Physician's Practice

St. Luke’s

B E A T 

for physicians

Robot-assisted partial knee replacement now at St. Luke’s

E

ach year more patients are identified and treated for earlier stages of arthritis. Some of this arthritis affects only part of the knee, which has led to the need for partial knee replacement as an alternative to total knee replacement.

Partial knee replacement surgery is now available for osteoarthritis suffers at St. Luke’s. The hospital recently acquired the Navio™ Surgical System, which is a roboticassisted orthopedic system. Navio provides surgeons with a hand-held, computer-assisted bone cutting tool, which is precisely guided with the robot’s navigation system.

Using a smaller, minimally invasive incision the surgeon may treat either the medial, patellofemoral or lateral compartment of the knee.

During the partial knee replacement the surgeon is able to replace the damaged joint surface and rebalance the knee’s alignment, saving all ligaments.

The longevity of the implant will vary from patient-to-patient.

A1

Robot-assisted surgery Minimally invasive partial knee replacement surgery is now at St. Luke's.

A2

Spying in surgery A tool in St. Luke’s surgical suites gives surgeons a better picture of blood flow.

A4

Healthy Lifestyle Clinic UnityPoint Clinic – Pediatrics at Hiawatha has created a program to combat childhood obesity.

A6

Specialties Resource Guide Services you’ll find only at St. Luke’s.

“Ideally we want to wait as long as possible before surgery,” said Dr. Munjal. “There are many adults who are quite young, under 65, in a lot of pain that would benefit from partial knee replacement.

The Navio Surgical System will allow me to be much more precise and provide the best outcome possible for patients and thereby improves their quality of life.”

To request a partial knee replacement consult with Sandeep Munjal, call (319) 398-1545.

P.O. Box 3026 Cedar Rapids, IA 52406-3026 319/369-7211 unitypoint.org/medical-staff

St. Luke’s Hospital – A1

One of the many benefits of the robotic-assisted orthopedic system is that patients do not need a CTscan prior to surgery, which reduces a patient’s exposure to radiation and cost. Navio’s computer digitizes the patient’s anatomy kinematics during the surgery. This allows the surgeon to create a unique surgical plan, which is tailored to each patient’s specific anatomy and ligament balance.

“This is exciting technology,” said Sandeep Munjal, MD, Physicians’ Clinic of Iowa orthopedic surgeon.

“A smaller incision means a faster recovery and rehabilitation time for the patient. The Navio is very precise. Its computer matches the patient’s anatomy, basically creating a 3-D model of the patient’s knee.

This allows me to accurately line-up the joint replacement, which is far superior to using the naked eye.”

In this issue

Spying in surgery S

‘

py doesn’t lie.’ This is the mantra often repeated in surgical suites at St. Luke’s Hospital. The Spy Elite (fluorescence angiography) is a portable unit, which allows surgeons to visually assess and objectively analyze the quality of blood flow in vessels and tissue perfusion in real-time during surgery.

Indocyanine green dye (ICG) is injected into the patient and is seen by the surgeon as it pulses through veins. The Spy uses an infrared laser, which shows the fluorescent properties of the dye.

Spy assists the surgeon in making an informed decision based on relevant information.

A2 – St. Luke’s Hospital

“The spy can interpret numbers, said Karen Libenguth, RN, CPSN, St. Luke’s Surgery Department plastic surgery technical specialist.

“It uses color and percentile to give surgeons a comparison between healthy and damaged tissue. It still takes the surgeon to interpret what those numbers mean and other variables taken

into account like age and chronic conditions. But generally the higher number means better perfusion and chance of tissue survival.”

Only at St. Luke’s The SPY System was FDA cleared in 2005 for use in cardiac surgery. The SPY Elite System was launched in 2009 for plastic reconstruction. St. Luke’s acquired the Spy about two years ago. St. Luke’s is the only hospital in Cedar Rapids with the technology. It’s used at St. Luke’s mostly for general and plastic and reconstructive surgery.

“ It uses color and percentile to give surgeons a comparison between healthy and damaged tissue."

Karen Libenguth, RN, CPSN St. Luke’s Surgery Department plastic surgery technical specialist

“I believe using the Spy decreases the risk of complications, which is what is best for the patient and overall saves money,” said Kahlil Andrews, MD, Physicians’ Clinic of Iowa plastic and reconstructive surgeon. “Forty percent of the time it changes what I do in the OR. It depends on the indication especially with breast reconstruction. Its biggest use for me is assessing mastectomy flaps.

We put in the tissue expanders and fluid and use the Spy to assess blood flow to the tissues. If the blood flow doesn’t look good we may take some fluid out but if it looks good we might be able to put more fluid in the expander.

