” recalled Hoffmann. “I don’t like to deliver this type of news over the phone but she wanted to know right away. I remember telling her it could be a benign tumor and that we would get her in to see Dr. Mary Hlavin, a UnityPoint Clinic neurosurgeon as soon as it was possible to find out what the mass was.”

“We were enjoying our lunch,” recalled Darlene. “There was really no warning that anything was wrong and I suddenly had a seizure. After it passed we went back to our hotel room so I could rest.

I am diabetic so we thought maybe it was related to that, coupled with jet lag.”

Darlene said she felt fine and had no other episodes. A short time after Darlene returned home she had a routine check-up with Julie Hoffmann, a nurse practitioner at UnityPoint Clinic – Shellsburg.

Mary Hlavin, MD, UnityPoint Clinic neurosurgeon

“I had the CT scan and was told the doctor saw a mass,” said Darlene. “I was then sent for an MRI, so the doctors could get a better image and determine what it was they were seeing.”

“I typically see these patients within 24 hours of when I am contacted by their doctor,” said Dr. Hlavin. “I want to get them in here, talk about what I see and discuss treatment options.”

Unexpected diagnosis “Dr. Hlavin was wonderful to us,” said Larry O’Brian, Darlene’s husband. “She sat down with our family and explained that Darlene had a meningioma brain tumor, which had formed outside of her brain. Dr. Hlavin told us it was most likely benign. It was unexpected news.”

“This type of brain tumor has a certain look and typical appearance,” said Dr. Hlavin. “The vast majority of meningioma tumors are benign. Over 25 percent

4 | unitypoint.org/cedarrapids

of individuals ages 65 and older may have one of these tumors and not know it. And if they have no symptoms they may never know it exists.”

Dr. Hlavin said there are typically three treatment options for individuals with a meningioma brain tumor. If the tumor is relatively small and isn’t causing issues, observation is recommended. A second option is surgery if the tumor is causing problems, as it was in Darlene’s case.

And radiation therapy may be a third option if a surgeon isn’t able to remove the entire tumor or if the tumor is in a spot where surgery is not safe.

“Darlene’s tumor was about three centimeters,” said Dr. Hlavin. “I had some initial concerns about her tumor because it looked like it might be invading the skull. After some discussion we decided surgery to remove the tumor was the best route.”

“We felt grateful Julie Hoffmann put us in touch with Dr. Hlavin and that she was going to remove the tumor,” said Larry. “Dr. Hlavin put us at ease and let us know she had done this surgery many times. We felt completely confident in her skills and think a lot of her as a person.”

Successful surgery The surgery was a success and Dr. Hlavin was able to remove most of Darlene’s tumor. Darlene stayed in a private room at St. Luke’s for about three days.

“I had great care,” said Darlene. “Dr. Hlavin did an excellent job in removing the tumor and putting me at ease. The nurses were great. I felt the care was so well coordinated.”

In accordance with state law Darlene was restricted from driving for six

months because of the seizure and she had routine follow-up MRIs to make sure the tumor didn’t return.

“A small percentage of patients will have tumor regrowth so we monitor the patient for a period of time. It has been about two years since her surgery and I would say Darlene is doing great. There has been no regrowth and we’re down to yearly MRIs. Reoccurrences are uncommon.”

UnityPoint Clinic healthcare providers put their patients at the center of everything they do, they collaborate as a team and surround patients with care that is coordinated between the patient’s doctor’s office, hospital and their home.

To find a UnityPoint Clinic or primary care provider that is right for you log on to myunitypointdoctor.com.

Coordinated care “Having Dr. Hlavin as a resource in our community is great,” said Hoffmann. “And being part of the UnityPoint Health system helps streamline the coordination of care between her office, our clinic and the hospital.

As Darlene’s primary care provider I am kept in the loop and know what is being done for her and how I may follow-up to provide further support.”

“I feel good,” said Darlene. “I am very grateful to Julie for sending me to get that CT scan when I thought the seizure was probably nothing. I am happy with the great care I received from Dr. Hlavin. It was so well coordinated and I felt like my care was always in great hands.”

