Holy Name Medical Center: Advances in Compassionate Care March 2011

advances in medicine + c o m pa S S i o N at e c a r e F o r e v e r y S ta g e o F l i F e

S U P P L E M E N T TO B E R G E N H E A LT H & L I F E

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gIVINg PaTIeNTs CHoICes It isn’t just the Internet that has changed the way educated patients approach their healthcare, says Holy Name Medical Center’s Daniel H. Smith, M.D. “Starting back in the 1960s, women rebelled against mastectomy—the removal of an entire breast—and demanded other treatment choices,” says Dr. Smith. “Thanks in part to these women, patients today do not passively accept one way of receiving treatment, but instead want options.”

Now, Holy Name Medical Center is expanding its Women’s Health Services division to help women understand their options more fully than ever, with a variety of prevention, wellness and compassionate care services.

Through proven preventive initiatives, such as the vaccine to prevent human papillomavirus, Pap smears to detect cervical dysplasia and cancer, and genetic testing and counseling for women who test positive for the BRCA1 and BRCA2 “breast cancer” genes, Dr. Smith and others at Holy Name can educate women and assist them in making healthcare choices that are right for them and their families over their lifetime.

“We are looking at introducing the concept of a ‘living will’ early in the life cycle so that over a woman’s lifetime, she can make the heathcare choices that best suit her and her lifestyle and philosophies,” says Dr. Smith.

These services will be coordinated with Dr. Smith’s newly developed fund for Ovarian Cancer Awareness.

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the laparoscope’s close relative: the robotic da Vinci® surgical system. one of the pioneers of using the da Vinci® robot is now at Holy Name Medical Center full-time, caring for patients with gynecologic malignancies. Daniel H. smith, M.D., Chief of gynecologic oncology at Holy Name, says he “reinvented himself with the use of robotic surgery” after practicing his specialty using “maximally invasive” techniques for more than 30 years.

“There is no comparison to what the da Vinci® offers in terms of precision, superb visuals of the surgical field and the outcomes I can provide for my patients,” says Dr. smith, who is the only physician in northern New Jersey to have been board-certified and then re-certified in obstetrics/gynecology, gynecologic oncology and general surgery. His advanced expertise qualifies him to treat gynecologic cancers not only at their original site, but also in areas to which they may spread, including the colon, bladder, blood vessels and other pelvic regions.

Dr. smith is also utilizing single-incision laparoscopic surgery (sIls) for gynecologic conditions at Holy Name’s Minimally Invasive Center. The technique affords him the ability to operate through just one keyhole incision. also being added to Holy Name’s gynecologic oncology services include clinical trials through the National Cancer Institute’s gynecologic oncology group and weekly Tumor Board conferences, where treatment decisions about individual patients are reviewed by a multidisciplinary panel of physicians.

Holy Name’s Regional Cancer Center is also planning a program for intraoperative brachytherapy with minimal shielding, a treatment that involves radiating the area of a tumor during surgery just after the primary tumor has been removed. “Because this technology requires minimal shielding,” says Dr. smith, “it’s flexible and can be used anytime, in any operating room.”

cancer surgery foR WoMeN a master surgeon embraces the new minimally invasive robotic technology gYnecoLogists were the first physicians to perform minimally invasive procedures with the laparoscope—a thin, flexible surgical tool inserted through a small incision and used to view internal organs. over the past two decades, laparoscopic surgery became the standard tool for diagnosing, staging and treating many gynecologic conditions and diseases, including cancer, benign growths, endometriosis and infertility. encouraged by laparoscopy’s ability to produce successful outcomes for patients while reducing blood loss, pain, infections and recovery time, gynecologists embraced

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kindest cuts Surgeons work together to develop the most advanced minimally invasive methods How best can a surgeon assure patients less pain, a quicker recovery, and a reduced risk of complications? That question is explored every day at Holy Name Medical Center’s Minimally Invasive Center. The new facility seeks to expand the medical center’s laparoscopic and robotic surgical capabilities while creating an academic environment in which surgeons and other physicians can keep up with the latest advances in minimally invasive therapies, both surgical and non-surgical.

The Center’s director, general surgeon Hee Yang, M.D., wants to encourage his colleagues to share their experience and wisdom. To that end, he has begun holding monthly conferences for physicians and surgeons that focus on exploring the least invasive ways to diagnose and treat common medical conditions and diseases.

“These conferences provide a forum where surgeons can showcase their skills, teach others, and work together,” says Dr. Yang, who is also medical director of Holy Name’s Korean Medical Program.