That is very valuable.”

“Fluorescence angiography is extraordinarily helpful in general surgery to determine the vascularity to structures,” said Robert Brimmer, MD,

Physicians’ Clinic of Iowa general surgeon. “The primary area I use the Spy relates to assuring viable skin flaps after mastectomies or oncoplastic operations. Other surgeons use the technology to ensure adequate blood flow to the portions of the colon or small intestine being anastomosed. Adequate blood flow allows tissues to heal. The Spy gives the surgeon visual information while the patient is still in the operating room thus minimizing wound healing complications.”

“Immediate breast reconstruction following mastectomy can have up to a 60 percent complication rate,” said Andrews. “Delayed reconstruction has a lower complication rate at about 30 percent. So the Spy is a big tool to help prevent these complications for patients following breast reconstruction. It’s not just death of the tissues it’s the risk of infection from the tension put on the mastectomy flap. It’s all of these things combined, which raise the complication risks – so the Spy is a great tool to help reduce these risks.”

“The beauty of Spy, which is different from fluorescein, is that it washes out of the tissues in about 30 minutes,” said Andrews.

“So it allows the opportunity to debride more tissue if it’s needed

Kahlil Andrews, MD Physicians’ Clinic of Iowa plastic and reconstructive surgeon

or take more fluid out of the tissue expander, which is why I often use the Spy in the recovery room. The tissue may look a little dusky in the OR, but after I make adjustments and by the time we get to the recovery room, it’s looking much better. On the flip side, if I need to take more fluid out I can at that time too. I have three ‘spys’ per vial of dye. So if it’s needed every 30 minutes you can do another test.”

“There was a case where the surgeons were questioning whether to amputate above or below the

SpyElite image courtesy of Novadaq Technologies Inc.

knee,” said Libenguth. “And the Spy actually saved the knee and another five inches. The surgeons used it to determine where to make their incision. There was an old skin graft just below the knee and they weren’t sure if it would profuse but it did and the leg did really well.”

“The Spy gives me a level of confidence what we are leaving behind is healthy,” said Andrews.

“It’s been remarkable and gives me peace of mind that I am able to do the best surgery and ultimately provide the best care to patients.”

Temporal Artery - Vasc Native Temporal Circulation Pre Anastomosis

To learn more about the Spy Elite, call Karen Libenguth, RN, CPSN, St. Luke’s Surgery Department plastic surgery technical specialist at (319) 369-7413 or e-mail her at karen.libenguth@unitypoint.org.

St. Luke’s Hospital – A3

“I find the SPY to be a valuable tool in the OR,” said Kerri Nowell, MD, Physicians’ Clinic of Iowa general surgeon. “The data gathered is more informative than the traditional Wood’s lamp and fluorescein. I have altered my resection margins, both small bowel and colon, based on the data obtained.”

“ The Spy gives me a level of confidence what we are leaving behind is healthy.”

Healthy Lifestyle Clinic C

hildhood obesity has more than doubled in children and quadrupled in teens in the past three decades according to the Centers for Disease Control and Prevention (CDC). CDC statistics indicate in the United States, children aged 6 to 11 have seen obesity rates climb from 7 percent in 1980 to nearly 18 percent in 2012. In teenagers, the percentage has increased from 5 percent to almost 21 percent over the same time frame.

With these statistics in mind helping kids make healthier choices is a goal of UnityPoint Clinic – Pediatrics at Hiawatha.

However this initiative was proving harder than Nurse Kara Stineman thought it would be.

“When we started implementing the medical home I was discovering I had no resources for obese pediatric patients,” recalled Stineman. “There used to be a local program aimed at children and families but it went away so I decided we needed our own program.”

A4 – St. Luke’s Hospital

Stineman approached Pediatrician Lance Goodall, also at UnityPoint Clinic - Pediatrics at Hiawatha.

child and family where they learn about healthy eating and exercise.

The overall goal of the clinic is to help children and their families be happy and healthy.

“I struggle with my weight and I’ve gone through weight loss,” said Goodall. “One of the things I remember is when I was losing weight people were still making fun of my weight and I just got to the point where I was thinking ‘forget it, there’s no point.’ So one of the things I wanted to be sure of was this would be a friendly, non-judgmental and positive environment for the kids and really work with them.”

Program focus The Healthy Lifestyle Clinic is aimed at children under age 18 with the primary focus on teenagers, as this is when puberty hits and also a time when weight creeps up.

“It’s a time when they are more in control of their diet,” said Goodall.