Darlene O’Brian credits her UnityPoint Clinic Nurse Practitioner, Julie Hoffmann, for recommending brain scans after a seizure, which eventually discovered a brain tumor.

St. Luke’s Health Beat | Winter 2014 | 5

Ali Graves, Kateliyn CurtisSwore, Rebecca Graves and Grace Swore enjoy a meal together in Cedar Rapids.

Lifesaving training CPR and care from Cedar Rapids’ Heart Hospital saves woman’s life

I

f it wasn’t for CPR and the medical team at St. Luke’s Hospital, 35year-old Rebecca Graves wouldn’t be here today to share her story.

“A little over a year ago I went into sudden cardiac arrest at my home,” said Graves.

“One minute I was sitting on the bed vomiting and the next minute I was on the floor with my eyes rolling in the back of my head and my lips were blue.”

Her fiancé’s daughter, Kateliyn, who is 12, started CPR while her sister, Kylee, called 911. Her fiancé, Ashley, took over CPR from his daughter until an ambulance arrived.

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“I don’t remember a lot leading up to the cardiac arrest,” admitted Rebecca. “It happened on a Monday after a long weekend, which involved a family funeral. I hadn’t been feeling well but never felt it was a life or death emergency. Everything happened so suddenly.”

Rare heart condition “Rebecca has a rare congenital heart defect called transposition of the great arteries (TGA),” said Dr. Mark Zittergruen, UnityPoint Clinic – Pediatric Cardiology.

“This is a heart condition present at birth and occurs when the two main arteries going out of the heart are switched in position. The result of these transposed

vessels is that too little oxygen in the blood is pumped from the heart to the rest of the body, which is incompatible with life.”

About four in 10,000 babies are born each year with this condition. Dr. Zittergruen sees babies born with this condition in Cedar Rapids about once every couple of years.

There are two potential surgeries for children born with this condition. The Mustard procedure, which creates a tunnel or wall to redirect blood flow or the arterial switch procedure, which basically “switches” the two arteries and puts them back where they should be. The Mustard procedure was a pioneering surgery many years ago but now, because of surgical advancements, most children have the arterial switch.

“When I was six months old I had the Mustard procedure,” said Graves. “The surgery corrected my heart problem.

For the most part I have been able to live a normal life. I went on to have a family and don’t typically give my heart condition much thought.”

“I started seeing Rebecca in October 1999,” said Dr. Zittergruen. “She was pregnant with her first child and her doctor asked me to follow her during the pregnancy.

I see some adult patients like Rebecca, who have these rare heart conditions. Many of them have done well as they have aged, and because of that there is a growing movement to have more adult cardiologists trained to oversee patients with congenital heart disease.”

Fighting to live “Rebecca was fighting for her life when she arrived at St. Luke’s Emergency Department,” said Robin Brown, nurse manager in the cardiac critical care unit (CCU). “Paramedics had intubated her (placed a breathing tube) and started several medications in an effort to stabilize her.

She was treated with the hypothermia protocol to reduce the risk of damage to her brain after cardiac arrest.”

“She had several contributing factors working in her favor, quick response, young age and an experienced medical team along with her strong will to live,” said Brown.

“Because of her surgery when she was an infant and the stitches in her heart she is more susceptible to heart rhythm disorders,” said Dr. Zittergruen. “I would venture to guess that the vomiting that lead up to her cardiac arrest depleted her electrolytes. These things can make your heart a little twitchy and interrupt the rhythm. An ICD can detect when her heart goes out of rhythm and shock it back into correct sinus rhythm.”

Grateful patient “After my stay at St. Luke’s I had the ICD placed,” said Graves. “I was able to return home in a matter of days. I am told I will eventually need a heart transplant but I am grateful to be alive. I’m thankful for my family and their quick thinking to start CPR and everything the staff did for me at St. Luke’s.”

“This is an example of good, effective care coordination,” said Brown. “The team came together and saved this woman’s life. It’s also a testament to why everyone should learn CPR. Shortly after her hospital stay Rebecca and her mom came back to the Cardiac Care Unit to thank us. To see Rebecca so soon after hospitalization was rewarding and a reminder of how our mission, which is to give the healthcare we’d like our loved ones to receive is a team effort. To see her looking so good and full of life was awesome.”