“By taking a holistic, multidisciplinary Hee Yang, M.D.

approach to disease and then treating it with either a laparoscopic or robotic procedure, physicians within several specialties can help patients heal faster.”

Take leg pain, for example. It can indicate peripheral vascular disease (PVD), a narrowing or blockage in a large artery other than those of the heart or brain. People with PVD are also at risk of developing a life-threatening blockage in a coronary artery, so a patient may benefit

from not only a nonsurgical or minimally invasive surgical procedure to treat the PVD but also a coronary angioplasty and stenting procedure to reduce the risk of a heart attack.

“A vascular surgeon, a diagnostic cardiologist, and an interventional cardiologist would all work together in the patient’s best interests,” says Dr. Yang.

“This is the collegial spirit that we are fostering within the Center.”

Twenty years ago, Dr. Yang was one of the first surgeons in the nation to complete a fellowship in minimally invasive surgery.

Over the years, he honed his laparoscopic skills and is now adapting some of these techniques to the da Vinci® robotic surgical system, a technology pioneered in New Jersey by Holy Name’s director of Gynecologic Oncology, Daniel Smith, M.D. Dr. Smith now relies almost exclusively on the da Vinci® as he performs complex surgeries to stage and treat gynecologic cancers and metastases of the pelvic region.

Dr. Yang and Dr. Smith are teaching Holy Name surgeons a technique called single-incision laparoscopic surgery (SILS), which requires just one small incision through which the surgeon operates with special instruments. Having one tiny scar is appealing. “Patients love it,” says Dr. Smith.

“They ask for it for simple pelvic problems.”

Robotic and laparoscopic surgery: the basics Minimally invasive laparoscopic surgery entails operating with small instruments and a special scope that are inserted into the patient through small incisions, or “ports,” placed below the navel. The surgeon is guided by visuals projected onto a monitor that are created by a tiny fiber-optic camera lodged within the laparoscope.

Robotic surgery takes laparoscopic surgery steps further. The instruments used during the operation are maneuvered by a five-armed surgical robot that is moved by a surgeon using hand controls that resemble joysticks. While the surgeon sits at a console in the operating room near the patient, he/she views the surgical field in high-resolution magnification and performs the procedure using the robot’s arms. Because both laparoscopic and robotic surgeries involve small, rather than large, surgical incisions, patients experience less pain and bleeding, a shorter hospitalization and faster healing.

Northern New Jersey’s first robotic thyroidectomy—removal of a thyroid gland—was performed by otolaryngologist James Lee, M.D., with the assistance of Minimally Invasive Center Director Hee Yang, M.D.

For referral to a Holy Name surgeon | 1-877-HOLYNAME (1-877-465-9626) 3 www.holyname.org

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when care means

CoMfoRT a special facility assures dignity, pain relief and peace during life’s transitional chapter

not too ManY Years ago,

medicine shied away from one salient fact: Its victories are temporary. But today the profession better understands its double duty—not only to strive for cures, but also to provide the best possible quality of life when a cure is no longer a viable expectation. That mandate fits in perfectly with the caring approach that has marked Holy Name Medical Center since it was established in 1925. and it has given a whole new life to an estate in saddle River called Villa Marie Claire.

Villa Marie Claire has served as a residence for more than a century—first as the dwelling of Thomas and Marie Claire Mahoney and then as a home for the numerous ministries of the sisters of st. Joseph of Peace, the order that founded Holy Name and continues to sponsor it. over the years, the Villa and its expansive property have served as a home for girls, a working farm for orphan boys, a retreat house and a retirement home for elderly sisters and

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members of the community. Now it provides inpatient hospice care for men and women who are nearing the end of life. The first facility of its kind in Bergen County to offer this level of hospice care and the only one in the tri-state area to provide temporary lodging for family members in a nearby wing, Villa Marie Claire is a valuable addition to Holy Name Medical Center’s comprehensive Hospice and Palliative services.

AN EMPHASIS ON QUALITY The term “hospice” once described a way station for pilgrims journeying to the Holy land. Today, at Holy Name, hospice is a holistic care philosophy that emphasizes quality of life rather than length of life for people with advanced illness. Men and women who are no longer receiving curative treatment for diseases such as cancer, aIDs, multiple sclerosis, alzheimer’s disease and other terminal illnesses choose hospice care for symptom management, pain relief, spiritual support and peaceful care.

