Breakthroughs Fall 2014 by Providence Health & Services

breakthroughs LIVING WELL ON THE WESTSIDE | FALL 2014

AWASH IN HAPPINESS Modern treatments for rheumatic conditions restore patientsâ&#x20AC;&#x2122; lives. p.26

letter

breakthroughs

from the CEO

LIVING WELL ON THE WESTSIDE FALL 2014

In January, I journeyed from my office at Swedish Health Services in Seattle to Santa Monica to be part of a transition team to listen to Saint John’s physicians. My goal was to solicit their opinions of how to effectively add Saint John’s Health Center and the John Wayne Cancer Institute to the Providence Health & Services system. During the two days I spent at the Health Center,

SAINT JOHN’S HEALTH CENTER EDITORIAL STAFF

Chief Executive Marcel Loh Director of Marketing & Communications Connie Matthews Barilla

I was able to meet many members of the staff. What a first impression! I was struck by the devotion the physicians and staff displayed and by the strong

Marcel Loh Chief Executive

commitment to the community. I never have witnessed such a warm, welcoming environment.

Now I am privileged to be the new chief executive of this storied, outstanding health care institution. I couldn’t be prouder and more excited about my new role. Providence Saint John’s Health Center already is nationally ranked in such fields as cancer, neurosciences, cardiac care and orthopedics. The John Wayne Cancer Institute is a center for innovation and research. And yet the Health Center has never lost sight of the fact that its first priority is to care for, serve and meet the needs of its community. In the weeks and months ahead, I’m looking forward to partnering with all caregivers to build upon this long tradition of excellence. With our talented physicians, compassionate nurses and dedicated staff and volunteers, we possess all of the characteristics for continued success. But we won’t stop there. We will strive to advance high quality and safe health care by embracing leading-edge strategies and solutions. My wife Jane and I are eager to experience life on the Westside and become part of the fabric of this great community. We are humbled by the opportunity to join the Providence Saint John’s Health Center and John Wayne Cancer Institute families, and look forward to meeting all our new family. With utmost respect, Marcel 2

breakthroughs FALL 2014

58 11th Street, Hermosa Beach, CA 90254 Tel 310-376-7800 Fax 310-376-0200 moontidemedia.com

VP, Branded Media Emily S. Baker Art Director Angela Akers Editor Shari Roan Copy Editor Laura Watts Contributors Dawn Hoffman, Lorie Parch, Zoe Sophos Photographers Scott Gilbert, Michael Neveux, Lauren Pressey, Remy Haynes Managing Partners Charles C. Koones Todd Klawin

contents departments 2 | Letter from the Chief Executive 14 | On the Horizon 31 | Happenings 34 | Shout Outs

features

profiles

16 | Brave of Heart

20 | Sharing and Caring

With new treatment options, Saint Johnâ&#x20AC;&#x2122;s cardiologists alleviate their patientsâ&#x20AC;&#x2122; fears.

22 | Things Are Looking Up

New screening technology and improved surgeries have altered the outlook on lung cancer.

26 | Taking the Ache out of Arthritis

Early treatment can significantly curb the risk of disability.

A long-standing support group helps people who are insulin-dependent.

24 | No Generation Gap Here Karen and Emma Register share a love of volunteering.

ON THE COVER Aimee Bower has returned to an active lifestyle after treatment of rheumatoid arthritis. FALL 2014 breakthroughs

in good health Examining Acupuncture for Side Effects of Breast Cancer Treatment Many postmenopausal women with breast cancer take a type of medication called

the joint pain. “Acupuncture has been

an aromatase inhibitor. This drug blocks

used for centuries to treat

the body’s production of estrogen and is a

inflammation,” Dr. DiNome

proven therapy for breast cancers that are

explains. “More recent-

hormone-sensitive. However, aromatase

ly, Western medicine has

inhibitors can cause significant joint pain.

studied the benefits of acu-

Many patients discontinue the therapy be-

puncture. With our brilliant

cause of this side effect.

immunologists at the John

Maggie DiNome, MD, chief of general sur-

Wayne Cancer Institute,

gery at Providence Saint John’s Health Center,

we are setting out to study,

acting director of the Margie Petersen Breast

with much more depth, the

Center and medical director of the Cancer

body’s immune response to

Prevention Clinic, has launched a clinical trial

acupuncture.”

that will examine whether acupuncture can

almost 20% of these women will discontinue

“It’s particularly important to address

this otherwise lifesaving therapy because of

successfully reduce treatment-related joint

this issue because we are placing more

this side effect. If women cannot derive the

pain. Dr. DiNome and her colleagues at the

women on long-term aromatase inhibitor

intended benefit from our recommended

John Wayne Cancer Institute believe the estro-

therapy—often in lieu of chemotherapy,” Dr.

treatments because of intolerance, then we

gen deprivation induced by the treatment may

DiNome says. “Unfortunately, up to half of

are doing a disservice if we do not attempt to

trigger an inflammatory response that causes

the women will experience joint pains, and

address the problem with them.”

are blue jackets or polo

The Angels are Outfitted

shirts with a logo incor-

Angels are on duty each day from

porating Providence, the

9 a.m. to 9 p.m. They check to see if patients

Health Center’s new spon-

need reading material, a blanket, a glass

sor, into the design.