St. Luke’s is an accredited Chest Pain Center by the Society of Cardiovascular Patient Care (SCPC), which means the hospital meets or exceeds stringent criteria for treating heart patients.

When it comes to matters of the heart don’t wait. Call 911 or go to St. Luke’s ER immediately.

Mark Zittergruen, MD, UnityPoint Clinic – Pediatric Cardiology and Robin Brown, cardiac critical care nurse manager cared for Rebecca Graves after her cardiac arrest.

“I remember I was called in by Dr. Todd Langager, UnityPoint Clinic – Cardiology to consult on Rebecca’s care that evening,” recalled Dr. Zittergruen. “She was very sick.

I remember being very worried about her.

We decided she needed to see a pediatric electrophysiologist (works with heart rhythm disorders) to perform a thorough evaluation and she would likely need an implantable cardioverter-defibrillator (ICD), which is a small device used to regulate irregular heartbeats.”

Thankfully Rebecca’s condition improved and the hypothermia protocol was discontinued.

St. Luke’s Health Beat | Winter 2014 |

7

A change of heart S

t. Luke’s is one of three hospitals in the world using a new technology to treat patients with heart rhythm problems.

The week before Michael Strope, 56, planned to walk his daughter, Kaitlyn, down the aisle, he was hospitalized at St. Luke’s Hospital for pneumonia. It was in the spring of last year, and he’d been feeling fatigued for quite some time.

“They asked me if I knew that I had atrial fibrillation, which was a total surprise to me,” Strope said.

Atrial fibrillation means there is an irregularity in the rate or rhythm of the heartbeat. The atria, which are the two upper chambers in the heart, fibrillate

– or contract quickly and irregularly – because rapid, disorganized electrical signals interrupt normal electrical activity. Though the heart can pump blood with atrial fibrillation, it doesn’t do so effectively.

“I knew I’d been having some issues where I was pretty fatigued. And so they put me on some medicine first. It didn’t work,” Strope said. He was given blood thinners to keep his blood from clotting.

With atrial fibrillation there’s a greater risk blood will pool in the heart’s upper chambers and form a blood clot, increasing the risk of stroke. Strope underwent three electrical cardioversion procedures, in which his heart was given low-energy shocks to start a normal rhythm. Those attempts failed.

“I couldn’t feel my heart beating funny, but my pulse was elevated. I would get fatigued very quickly,” he explained.

“Even walking up the stairs was difficult. I’d get halfway up and have to stop.” Strope, who has always been very active, began shortening his days doing maintenance for First Assembly of God church in Cedar Rapids. He cut out the extra carpentry jobs he did for friends

and previous clients from his work as a general contractor.

Strope’s cardiologist, Dr. Todd Langager, UnityPoint Clinic – Cardiology, recommended he see Dr. Mohit K. Chawla, who specializes in electrophysiology at UnityPoint Clinic – Cardiology. Seven years earlier, Strope had been treated for a congenital heart rhythm problem, called Wolf-Parkinson’s White Syndrome, in which his heart raced. He’d had two catheter ablations, a procedure in which a catheter is inserted through a vein in the leg and threaded to the heart, where it uses electrical energy to burn the heart tissue causing the abnormal heart rhythm.

“Mr. Strope had been on atenolol, Cardizem and flecainide by Dr. Langager without success,” Dr. Chawla said. He suggested Strope have a catheter ablation procedure to correct his atrial fibrillation.

“When I met Dr. Chawla, I immediately liked him,” Strope said. “To find a doctor that actually has a sense of humor is very rare. He took all the time I needed to answer every question I had. He answered in a way I could easily understand.”

For Strope’s procedure in mid-October, Dr. Chawla used a new high-resolution technology that includes more electrodes

“It’s a huge benefit to our patients. They get a technology that they can’t get anywhere else....

This is saving patient time, lab time, procedure time and risk to the patient.”