“our goal is to create and foster a pain-free life through symptom management and supportive therapies so this part of life’s journey may be spent in dignity and comfort, with patients, their caretakers and loved ones functioning as partners,” says Jean a. leone, R.N., B.s., M.s., executive director and clinical administrator of Hospice and Palliative services at Holy Name Medical Center and Villa Marie Claire.

Trained to be sensitive to a wide variety of faiths and cultures, the Hospice and Palliative services team welcomes all members of a patient’s support system to participate in their loved one’s care, including family, friends, caregivers, neighbors and even cherished pets. Integrative therapies such as pet therapy, massage, Reiki, and music therapy are combined with clinical pain and symptom management therapies. The team includes physicians; nurses; medical social workers; physical, occupational, and speech therapists; hospice and palliative aides, and specially

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PallIaTIVe CaRe aT HolY NaMe

CLOCKWISE FROM UPPER LEFT: AWASH IN SUNSHINE, THE FAMILY ROOM IS WARM AND WELCOMING; EVERY PATIENT BED FACES A WINDOW WITH VIEWS OF THE ESTATE; ONE OF THE VILLA’S WELL-APPOINTED GUEST ROOMS FOR LOVED ONES; THE INTERFAITH SANCTUARY HONORS ALL RELIGIOUS TRADITIONS.

trained volunteers who can provide respite for the patient’s caregivers.

“Too many individuals spend their last days in pain and distress in a hospital room, when they could be in a peaceful, homelike environment where their symptoms are managed, their loved ones supported, and all can experience an enhanced quality of life,” says Dianne Harrison, R.N., an advanced practice nurse whose responsibilities include “navigating” patients through all services.

“Villa Marie Claire exemplifies this type of environment.”

T H E V I L L A’ S N E W R O L E The transformation of Villa Marie Claire into Holy Name’s newest facility follows a natural evolution in meeting the needs of the Medical Center’s northern New Jersey community. several years ago, the sisters of st. Joseph of Peace proposed the Villa’s new role as an extension of their healing mission. In January, Villa Marie Claire welcomed its first hospice residents.

“This is a dream come true for families in New Jersey and the culmination of my life’s work,” says leone, who has spent most of her nursing

career in hospice and palliative care.

Villa Marie Claire features 20 beautifully appointed private patient rooms, accommodations for families, high ceilings and wood floors, fireplaces, an interfaith sanctuary, private and community spaces, an in-ground outdoor swimming pool, 26 acres of grassy fields as well as a proposed labyrinth, a meditation garden and walking trails. also in development are special events and services including educational lectures, cultural entertainment, a respite center for caregivers, a pet therapy program and community bereavement retreats.

“People who are terminally ill can still be effective,” says Charles Vialotti, M.D., Medical Director of Villa Marie Claire. “They can make decisions. They can participate in family life. If they suffer from complications of treatment, they may lose that opportunity. We want to provide our patients with every potentially effective treatment, but we don’t want to encourage them to receive treatment that we know is medically futile. In a nurturing environment where palliative care is explained and accepted, patients live better and often longer, and families are able to come to terms with what’s happening.”

Holy Name HoSpice aNd palliative care | 201-833-3188

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Hospice and Palliative Services at Holy Name Medical Center aren’t limited to end-of-life care. They are provided to patients with many kinds of chronic or progressive illnesses, such as heart failure or emphysema, who may or may not qualify for hospice.

Besides the hospice care offered at Villa Marie Claire (see main article at left), Holy Name’s comprehensive Hospice and Palliative Services can be provided in a variety of other environments, including a patient’s private home, at a hospital or in a nursing home, assisted living community or residential group home. In any setting, the professionals at Holy Name are guided by the same compassion and high standards of care.

“The spirit of the Sisters of St. Joseph of Peace resides in the work we do,” says Peg Blake, R.N., unit director for Hospice and Palliative Services, “and inspires us to achieve dignity and peace for our patients and their loved ones at every stage of the journey.”