“Perhaps they are drinking more soda and eating chips when they hadn’t before.”

“We look at the kids with a BMI percentile over 85 percent,” said Stineman. “The children need to be UnityPoint Clinic patients and be on Medicaid. The reason we

“Dr. Goodall did his residency at the University of Missouri and one of the doctors there started a program for children struggling with obesity,” said Stineman.

“Dr. Goodall gave me the idea to involve a mental health provider, physical therapist and dietitian, along with the physician side of things.”

Last fall Stineman, with the direction of Goodall, launched the UnityPoint Clinic Healthy Lifestyle Clinic. This program consists of seven sessions for the Kara Stineman, RN and Lance Goodall, MD, UnityPoint Clinic - Pediatrics

can’t do it with private insurance patients is because it would likely be too costly. Insurance may not pay for it or if they did there would be a lot of co-pays for the doctor, dietitian and physical therapist for each of the seven sessions.”

“Part of our criteria for this program is – do the kids feel their weight interferes with what they want to do with their peers? We want to help kids who have had significant weight gain and are not able to participate in activities they want to do because of their weight,” said Goodall. “If they see it is limiting them and the things they want to do in life then they may be more motivated to do something about it.”

Getting families enrolled has been an unexpected challenge. The first session had one individual participate. She had success and was committed to the program.

The program consists of an initial evaluation by a physician, dietitian and physical therapist. Once eight children are identified for the program the next program will commence.

“This program helps not only the child but the whole family,” said Stineman. “They learn these tips

The goal of the Healthy Lifestyle Clinic is to educate patients and their families about healthy options for diet, activity and mental health.

The program consists of seven weeks of educational programing.

Content includes: • The importance of breakfast

• Increasing fruits and vegetables

• Portion distortion

• Reading food labels

• Tips for eating out

• Cooking demonstrations

too – it becomes a family effort so we try to center our approach around things the whole family can do to improve their lifestyle. Even though it’s not for the parents I think they will see a lot of benefit from this program too.”

“During our first session we had a young woman whose self-esteem was bolstered by the end, it was rewarding to see her confidence increase and it solidified we were doing all of the right things,” said Goodall. “I read a study that indicates being overly aggressive with kids and making them feel obese is not the way to go and it could even increase their weight so our goal is to have a neutral and

friendly environment that says we want you to be healthy and not be judgmental. I think we’ve done that with this program.”

To refer a child to the Healthy Lifestyle Clinic, call Kara Stineman at (319)743-1440 or e-mail kara.stineman@unitypoint.org.

P.O. Box 3026 Cedar Rapids, IA 52406-3026 319/369-7211 unitypoint.org/medical-staff

St. Luke’s Hospital – A5

A physical therapist works with the children and families to help them add more cardiovascular exercise to their routine and show them exercises they can do in their home without special equipment. Through a partnership with the YMCA the families will also be offered a free one-month membership at the conclusion of the program.

Educational programing

UnityPoint Health – Cedar Rapids provider specialties resource guide Services found only at UnityPoint Health UnityPoint Clinic - Cardiology ..............................................................................................(319) 364-7101 The largest and most experienced cardiology practice in eastern Iowa, which offers a full spectrum of advanced cardiovascular services. The cardiologists travel to more than eleven surrounding communities and have satellite offices in Manchester and Dubuque, Iowa.

Child Protection Center.........................................................................................................(319) 369-7908

St. Luke’s Child Protection Center works with law enforcement and DHS on allegations of child abuse. This includes sexual abuse, physical abuse, children exposed to illegal drugs and children who have witnessed violence.

Community Anticoagulation Therapy (CAT) Clinic ...................................................... (319) 558-4046

The CAT Clinic cares for patients taking a variety of anticoagulation medications. The Clinic nurses have extensive experience in critical care and other areas of nursing.

Continuing Care Hospital (CCH) at St. Luke’s ..................................................................(319) 286-4324

CCH is a Long Term Acute Care Hospital (LTACH) specializing in acute care for patients needing a longer hospital stay. CCH is a hospital within a hospital and is located on the sixth floor of St. Luke’s.

Dental Health Center ............................................................................................................ (319) 369-7730 The Center provides comprehensive and preventive dental care for low-income children and developmentally disabled adults.

Family Health Center .............................................................................................................. (319)369-7397 St. Luke’s Family Health Center is a Title 10 agency serving Benton, Jones and Linn Counties in Iowa for low or no cost birth control options and annual exams.

Feeding Clinic .......................................................................................................................... (319) 286-4327 For children experiencing significant feeding challenges – difficulty gaining weight, failure to thrive, food intolerance/allergies, oral aversion and oral motor problems.