of water or would like to contact family or

“We had several different

friends. They communicate with the health

uniforms in use,” says Janie

care team to make sure the patients’ needs

Crane, the Angels coordi-

and concerns are promptly addressed.

nator. “Some were old, and

“Our main job is to advocate for the pa-

some were new. We decided

tients,” Crane explains. “We help make their

to start fresh. We hope

stay at Providence Saint John’s as pleasant as

everyone will look all spiffy

it can be. No one wants to come to the ER, but

and nice.”

we try to make the patient comfortable and the

The Angels are a spiffy organization, to be The Angels of the ER volunteer group has

Now composed of 43 members, two

sure. The group was formed 14 years ago to

experience as stress-free as possible.” The Angels were the recipients of an

received new uniforms thanks to a generous

provide volunteer services to patients and

award from the American Hospital Associa-

gift by the Irene Dunne Guild. The uniforms

families in the emergency department.

tion in 2011 for Volunteer Excellence.

breakthroughs FALL 2014

in good health All Hands on Deck Infection control is always a priority at Providence Saint John’s Health Center. However, with the first cases of Ebola virus infection recently confirmed in the United States, the health care staff has been undergoing additional training to ensure preparedness to treat an Ebola patient while protecting the staff and other patients. Numerous occupational safeguards are undertaken as part of this response plan. For example, in caring for a patient with Ebola, all donning and doffing of their personal protective equipment—such as gowns, gloves and masks— would be under supervision, and health care workers will not

Multiple Concussions Alter Hormones Research led by Daniel F. Kelly, MD, director of the Brain Tumor Center and Pituitary Disorders Program at Providence Saint John’s

be permitted to enter or exit a room without the approval of a safety officer. The Health Center also is conducting drills to familiarize the staff with recently released government protocols

Health Center, adds to the growing concerns about the long-term

regarding donning and removing personal protection

repercussions of brain trauma suffered by football players. The study,

equipment. In one exercise designed to help employees

published recently in the Journal of Neurotrauma, found that multiple

use personal protective equipment, water color paints are

concussions were associated with reduced levels of some hormones

dabbed on gloves, gowns and masks before employees

and that diminished hormones increase the risk of other disorders. The impact of multiple concussions in athletes of all ages is one of the most pressing issues in sports medicine and neurology. The study by Dr. Kelly adds to the list of potential complications from multiple concussions. He analyzed 68 retired NFL players who were, on average,

practice removing their gear. The protective gear has to be removed without paint transferring to the skin or clothing, indicating that the protocol was followed successfully. Numerous employees are involved in planning for a

47 years old and who had an average of three concussions and a poor

possible Ebola patient, and Providence Health & Services

quality of life based on mental component scores.

hospitals are sharing resources. One Providence hospital, St.

The study found deficiencies in either growth hormone, gonadotropin or testosterone in 23.5% of the retired players. Men with reduced levels of growth hormone typically have high levels of fats

Patrick’s, in Missoula, Montana, is one of the four Biosafety Level 4 facilities in the country.

and cholesterol in the blood and can have an increased risk of heart disease and diabetes. Deficiencies in testosterone and gonadotropin can impact mood and contribute to erectile dysfunction.

Shopping on Amazon can now benefit the research at John Wayne Cancer Institute at Providence Saint John’s Health Center. Just log in to your Amazon account at smile.amazon.com and type “John Wayne Cancer Institute” in the search bar. Select the Institute and begin shopping. Amazon will automatically donate a half-percent of your total purchase to the Institute every time you shop. FALL 2014 breakthroughs

in good health

Making Good Use of the Emergency Department During Flu Season The emergency room at Providence Saint John’s Health Center can be a busy place, especially during the cold and flu Russ Kino, MD season. We asked Russ Kino, MD, director of emergency services, how he manages the ER during oubreaks of infectious disease and potential threats like Ebola.

let them know they are going to the emergency

going on in the county. Right now, there’s

department, because their doctors may want to

an outbreak of measles and pertussis, so

provide important information to us about how

I’m constantly updating our nurses and

to best manage the patient.”

doctors on those illnesses. I also get Centers for Disease Control and Prevention updates

Do people know when

How do you manage the emergency

about communicable diseases, such as the

to use—or not use—the

department during particularly

Ebola virus. We have a plan to manage any

emergency room?

challenging flu seasons when things

of these diseases. I’m always circulating the

get very busy?

criteria for diagnosis among the emergency

“Most people who come here are pretty sick. One in

“We’ve had flu seasons where there have

department staff and what one would do if

four patients who visit the ED stay in the hos-

been epidemics. We’ve instituted careful

they thought they had a patient with a serious

pital. So on average, the people who come here

measures for the waiting room and in triage.

communicable disease. We also have disaster

need to come.”

For instance, we put a mask on anyone with flu

management teams for any type of disaster,

symptoms. We take pains to make sure they

whether that’s a disease outbreak or a bomb

Is it hard for people to know when to

don’t infect other patients, and we keep them

or radiation leak. A lot of planning goes into

come to the ER for flu symptoms?

in an isolated part of the emergency depart-

running an emergency department!”

“It can be hard to know. If they have symp-

ment. We try to run a rapid screen on them

toms of the flu or common cold and it’s some-

to see if they have influenza. Then, if they are

What’s your best advice for avoiding

thing similar to what they’ve had before, they

really unwell and have something else going

the flu or a communicable disease?

usually don’t need to come to the emergency

on like dehydration or pneumonia, then they

department. They should call their primary

would get admitted.”