Holy Name’s Hospice and Palliative Services feature: physical, psychosocial and spiritual support access to a full-service Medical Center an interfaith- and intercultural-educated healthcare team a personal care navigator (advanced practice nurse) to coordinate all aspects of care early access to palliative care integrative therapies ■

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lefT To RigHT: GREGORY LOVALLO, M.D. MUTAHAR AHMED, M.D. VINCENT LANTERI, M.D. MICHAEL ESPOSITO, M.D. AND NITIN PATEL, M.D.

uRologY IN THE

robot age

pioneering doctors helped transform a specialty with robotics, giving prostate cancer patients a better quality of life

it’s been 10 Years since Michael esposito, M.D., and his partner, Vincent J. lanteri, M.D., sat down at the console of a da Vinci® robotic surgical system and began to revolutionize the treatment of prostate cancer in their urology practice and in the tri-state area. since then, the two urologists and their partners, Mutahar ahmed, M.D., gregory g. lovallo, M.D., and Nitin Patel, M.D., have performed more than 3,000 robot-assisted radical prostatectomies, maneuvering the da Vinci®’s four arms to remove cancerous prostate glands. The group has been instrumental in making this procedure the gold standard for treating early-stage prostate cancer that has not spread beyond the gland.

“The scientific data show that robot-assisted prostatectomy is as successful in eradicating the cancer as a traditional open surgical procedure that is much more difficult for the patient,” says Dr. esposito, who along with Dr. lanteri and Jeffrey a. stock, M.D., wrote Urologic Robotic Surgery, a major textbook used in the education of urologists.

Bringing laparoscopic surgery forward by a significant

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leap, robot-assisted prostatectomy affords patients all the usual benefits of a minimally invasive laparoscopic procedure— keyhole incisions and less pain, less blood loss and quicker recovery than with an open prostatectomy—while also preserving patients’ continence and sexual potency. The da Vinci®’s superior three-dimensional views of the surgical field, tiny instruments, precise suturing and manual dexterity and flexibility enable urologists at Holy Name Medical Center to spare the vital blood vessels and nerves surrounding the gland so that incontinence and impotence can be avoided.

T H E V E R S AT I L E R O B O T although robot-assisted radical prostatectomy remains the mostperformed urologic procedure using the da Vinci® robot, it is far from the only one. Drs. esposito and lanteri and their group have adapted the technology to remove cancerous bladders, kidney tumors, nonfunctioning kidneys and masses in the adrenal glands as well as prostate glands. The surgical robot is also used in procedures to treat female incontinence, conditions of the ureters and obstruction of the uteropelvic junction, the area of the urinary system where the pelvis meets the ureters as they funnel urine from the kidneys to the bladder.

Holy Name’s board-certified urologists treat the entire spectrum of illnesses and diseases that affect the urinary system and the male reproductive system.

9 sIgNs of TRouBle Call your primary care doctor

commoN riSK

or urologist if you experience any of these symptoms, which may indicate a urologic problem that requires treatment: difficulty urinating blood in the urine burning or itching when urinating frequent or urgent need to urinate excessive nighttime urination lump or swelling of the testicles or penis pain in any area of the urinary system back or kidney pain difficulty conceiving a baby

FactorS For

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Holy Name pHySiciaN reFerral | 1-877-HOLYNAME (1-877-465-9626)

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speedy emergency care When time is critical, ill or injured patients get prompt attention at Holy Name Nowhere is waiting for service more annoying—or stressful—than in a hospital emergency room when you are sick, injured or in pain. Recognizing this, Holy Name Medical Center’s George P. Pitkin MD Emergency Care Center strives to see patients as quickly as possible. And with its 41 treatment areas, a fast track area for minor injuries and a separate pediatric zone, the Center has about 54,000 visits each year.

Holy Name aims for a “door-todoctor time” of less than 30 minutes, shorter than any other hospital emergency department in Bergen County. Within a half hour, every noncritical patient is evaluated by a physician who is board-certified in emergency medicine or pediatrics, or a physicians’s assistant. Patients who are brought in by ambulance or are experiencing serious symptoms—such as severe pain, loss of consciousness, burns or head trauma—are seen without delay.

“We try to make sure that no one sits in our reception area waiting to be

Randy Tartacoff, M.D.

Joanne Kambolis, M.D.

evaluated,” says Randy Tartacoff, M.D., who co-directs the Emergency Care Center with Richard Schwab, M.D. “Once patients are triaged and assessed by a nurse, they are brought to private treatment rooms with their family members to see a doctor.”

The Center’s physicians are boardcertified emergency medicine specialists and pediatricians (not residents), who coordinate patients’ care with Holy Name’s on-call specialists, private physicians, pediatricians and the Medical Center’s hospitalists (hospitalbased physicians), who are on site 24/7.

A 21,000-square-foot layout— featuring four treatment quadrants built around a central core area—allows for a smooth flow of patients from evaluation through to diagnostic testing, treatment and admission or discharge. Patients’ vital signs are monitored by nurses at each quadrant.