Mohit K. Chawla, MD, UnityPoint Clinic – Cardiology

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in the tip of the catheter to give doctors a clearer view of the area they’re treating. Dr. Chawla likens the difference between past catheters and the new high-resolution catheter to the difference between black-and-white television and super high-definition TV. “The clarity of what we’re seeing, what we’re burning is so much more clear that we’re placing burns in very specific places and not over burning,” Dr. Chawla said. “It’s a huge benefit to our patients. They get a technology that they can’t get anywhere else in the world except Emory University School of Medicine and University of Alabama at Birmingham – and now St. Luke’s Hospital in Cedar Rapids.”

Dr. Chawla was the second cardiologist in the world to use the new Boston Scientific electrophysiology catheter. It enables doctors to vastly improve their precision, performing four or less burns in a procedure that used to require 10-25. “This is saving patient time, lab time, procedure time and risk to the patient,” Dr. Chawla said. “It has dramatically changed how we do the procedure.”

Strope has a high regard for Drs. Chawla and Langager. “I would recommend Dr. Chawla to everybody. Dr. Langager is a great doctor, also,” he said. Strope also expressed gratitude for the nursing staff at St. Luke’s, citing his experience with multiple stays over the last year, from a week of inpatient care for pneumonia to three cardioversion procedures and the catheter ablation. “Everybody who walks into your room asks if you need something before they leave,” he explained.

two new grandchildren to their family. Kaitlyn and daughter-in-law, Kelsey, are due on April 22. Strope said, “Grandkids are the best thing in the world.”

To learn more about UnityPoint Clinic – Cardiology, go to cardiology.unitypointclinic.org or call 319/364-7101.

Since having the procedure, Strope feels better every day. Now he and his wife, LeAndra, who have three sons, a daughter and three grandchildren, are preparing to welcome

“I’m very happy I did it,” Strope said. “There was a lot less pain with this surgery than the previous ablation.” He was in the hospital overnight and went home the evening of the second day. He experienced soreness where the catheter tubes were inserted but he was able to walk around. “There’s a big difference in the quality of hours I can work during the day now,” he said. “Before, all of the time I felt like I was walking in a swimming pool full of water. I’m out of the pool now.”

Michael Strope is happy to be back at work after diagnosis and treatment of atrial fibrillation.

St. Luke’s Health Beat | Winter 2014 | 9

Levels of

rehabilitation A stroke survivor continues making progress

S

ummer flu is always surprising, and forklift operator Mark Davis, 42, figured he was among the unlucky few last June when he began experiencing flu-like symptoms – cough, fatigue, diarrhea, fever and painful joints. “That’s what made me come into the hospital emergency department,” Mark said. He was admitted on June 29 and, it turned out, Mark had a serious staph infection.

“There were a lot of doctors looking at him because his kidneys were failing,” said Angela Davis, Mark’s wife. “They were trying to figure out which staph infection he had.” Nine days after he was admitted, Mark had a stroke in his room at St. Luke’s.

“The staph infection went to my heart. And the valve in the heart ended up breaking up and causing the blood clot that went to my brain.

That’s what caused the stroke,” Mark said.

“To be honest, when he went in for the infection, I never imagined getting a call that he had a stroke. Although, they did say he had a very, very minor stroke on June 30,” Angela said.

“He was having trouble with his hand and I think his speech was a little off, but you could still understand him. So I suppose in that case, we should’ve known it could happen.”

“The type of stroke Mark had is not common,” said Dr. Craig Dove, medical director for St. Luke’s Physical Medicine and Rehabilitation. “It was from an infection that formed in Mark Davis and his wife, Angela, and twins, Taryn and Dakota use Wii at home, which aids in his recovery.

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his heart.” The infection was caused by methicillin-sensitive staphylococcus aureus (MSSA), a type of bacteria that is very common in the environment and normally found on the skin, sometimes in the inner nose. It can cause minor skin infections, but it can also cause life-threatening infections.

Mark’s infection began in his joints and moved to his heart. “Embolic strokes, which are caused by blood clots, are typically associated with atrial fibrillation,” Dr. Dove said, however, in Mark’s case, the embolic stroke was caused by hemorrhages resulting from his infection. “A shower of infectious emboli (blood clots) went from his heart to the brain,” Dr. Dove explained.