“The most important thing you should do is get the flu shot. Just yesterday, an article came out that said in an office setting, a virus spreads

care doctor. But if they think its qualitatively different and they aren’t feeling particularly

Do you practice for outbreaks of

within two to four hours of the sick person

well, especially if they are older or have a co-ex-

communicable diseases, like flu or

entering the building. The best possible advice

isting illness like diabetes or an autoimmune

measles or pertussis?

to give people is that they really can’t wash

illness, they should come to the emergency

“Yes. We get regular updates from the

their hands enough. Hand-wash every time

department. But even as a mere courtesy, peo-

Los Angeles County Communicable Dis-

you touch common objects. That is the most

ple should call their primary care provider and

eases Agency to keep us updated on what is

effective way to stop getting sick.”

breakthroughs FALL 2014

in good health YOUR GUIDE TO THE EMERGENCY DEPARTMENT AT PROVIDENCE SAINT JOHN’S HEALTH CENTER The emergency department sees more than 30,000 patients each year and strives to provide the best possible treatment and experience for patients. Here’s a snapshot of what makes this ER special.

21ST

22ND

STATE-OF-THE-ART CARE The emergency department is equipped with the latest

ARIZONA AVENUE

technology to handle a vast range of critical condi-

• Critical airway equipment that allows physicians superb visualization 23RD

ST JOHN’S HEALTH CENTER

tions. These include: of the airways when a patient is experiencing respiratory difficulty requiring intervention. • Arctic Sun hypothermia technology that is used to carefully and gradually lower body temperature in cases of cardiac arrest. The cooling minimizes damage to tissues that have been starved of oxygen.

COMFORT Saint John’s Health Center’s emergency room features

LOCATION

27 spacious private exam rooms with TVs, phones

Providence Saint John’s Health Center’s emergency

and Wi-Fi access. The rooms are designed to allow

room is now located on Arizona Avenue on the first

procedures to be performed at the bedside and provide patient privacy

floor of the Howard Keck Center. The ER is situated

throughout the procedure. Our patients also receive attention from

close to imaging and diagnostics and is a straight elevator ride up to

members of the award-winning Angels of the ER volunteer group. The

surgery, the cath lab and labor and delivery.

volunteers assist with patient comfort and communicating with relatives

PARKING

and the medical staff.

Having the ER’s entrance facing Arizona Avenue

PRIVACY

has also greatly improved parking. Valet parking is

Bedside registration allows emergency department

available 24 hours a day, seven days a week.

personnel to gather patient information while patients are resting in a private area, rather than waiting for

FAST TRACK TREATMENT FOR MINOR AILMENTS

assistance in the reception room.

Fast Track is designed to improve the experiences

PHYSICIAN PERFORMANCE

of emergency room patients who come in for minor

Providence Saint John’s Health Center emergency

ailments, such as a laceration or sprained ankle. These patients are

room physicians are ranked in the 94th percentile in

directed to a dedicated area where they can be treated and discharged

patient satisfaction by Press Ganey, an independent

without waiting for more complex or serious patients to be seen. The

health care consultation company that provides comparative hospital

goal is to expedite care so we can get patients in, out and home.

data nationwide.

FALL 2014 breakthroughs

in good health Introducing Marcel Loh, the Health Center’s New Chief Executive Nationally known hospital administrator Marcel Loh took the reigns in September as chief executive of Providence Saint John’s Health Center and the John Wayne Cancer Institute. Loh previously served for 14 years in executive roles with Providence affiliate Swedish Health Services, a five-hospital, not-for-profit system in greater Seattle. He holds a master’s degree in hospital administration and served as an Army officer in the Medical Service Corps, retiring from the Army Reserve as a lieutenant colonel. Loh also has been active in regional and national health care industry groups. He is the past chairman of the Washington State Hospital Association, a fellow in the American College of Healthcare Executives (ACHE) and serves on the ACHE national Board of Governors. We sat down with Loh after his first week on the job to learn more about the new chief.

What led to your interest in health care? “I knew I wanted to be in health care and, as a third-year medical technician student, realized that the business classes I was taking on the side were more intriguing to me. It was then that I found a way to put medicine and business together and knew I could still focus on a career that could help people. Health care and medicine are about the patient and improving care to the patient.”

breakthroughs FALL 2014

in good health

Did you learn anything from your

It’s been called a community

You’ve been involved with the Amer-

military experience that has helped

hospital with academic medicine.

ican College of Healthcare Executives

in your health care career?

Is that your impression?

in leadership positions. What are some

“I took a lot of lessons away from my

“Yes, and in my short time here, I would

experience in the military. People think

describe Saint John’s as a community hos-

if you’re in the military all you do is bark

pital on steroids. There is much more going

orders. But it allowed me to be in leadership

on than a typical community hospital: the

American College of Healthcare Execu-

positions and learn leadership skills much

education, the research, the John Wayne

tives, and I’m a fellow, which is considered

earlier than I normally would have. I also

Cancer Institute, and the degree of commu-

board-certification for health care leadership.

had the opportunity to serve my country.”

nity support. All of this was an added bonus,

A challenge for health care leaders today

which attracted me to Saint John’s.”

is the major pace of the change. With the

of the most pressing issues today for healthcare administrators? “I’ve been a long-time member of the

Affordable Care Act and health care reform,

What excites you the most about joining the leadership team at Providence

Do you see the John Wayne Cancer

we’re all learning what the new environment

Saint John’s Health Center?