Inpatient Hospice Unit ......................................................................................................... (319) 369-7744 The hospice unit within the hospital improves end-of-life care for patients who must remain in the hospital for their last days.

Intraoperative Electron Radiation Therapy (IOERT) .......................................................(319) 369-7216

A6 – St. Luke’s Hospital

IOERT combines lumpectomy with an initial, concentrated dose of radiation precisely focused on the area where most breast cancers recur. Following IOERT radiation treatments may be cut in half.

Intensivists ............................................................................................................................... (319) 369-7222 First intensivist program in Cedar Rapids, physicians have specialized critical care training.

International Travel Health Clinic ....................................................................................... (319) 363-3565 Assists individuals in obtaining the proper vaccinations before traveling to a foreign country.

LifeGuard Air Ambulance .................................................................................................... (319) 362-1029 Helicopter ambulance program, which provides 24/7 coverage to patients and emergency response teams.

Living Centers ......................................................................................................................... (319) 366-8714 St. Luke’s Living Centers offer skilled nursing and rehabilitation services for both short-term and long-term care.

Medical Weight Loss Clinic ..................................................................................................(319) 558-4867 At the UnityPoint Clinic Multi-Specialty Medical Weight Loss Clinic there are no restrictions on weight or BMI.

MedLabs ..................................................................................................................................(319) 368-5650 This outreach laboratory supports physician office practices in the Cedar Rapids region, which covers Linn, Benton, Cedar and Jones Counties.

Mental health child/adolescent unit ....................................................................................(319) 369-7441 A secure center, which provides treatment for children (ages 6-12) and adolescents (ages 13-18). Both programs are family-centered and designed to help children and adolescents who have serious behavioral problems, emotional disorders or adjustment difficulties.

Neonatal Transport Team ....................................................................................................(319) 861-6800 Team consists of registered nurses and respiratory therapists who are specially trained in the management and transport of critically ill or premature newborns.

Neurosurgery ..........................................................................................................................(319) 369-7085 Physicians provide specialty brain and spine services. Consults are welcome.

Newborn Intensive Care Unit (NICU) ...............................................................................(319) 861-6800

Cedar Rapids’ only Advanced Level II Regional NICU. Physicians provide care for extremely low birth weight babies and babies born at 23+ week’s gestation.

Open-Heart Surgery ............................................................................................................. (319) 369-7225 St. Luke’s is the only hospital to perform open-heart surgery in Cedar Rapids and have been named as a top cardiovascular hospital four times in the last ten years. St. Luke’s is also an accredited Chest Pain Center.

Pediatric Cardiology ................................................................................................................ 319) 368-5757 Cedar Rapids’ only pediatric cardiologist offers a full service, non-invasive heart care clinic that performs echocardiograms, stress testing and consultations for newborns, children and adolescents.

Pediatric Hospitalist ..............................................................................................................(319) 861-6800 Physicians with the first pediatric hospitalist program in Cedar Rapids work with a child’s family physician and keep them updated about admission, discharge and changes in a child’s condition during a hospitalization.

Physical Medicine and Rehabilitation Clinic ......................................................................(319) 369-7331 Team includes physiatrists, a neurologist, a medical health psychologist and neuropsychologist that work with patients who need rehabilitation after a stroke, spinal cord injury, traumatic brain injury, amputation and other conditions.

Psychiatry Hospitalist ........................................................................................................... (319) 369-7959 Full-time hospitalists treat hospitalized pediatric and adult psychiatric patients.

Pulmonary Rehab .................................................................................................................. (319) 369-7736 Specialists who provide rehabilitative care to people who have chronic pulmonary disease.

Robotic Training Center .......................................................................................................(319) 369-7860

Surgery Center Cedar Rapids .............................................................................................. (319) 558-4800 A partnership including UnityPoint Health - St. Luke’s Hospital and more than 100 Cedar Rapids community surgeons and anesthesiologists who provide multispecialty surgical and procedural services for eastern Iowans.

Witwer Children’s Therapy (Developmental Pediatrics) ................................................(319) 369-8407 One of the largest outpatient pediatric therapy centers in Iowa. Therapists work with a variety of children with special needs, which include: ADHD, autism, cerebral palsy, developmental disability, Down Syndrome, feeding and swallowing difficulties, sensory processing disorders and speech and language difficulties.

St. Luke’s Hospital – A7

As the first Cedar Rapids hospital to offer the new technology, more robotic surgeries are performed at St. Luke’s than any other hospital in the state. St. Luke’s is one of 15 top-performing and teaching hospitals for robotic surgery in the U.S.