Adjacent lab and radiology services enhance the Emergency Care Center’s efficiency.

Special rooms are set aside for gynecologic, psychiatric and dental emergencies and for patients with contagious diseases.

“Our department is surprisingly calm and quiet,” says Dr. Tartacoff. “The design minimizes exposure to intimidating sights and the sounds of other patients.”

Primary Stroke Center and Chest Pain Center designations mean that patients coming to the Emergency Care Center undergo diagnostic tests and treatment following protocols set forth by national

benchmarking agencies. Holy Name’s fully staffed cardiac catheterization lab and interventional radiology suite allow for rapid lifesaving procedures such as angioplasty, and nonsurgical treatments that use imaging guidance for vascular emergencies such as a blood clot in the leg or internal bleeding.

By mid-2011, the Center plans to introduce Bergen County’s first cooling hypothermic treatment for patients with acute injuries or illnesses. “Lowering body temperature has been shown to protect the brain and reduce damage to other organs,”says Dr. Tartacoff. “It’s an exciting advance.”

A childfriendly space At Holy Name Medical Center’s Emergency Care Center, a separate, child-friendly pediatric triage and waiting area was designed to treat—as well as reassure— sick and injured youngsters.

Open weekdays from 4 p.m. to midnight and weekends from 12 p.m. to midnight (when most pediatric emergencies occur and pediatricians’ offices are closed), the pediatric emergency section is staffed by board-certified and board-eligible pediatricians and certified pediatric nurses with many years of emergency care experience.

“We coordinate care with our patients’ own pediatricians and have a full roster of pediatric subspecialists on call for consultation, including pediatric urologists, plastic surgeons, and gastroenterologists,” says pediatrician Joanne Kambolis, M.D., who is assigned to the facility full-time.

Holy Name is northern New Jersey’s state-designated Medical Coordination Center, providing regional planning and organization of medical resources in case of a large-scale natural or man-made disaster. The emergency care center staff is trained to manage mass-casualty situations that would require decontamination or radiation detection in patients.

Emergency Care Center | Mobile Intensive Care Unit | 1-877-HOLYNAME (1-877-465-9626) 7 www.holyname.org

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cancer IQ

test your

t H e Q u i Z b e L o w i s b a s e D o n i n F o r M at i o n F r o M t H e a M e r i c a n c a n c e r s o c i e t Y. s e e H o w M u c H Y o u K n o w a b o u t c a n c e r , r i s K Fa c t o r s a n D P r e V e n t i o n .

Quiz answers appear upside-down at the bottom of this page.

1. what is the most common of all cancers?

A. Breast cancer B. Colon cancer C. Skin cancer D. Prostate cancer

2. Non-smokers who breathe in secondhand smoke take in nicotine and other toxic chemicals just like smokers do.

True False

3. i can stay in the sun as long as i want if i’m wearing sunscreen.

True False

4. what can i do to prevent cancer?

A. Maintain a healthy weight throughout life B. Adopt a physically active lifestyle C. Stay away from tobacco D. All of the above

5. men with a pSa level in the borderline range between 4 and 10 have about a 1 in 4 chance of having prostate cancer.

True False

6. How often should women get mammograms?

A. If you’re 50 or older, every 6 months B. If you’re 40 or older, every year C. If you’re 30 or older, every year D. If you’re 40 or older, every 6 months

7. testing for polyps does nothing to prevent colon cancer, even if found early.

True False

8. what are two common signs of melanoma?

A. Asymmetrical shape mole and ragged border mole

B. Large number of freckles and single color mole C. Discolored mole and freckles D. None of the above

9. what are the most common myths about colon cancer?

A. Age matters when it comes to colorectal cancer B. African Americans are not at risk for colorectal cancer C. It’s better not to get tested for colorectal cancer because it’s deadly anyway D. B and C

10. inherited mutations of the brca1 and brca2 genes can not only cause hereditary breast cancer, but also ovarian cancer.

True False

ANSWERS: 1. C; 2. TRUE; 3. FALSE; 4. D; 5. TRUE; 6. B; 7. FALSE; 8. A; 9. D; 10. TRUE

If you scored . . .

10 correct answers: Congratulations! You’re a cancer-health whiz.

8 to 9 correct answers: You have a good understanding about cancer, its risks and prevention—just look over that missed answer or two to brush up.

7 or fewer correct answers: good try. To learn more, visit the websites of the american Cancer society (www.cancer.org) and Holy Name Medical Center (www.holyname.org; click on “Conditions and Treatments”).

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