Institute as an example of combining

looks like—with population health manage-

“I was fortunate to be part of a fact-finding

research, education and health care?

ment, challenges with reimbursement and

team exploring the possibility of adding Saint

“Yes. The John Wayne Cancer Institute

physician alignment. My association with the

John’s to the Providence Health & Services

is probably one of the most unique insti-

ACHE allows me the opportunity to not only

system. Through this process I visited with

tutes of the whole Providence system. The

speak about these challenges but to learn

about 20 to 25 physicians over a few days.

physicians and researchers have been part

from my colleagues.”

There was something special about Saint

of many firsts in cancer breakthroughs. I

John’s that I had not seen in my 30-plus years

think there is a tremendous opportunity for

in health care. It was the passion and commit-

growth, and I’m excited to be able to work

ment and loyalty of the physicians and others

with the Institute team.”

Can you tell us a little about your family? “Jane and I have been married for 36 years, and Jane has been a very active hospital volunteer. In Seattle, she volunteered at

I met. It almost gave me goose bumps. Saint John’s has this welcoming family feel I never

At Swedish Health Services, you were

the hospital one day a week and was active

have seen before. My wife Jane and I are both

involved in many innovations in health

in the fundraising of the foundation. Jane is

very excited to be joining the Saint John’s

care. Can you tell us about some of the

a retired teacher who taught both elementa-

family and being a part of the very special

projects you oversaw there?

ry education and music. We have two grown

and unique Santa Monica community. We’re

“I was the executive leader that helped

children, Ashley and Aaron. We enjoy the

develop the Swedish Neuroscience Institute

arts, music and theater and are avid boaters.

and the Swedish Heart & Vascular Institute.

I’m an avid Seattle Seahawks football fan.

What do you see as the Health

Now both are nationally recognized. I’m

Since Los Angeles doesn’t have a team, I will

Center’s strengths?

very proud of that. As I look at Saint John’s,

remain a Seahawks fan.”

humbled by the opportunity.”

“I see many strengths: the family feel,

we already offer world-class health care in

impressive physicians, a dedicated and pas-

many areas and we have all the elements to

Are you looking forward to

sionate board of directors and Foundation

expand our world class services.”

Southern California life?

board of trustees, the national recognitions

“One thing about living in Seattle is we

of quality and safety, and most of all, the

have a lot of overcast days. I’m going to

focus on the patient.”

enjoy seeing more sunshine.”

FALL 2014 breakthroughs

in good health Community Connections: Getting to Know Providence Health & Services Earlier this year, Saint John’s joined Providence Health & Services and is now part of an expansive health care network featuring six hospitals and other ancillary health services. Here’s a look at some of the resources available within the Providence network.

Providence Focuses on End-of-Life Care

Dr. Patrick Soon-Shiong to Direct Cancer Genomics Services

Providence Health & Services,

Providence Health & Services has

Southern California, is establishing

named Patrick Soon-Shiong, MD,

a center devoted to research on

as the new global director for cancer

end-of-life care and changing the

services and bioinformatics. Dr.

conversation around how to best

Soon-Shiong is a physician, surgeon

meet the needs of the dying. The

and scientist known globally for

Institute for Human Caring will

applying the limitless potential of collaborative science and technology

support patients, families and Ira Byock, MD

clinicians across the five states with

Providence facilities and will serve as a national resource. Based at Providence TrinityCare Hospice in Torrance, the Institute

Patrick Soon-Shiong, MD

to improve the health and well-

being of patients battling life-threatening disease. He will work closely with oncology clinicians and researchers at Providence and

will be led by Ira Byock, MD, as chief medical officer. Dr. Byock is a

its affiliates to ensure every member of our communities, especially

leading authority on end-of-life care. He has been recognized as a

the poor and vulnerable, has access to the latest and most promising

visionary by the Academy of Hospice and Palliative Medicine and has

cancer treatments.

received the academy’s Lifetime Achievement Award. The institute represents a major commitment by Providence to accelerate value-based and whole-person health care for frail elders and seriously ill or otherwise vulnerable patients and their families.

Genomics and molecular data represent the most innovative approach to cancer risk prevention and treatment, providing physicians with information needed to personalize cancer care. “We are living our commitment to clinicians and patients alike,”

The goals of the center include generating greater attention to the

Dr. Soon-Shiong says. “Partnering with Providence and the many

personal side of illness, dying, caregiving and grieving.

clinicians treating cancer patients across its five-state system will

“There really is a crisis in the way we die,” Dr. Byock says. “When patients are faced with a crisis and they have not discussed their

dramatically advance how we care for people facing cancer.” Dr. Soon-Shiong is a longtime supporter of the John Wayne Cancer

wishes with family and care providers, there is a tendency to bring

Institute at Providence Saint John’s Health Center. He is also the

the best medical treatment to bear without considering that there is a

chairman of the Chan Soon-Shiong Family Foundation, chair and

whole human being with personal needs.”