On July 8, Mark had a major stroke that damaged his heart valve and impaired the left side of his body and his mental function. Mark underwent surgery to remove the clots from his brain. Later he had surgery to replace the damaged heart valve. During this time, Taryn and Dakota, the Davis’ 11-yearold twins, spent a majority of their summer visiting their dad in the hospital.

Three weeks following his heart valve surgery, Mark was admitted to UnityPoint Health Living Centers. He was weak from the surgeries and impaired by the stroke, and wasn’t strong enough for the intensive inpatient rehabilitation at St. Luke’s.

“Sometimes patients are too ill to be able to do three hours of therapy a day,” explained Dr. Dove. “Living Centers provides skilled nursing along with nurse practitioners or hospitalists who see patients daily. It offers closer medical supervision than many other skilled nursing facilities.”

Patients have to be ready the day they are admitted to inpatient rehabilitation to endure strenuous physical, occupational and speech therapy. Mark worked with Living Centers’ physical, occupational and speech therapists for nearly a month to build up the endurance he needed.

“At Living Centers we all work hard to help the patient achieve a higher level of functioning to enable them to go home or to strengthen them enough, as in Mark's case, to transfer to acute rehabilitation to receive an even higher level of therapy,” said Elizabeth Eichhorn, nurse practitioner, Living Centers. “Since we are a UnityPoint Health facility, we are able to coordinate care with St. Luke's Physical Medicine and Rehabilitation, UnityPoint Home Medical Equipment and UnityPoint Home Care.”

St. Luke’s inpatient rehabilitation, in addition to physical, occupational and speech therapy, provides recreation therapists, physiatrists, medical psychologists, neuropsychologists and nurses who specialize in rehabilitation.

“I started with a walker at Living Centers. And I got stronger with it there. Then I got away from the walker right away at St. Luke’s and started using a cane,” he said. “I was trying to get my arm working. It’s been slow to react. So I used what they Craig Dove, DO, St. Luke’s Physical Medicine and call a skateboard and pushed Rehabilitation medical director it left to right.”

“ Living Centers offers closer medical supervision than many other skilled nursing facilities.”

“When he came back to St. Luke’s, he still had significant weakness on his left side, including his face. His upper extremities were more affected than his lower extremities,” said Dr. Dove. Within three weeks, Mark was dressing himself and moving around better. He was released to St. Luke’s outpatient therapy, which he continues doing twice a week. “He has made significant improvements from a function standpoint,” said Dr. Dove.

“It’s been tough for Angela to run the kids and go to work and manage it all,” Mark said. “Now that I’m home, it seems better for the kids. I think they see the progress.”

The Davis family is now getting out, going to dinner and doing some of the activities they enjoy. “I’m just trying to get more independent. Trying to get my arm working and to walk better. I’m trying to improve my visual scanning. Eventually I hope I can drive again,” Mark said.

“It wasn’t the summer that we wanted or that we ever thought we were going to have, and you know, I’m ready to get to a different year,” Angela said.

To take a personal tour of St. Luke’s Living Centers, call 319/366-8714.

St. Luke’s Health Beat | Winter 2014 | 11

Ask the

expert

Why should I be concerned with my kidney health?

If you’re older than 30, your kidney Protect kidney health function has peaked and started to The following lifestyle changes will decline. It’s part of the normal aging help keep your kidneys healthy. process. Our bodies adjust well enough that we don’t notice the loss of kidney •Control blood pressure. “Most of us function until it’s severe. In fact, 26 mil- develop high blood pressure over time. lion people in the U.S. have kidney dis- It results from the slow, age-appropriate ease, according to the National Kidney loss of kidney function,” Dr. Cogdill Foundation, and most don’t know they said. When blood pressure gets too have it. One in three American adults high – hypertension – the body works risk developing kidney disease. overtime to remove salt water from the body. “Weight loss usually lowers “The most common causes for kidney blood pressure,” Dr. Cogdill advises. disease are diabetes, obesity, hypertension and over-the-counter pain pills, •Exercise if you have diabetes. all of which have increased over the “Weight loss pushes back a diagnosis last 20 years,” said Dr. Jason Cogdill, of diabetes for a couple of years. People nephrologist (kidney specialist) with with pre-clinical or just barely diagnosed UnityPoint Clinic – Multi-Specialty. diabetes who exercise have better The common problems associated with outcomes than people who take early kidney disease include difficulty medications,” Dr. Cogdill explained. controlling blood pressure, fluid retention and swelling.