CEO of the Chan Soon-Shiong Institute for Advanced Health, and

Part of the institute’s mission will be to help the entire Providence system embrace the full range of end-of-life care responsibilities— including meeting the needs of family members, managing the patient’s pain and addressing the patient’s spiritual needs.

of NantHealth—a health care company that focuses on innovative technologies to improve care. Providence also is entering into a partnership to create the country’s first clinical network for whole genomic sequencing. This effort is a collaboration among Providence, NantHealth and the Chan Soon-Shiong Institute of Molecular Medicine.

breakthroughs FALL 2014

in good health

Healthful Eating

This festive salad is filling enough to serve as a side dish or dessert at your holiday dinner. Packed with fruit and nuts, it’s a delicious alternative to traditional Waldorf salad or a high-calorie dessert. Courtesy of Mary Rotolo, RD, Nutrition & Diabetes Education, Providence Saint John’s Health Center

Cranberry-Waldorf Molded Salad Serves 16 1 package sugar-free Jell-o, either cherry or cranberry (8-serving size box) 2 cups boiling water 2 cups cold water 4 cups fresh cranberries 2 large (about ¾-pound) oranges, peeled and seeded

DID YOU KNOW?

Cranberry is one of only three fruit species that are native to North America. It belongs to the same family of fruits as blueberry and bilberry, which also are plants native to North America. Juice and extracts from the fruit were used as medicine by Native Americans, and the fruit was prized as a treatment of urinary conditions. Even today, cranberry is used to prevent urinary tract infections. Scientists believe that some of the chemicals in cranberries keep bacteria from sticking to the cells that line the urinary tract where they can multiply. Source: National Institutes of Health

2 large (about ½-pound) red apples, cored 2 cups celery, chopped 1 cup chopped walnuts or almonds lettuce leaves, rinsed (optional)

Mix Jell-o with boiling water, stirring until dissolved. Add cold water. Chill until thick, about 20 minutes. Coarsely chop cranberries (a mini-food processor works great). Chop oranges, apples and celery into ¼-inch cubes. Mix fruit with thickened gelatin. Add celery and nuts. Spoon into a large, fancy glass bowl or two 5- to 6-cup Jello molds. Chill for at least 4 hours or until the next day. Serve in the bowl or un-mold onto a platter. To remove salad from mold, dip mold in warm water and wait until salad breaks away from side of mold when gently shaken, about 2 minutes. Invert serving platter on top of mold. Holding tightly together, flip mold over onto platter. Remove mold. Tuck lettuce leaves under edge of salad. Nutrients per serving: Calories: 84 Fat: 4.5 grams Carbohydrates: 10 grams Dietary fiber: 3 grams

FALL 2014 breakthroughs

in good health Clinic Specializes in Normal Pressure Hydrocephalus Providence Saint

But unlike many other diseases that

tant professor of neuroscience and neuro-

John’s Health Cen-

cause dementia, NPH can be treated

surgery at the John Wayne Cancer Institute.

ter is now home to

if caught early, with many patients

Patients receive multidisciplinary—neuro-

a clinic specifically

recovering full cognitive function.

surgery and neurology—evaluation and

devoted to the Dr. Garni Barkhoudarian

The condition occurs if the normal flow of

treatment for normal pressure hydroceph-

diagnosis, treat-

cerebrospinal fluid throughout the brain and

alus as well as other disorders. Dr. Bark-

ment and research

spinal cord is blocked in some way, such as

houdarian manages the clinic with David

of a mysterious

by a tumor, infection or hemorrhage. This

Franc, MD, a neurologist who specializes in

condition called

obstruction causes the ventricles to enlarge,

dementia and neuroimaging.

normal pressure hydrocephalus. Normal pressure hydrocephalus (NPH) is caused

putting pressure on the brain.

“We have a formalized protocol for diag-

It’s not clear how many people develop

nosis, work-up, treatment and post-surgical

by a build-up of cerebrospinal fluid in the

NPH; however it’s most common in people

evaluation, including metrics, to monitor the

crevices of the brain.

age 70 and older. With proper screening

progress of each patient,” Dr. Barkhoudarian

by their primary care physicians, patients

says. “For adult patients with hydrocephalus

with this disorder can be identified for fur-

due to lesions in the brain, such as colloid

ther evaluation.

cysts or tumors, our neuroendoscopic tech-

The condition causes dementia, difficulty walking and incontinence.

The new Adult Hydrocephalus and Neuroendoscopy Center at Providence Saint John’s Health Center will provide an objective, systematic course of treatment and follow-up. Data will be compiled to help measure and monitor progress. There are similar cen-

patients. Finally, differentiating between NPH and non-NPH conditions is critical with regards to assessing the patient and identifying the correct diagnostic and treatment pathways for each patient.” Dr. Barkhoudarian, who is also director of the skull-base and endoscopic microdissec-

demic medical centers.

tion laboratory, treats NPH patients at Prov-

The program at Provi-

idence Saint John’s, some with remarkable

dence Saint John’s will

results. There are two standard courses of

provide expertise and

treatment: the surgical placement of a shunt

research in the com-

to drain fluid to the abdomen where it can

munity, making it

be absorbed as part of the normal circula-

to be treated and return for follow-up visits. There are many advantages

tory process, or utilizing an endoscope to bypass the blockage in the brain. Treatment can help improve ambulation, memory and incontinence by decreasing the size of the brain ventricles. Regular follow-up care by a physician is important in

for patients who seek

order to identify subtle changes that might

care at a dedicat-

indicate problems with the shunt or bypass.

ed center for this condition, says Garni

breakthroughs FALL 2014

invasive methods to surgically treat these

ters, but typically at aca-

simple for patients

niques allow for appropriate and minimally

Physicians will continue to research the condition to improve their under-

Barkhoudarian, MD, a

standing of it and will follow patients to

neurosurgeon and assis-

assess outcomes.

in good health Get Healthy Santa Monica Can good health habits spread throughout a community? According to a new study, the answer is yes—and the way these health habits spread may surprise you. Previous studies suggest that environments can clearly affect poor cardiovascular health. For example, residents of neighborhoods with lots of fast-food restaurants, high crime rates and few safe parks often have increased rates of heart attacks and strokes. The new study looked at something called “neighborhood cohesion.” This measure reflects whether people feel their neighbors are trustworthy, friendly and would help them during times of trouble. The study examined data from more than 5,000 American adults and tracked their cardiovascular health for four years. The researchers found that the more social cohesion in a neighborhood, the lower the risk of having a heart attack. The association was true

Tight-knit neighborhoods, the authors wrote, may help reinforce

despite other neighborhood characteristics, such as socioeconomic

positive health behaviors and discourage negative ones. The

status and individual household social support.

research was published in the journal BMJ.

become healthier. Recent statistics from the federal

0.24

09-10

Americans need to eat more fruits and vegetables to

WHOLE FRUIT

03-04

Kids and Those Darn Vegetables

0.40

government show modest improvements in fruit

untouched on kids’ plates.

years in the United States. Between 2003 and 2010, whole fruit intake among kids increased 67% while

VEGETABLES

0.22 0.54

09-10

and Nutrition Examination Survey released every two

0.31

03-04

The study was part of the expansive National Health

09-10

decade, although vegetables are still largely sitting

FRUIT JUICE

03-04

intake among children ages 2 to 18 over the past

0.55

intake of fruit juice declined slightly. Still, 60% of

Cup equivalents per 1,000 calories

children consume fewer fruits than recommended.

Source: Vital Sings: Fruit and Vegetable Intake Among Children —United States, 2003-2010, MMWR, Vol. 63, Aug. 5, 2014.

The findings on veggies were worse. There was no change in total vegetable intake from 2003 to 2010— despite a growth of programs, including healthier school lunch programs, meant to encourage vegetable intake. About 93% of kids consume fewer vegetables than recommended. White potatoes accounted for an average of 30% of total vegetable intake over the study period and were consumed mainly as less healthy forms of potatoes, such as fried potatoes and potato chips.

FALL 2014 breakthroughs

on the horizon

HOSPITAL EVENTS

NOVEMBER—DECEMBER The Type 1 Diabetes and Insulin Pump Support Group Providence Saint John’s Health Center People with type 1 diabetes and insulin pump users are welcome at this monthly meeting of education, information sharing and discussions on managing therapies. This support group helps make living with diabetes easier. Please feel free to bring dinner or a snack. Tuesday November 25, 6:30 to 8 p.m. Tuesday December 30, 6:30 to 8 p.m. Please see information on the room location at the Health Center information desk. For more information: Dalia Dvoretsky, 310-829-8077 Childbirth Preparation Classes and Maternity Tours Providence Saint John’s Health Center

breakthroughs FALL 2014

Two-part childbirth education classes: December 2 and 9, 5:30 to 8:30 p.m. One-day class: December 6, 10 a.m. to 4 p.m. Classes meet in the Howard Keck Center, third floor. Maternity tours begin at the Howard Keck Center and are approximately two hours long: November 20 – 11 a.m. & 2 p.m. November 22 – 10 a.m. & 12:30 p.m. November 26 – 3 p.m. & 6 p.m. December 11 – 11 a.m. & 2 p.m. December 13 – 10 a.m. & 12:30 p.m. December 16 – 3 p.m. & 6 p.m. December 18 – 2 p.m. & 4 p.m. December 20 – 10 a.m. & 12:30 p.m. December 30 – 11 a.m. & 2 p.m. Three-hour breastfeeding class to help prepare expecting women: December 23, 2 to 5 p.m. Three-hour baby care class for expecting parents: December 3 – 5:30 to 8:30 p.m. December 7 – 10 a.m. to 1 p.m. December 7 – 1:30 to 4:30 p.m.

For more information or for reservations: Elsa Ruedas, 310-829-8887 or elsa.ruedas@providence.org JANUARY 31, 2015 California Hormonal and Pituitary Patient Health Symposium Loew’s Santa Monica Beach Hotel 1700 Ocean Avenue, Santa Monica, 8 a.m. to 5 p.m. The Pituitary Network Association and Saint John’s Brain Tumor

Center will sponsor a patient health symposium for people with hormonal and pituitary disorders. The day-long symposium will feature presentations by physicians as well as patients and family members. Patients will learn how to be their own best advocate in obtaining high-quality health care. Continental breakfast and lunch are included with the $30 registration fee. For more information: pituitary.org/events

on the horizon

COMMUNITY EVENTS

NOVEMBER 1 THROUGH JANUARY 22, 2015 ICE at Santa Monica 1324 5th Street, Santa Monica Enjoy beachside ice-skating during the holiday season at the ICE outdoor rink on the corner of 5th Street and Arizona Avenue. The 8,000-squarefoot rink also has a private event cabana, and beginners can sign up for skating lessons. The Grand Opening celebration will be held on November 6. For more information: 310-260-1199 or downtownsm.com/ice NOVEMBER 11 STEAM Machine Santa Monica Pier Noon to 5 p.m. The second annual event celebrating science, technology, engineering, arts and mathematics with a special Rube Goldberg machine competition on the Pier. For more information: 310-458-8901 or santamonicapier.org