•Reduce sodium. “The U.S. average sodium intake is approximately twice When kidneys don’t function well, they the recommended low-sodium diet for don’t clean the blood properly. Wastes people with heart or kidney disease,” build up in the body, which causes Dr. Cogdill said. Reducing sodium health problems such as heart disrequires more than putting away the salt ease, anemia (low blood count), fluid shaker. “The biggest problem foods with overload, weak bones and nerve damhidden sodium are lunch meats, deli age. Chronic kidney disease can cause meats, breaded products, soups, frozen kidney failure if left untreated, which prepared foods and anything in a can,” requires dialysis or kidney transplant.

Dr. Cogdill explained.

People with kidney disease are hospitalized more often, have a reduced quality •Limit over-the-counter pain medicaof life and die prematurely from heart tions. Aspirin, acetaminophen, and disease and all other causes. If you have especially NSAIDs (ibuprofen, naproxen, high blood pressure and/or diabetes, and more) may damage your kidneys you are at the greatest risk for developif you take them regularly and often. ing kidney disease.

These medicines lower blood flow to the

12 | unitypoint.org/cedarrapids

Jason Cogdill, MD UnityPoint Clinic – Multi-Specialty

Common symptoms of poor kidney function Decrease in the amount of urination, nightJason Cogdill, MD, nephrologist time urination urge, fluid buildup, fatigue, UnityPoint Clinic – Multi-Specialty bone pain and fractures, loss of weight and appetite, numbness in the feet or hands, nausea, trouble sleeping, restless legs and trouble thinking clearly.

kidneys. Don’t take them daily or regularly without first consulting your doctor.

•Stop smoking. “Quitting tobacco is more powerful than most of the pills we can prescribe,” explained Dr. Cogdill.

“Despite the overall increase in chronic kidney disease, whether it’s mild, moderate or severe, most patients have no idea that they have any kidney problems. Most patients believe if they don’t have a symptom, there’s not a problem,” Dr. Cogdill said.

For your

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UnityPoint Health – St. Luke’s wants to connect with you. The hospital is on many social media platforms: Facebook, Pinterest, YouTube, Google+ and Twitter. Our goal is to connect with our patients, visitors and other community members in search of health and wellness information as well as patient stories.

So the next time you tap your tablet or check your cell we ask that you “Like” us, follow us or subscribe to one of our many social media sites and join the conversation.

health My UnityPoint Nurse It’s 10 p.m. and you have a child with a fever. Or maybe your husband sprained his ankle playing basketball. Should you take them to the Emergency Room or wait until the next day when the doctor’s office opens?

For questions like these, call My UnityPoint Nurse. It’s a free health information service for the public, sponsored by UnityPoint Health and staffed by registered nurses 24-hours a day, 7 days a week.

The nurses at My UnityPoint Nurse provide medical assessment and triage, up-to-date health information and physician and clinic referral service.

To contact My UnityPoint Nurse, call 800/424-3258.

All Things Baby We have our own little special delivery for new and expecting moms!

St. Luke’s Birth Care Center has created a special website called All Things Baby. It’s your go-to guide for everything that has to do with your baby bundle.

Here is some of the information you’ll find: • Due date calculator

• Contractions and labor information

• Baby name finder

• When to call the doctor

• Real Moms of Eastern Iowa blog • Feeding information • Pregnancy tips

• SIDS prevention

• What to pack for the hospital

• Baby’s first year

It’s all in one place ready for you to scour and learn everything you can before and after your little one arrives.

Go to unitypoint.org/allthingsbaby to help in your journey.

St. Luke’s Health Beat | Winter 2014 | 13

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