NOVEMBER 22 2014 Southern California MG Walk Ocean View Park 9 a.m. to noon All ages are invited to participate in this charity walk to raise funds and awareness for Myasthenia Gravis Foundation of America. For more information: mgwalk.org DECEMBER 5 Montana Avenue Holiday Walk Montana Avenue 5 to 9 p.m. Walk Montana Avenue from 6th to 17th streets to find gifts, have your photos taken with Santa, listen to live music and indulge in great food and drinks! This annual night is a wonderful way to spend time with neighbors, friends and family. For more information: montanaave.com/event/ montana-ave-holiday-walk

DECEMBER 6 Main Street Holiday Party Main Street 6 to 9 p.m. Youâ&#x20AC;&#x2122;re invited to the Main Street Holiday Party. Following the tree lighting at the museum, take part in a candlelight walk to the famous Shopping Cart Tree at Edgemar Courtyard. For more information: mainstreetsm.com

DECEMBER 6 Santa Monica-Venice Christmas Run 2600 Barnard Way, Santa Monica 7 to 11 a.m. Come join the running community as it kicks off the holiday season at the 37th annual Christmas Run. Exhibit your brand to runners and their families before and after the race at the exclusive Finish Line Expo. Registration opens at 6 a.m., followed by the 7:30 a.m. 10K start, 9:30 a.m. 5K start and 10:30 a.m. Kids Fun Run start. For more information: christmasrun.com JANUARY 17, 2015 Lei-Out Beach Ultimate Frisbee Tournament Central Beach 9 a.m. to 5 p.m. The 16th annual co-ed Lei-Out Tournament will feature top beach volleyball players representing more than 200 teams. For more information: leiout.com

FALL 2014 breakthroughs

PIONEERS in Heart Care Cardiovascular disease still affects many Americans, but the doctors at Providence Saint John’s are at the forefront of treatment and research. Written by SHARI ROAN

e are a nation of heart disease.

to better imaging to new implantable devic-

warfarin, but about half of all patients are

That’s been true for many

es, the Health Center is home to a number of

not able to control their abnormal heart

decades, and with high rates of

leaders in cardiology. Here’s a look at some

rhythms with drugs or can’t tolerate the

of the recent advances.

side effects. Warfarin lowers stroke risk, but

obesity, it will continue to be a fact for years to come. Yet deaths from heart disease and

blood levels of the drug must be frequent-

strokes in the United States have fallen, and

THE WATCHMAN DEVICE

ly monitored because they can be easily

patients today generally suffer less disability

FOR ATRIAL FIBRILLATION

thrown off by foods and other medications.

and discomfort from heart disease than in

Atrial fibrillation, or A-fib—a heart rhythm

previous generations.

abnormality affecting 6 million Americans—

obvious disadvantage—they increase the

occurs when the heart beats erratically. That

risk of bleeding, posing a particular problem

pitals for Cardiac Care™ for the past four

can lead blood to clot in the heart’s left atrial

as people age and the risk of falls increases.

years by Healthgrades™, Providence Saint

appendage. The condition is progressive

“We’re stuck in a difficult position with el-

John’s Health Center’s cardiovascular health

and, if untreated, can lead to chronic fatigue,

derly patients,” says Shephal K. Doshi, MD,

team is leading the way in improving lon-

congestive heart failure and stroke.

director of cardiac electrophysiology and

Ranked among America’s 100 Best Hos-

gevity and quality of life for patients. From new minimally invasive surgical techniques 16

breakthroughs FALL 2014

Patients can be treated successfully with medications, such as the blood thinner

Blood thinners also have another more

pacing at Providence Saint John’s Health Center. “It’s a catch-22.”

Pioneers in Heart Care The Watchman device is an expandable metal cage that looks like a parachute. It’s

cause heart rhythm disorders.

surgery. Endovascular surgical techniques

The Thermocool catheter enables doctors

used for arterial occlusive disorders include

guided through a catheter inserted into a

to more accurately control the amount

catheter-based treatments that require only

vein in the leg to the atrium to block the

of force applied to the heart wall during

puncture wounds and spare the patient from

appendage so blood can’t collect and clot.

radiofrequency ablation procedures, thus

an open surgery requiring large incisions.

Older patients with A-fib who take blood

improving safety and efficacy.

thinners are ideal candidates for the Watchman device.

“With endovascular repair, the risks

“Consistent and stable application of

of treatment have gone down,” Dr. Rao

contact force against the heart wall has been

explains. “In the past, these patients had to

demonstrated to have a significant impact

manage with bigger surgeries, and there was

reduce the risk of stroke so people don’t

on patient outcomes during catheter abla-

a higher risk with those open surgeries. But

have to take blood thinners,” says Dr. Doshi,

tion,” says Dr. Doshi. “Without this technol-

now that we can do it minimally invasively,

who was a pioneer in using the device in

ogy, doctors have to estimate the amount of

we can try to treat these patients instead of

the United States and worldwide. “The data

force being applied to the heart wall through

managing it with medication alone.”

show that the Watchman was better than

other indirect measures that have been

warfarin in reducing stroke and improving

shown not to be as effective.”

“It offers a way to seal off this pouch and

Dr. Rao and his colleagues can also treat peripheral aneurisms—a weak area of a

survival. Patients get the benefit of blood thinners without the risk of bleeding.” Dr. Doshi spearheaded the trial at Providence Saint John’s and has performed around 300 Watchman procedures—more than anyone in the United States. Although the Watchman does not have the Food and Drug Administration’s approval yet, it could come soon. An advisory committee already has voted in its favor. Once approved, the

Peter Pelikan, MD

Nicole Weinberg, MD

Shephal K. Doshi, MD

device will likely be covered by Medicare. THERMOCOOL

MINIMALLY INVASIVE TREATMENT

blood vessel that expands or bulges—with a

The Health Center recently became the first

FOR PERIPHERAL VASCULAR

minimally invasive technique called periph-

hospital in Southern California to offer the

DISEASE—INTRODUCING TAVR

eral endovascular aortic repair.

Thermocool Smarttouch Catheter, the first

Peripheral arterial disease is a type of

catheter approved by the FDA to feature

cardiovascular disease that causes restricted

would have been told they were not surgical

direct contact force technology for the treat-

blood flow due to obstructions in the

candidates at all,” Dr. Rao says. “Now we

ment of atrial fibrillation.

arteries and veins of the legs. It affects more

can treat them with minimal risk, and most

han 8.5 million Americans. Today, however,

can be treated as an outpatient. That’s a big

treatment for atrial fibrillation. Doctors

a number of surgical advances have made

advance. The need for a big hospitalization

insert a catheter through a small incision in

treatment of arterial occlusive disease easier

and major recovery are a thing of the past.”

the groin, which is then guided to the heart

than ever, says Rajeev Rao, MD, a vascular/

through a blood vessel. Once it reaches

endovascular surgeon at Providence Saint

MINIMALLY INVASIVE HEART

the left upper chamber of the heart—the

John’s Health Center.

VALVE REPLACEMENT

Catheter ablation is a minimally invasive

atrium—the catheter delivers radiofrequen-

Doctors are using minimally invasive

“Especially with aneurisms, these patients

The Health Center’s valve clinic has in-

cy energy to the heart wall to create lesions

endovascular techniques to treat these

troduced a new type of valve replacement

that block faulty electrical impulses that can

conditions, sparing patients from open

called transvascular aortic valve replaceFALL 2014 breakthroughs

Pioneers in Heart Care ment (TAVR). This minimally invasive pro-

lab and an operating room and is equipped

tions, such as coronary microvascular

cedure involves repairing a damaged valve

with the advanced medical imaging devices

disease, are more common in women than

without removing it.

required to perform minimally invasive

in men.

To perform TAVR, surgeons place a

cardiac procedures.

collapsible replacement valve through a

“The message is out there that heart disease is a leading cause of death among

catheter into the old valve, similar to placing

SPECIALIZED CARDIAC CARE

women, but I don’t think women realize the

a stent in an artery. Once the new valve is

FOR WOMEN

magnitude of it,” says Nicole Weinberg, MD,

expanded, the old valve is crushed out of the

Providence Saint John’s Health Center has

a cardiologist who specializes in women at

way and the new valve takes over the job of

specialists dedicated to treating women with

the Pacific Heart Institute in Santa Monica.

regulating blood flow.

cardiovascular disease. Heart disease is the

“It kills more women than all of the cancers

leading cause of death for both men and

combined and has some insidious disease

sternum and putting the patient on a heart-

women, according to the American Heart

states associated with it that can be ex-

lung machine, and thus completely stopping

Association. However, women often experi-

tremely risky.”

the heart, while surgeons replace the faulty

ence different symptoms than men.

Traditional surgery requires opening the

valve with an artificial one.

Heart disease often develops in women

For example, instead of chest pain and

about 10 years later than men. But women

pressure—one of the traditional symptoms

whose fathers or brothers have been diag-

says Peter Pelikan, MD, medical director of

of a heart attack—women may experience

nosed can take advantage of that informa-

Saint John’s Cardiac Catheterization Lab-

shortness of breath, pressure or pain in the

tion to prevent problems linked to heredi-

oratory. “Valves are put in either through

lower chest or upper abdomen, lighthead-

tary forms of the disease. All women should

an artery in the groin or a small incision in

edness, upper back pressure or extreme

understand that their risk for heart disease

the chest. The heart keeps beating, and the

fatigue. Moreover, some heart condi-

rises after menopause.

“TAVR is far less stressful for the patient,”

patient avoids all the trauma of opening the chest and cardiopulmonary bypass.” In addition to suffering less pain, patients typically experience a quicker and easier recovery. Carefully selected candidates for the procedure are people for whom open-heart surgery is too risky, generally older patients. To properly assess prospective patients,

“We educate women about hormone

TAVR is far less stressful for the patient.”

changes and what that means,” she says. “We talk to them about why they are OK for now but that they can’t just wait for a problem to come along. You want to attack their risk factors head-on." Women often benefit from seeking cardiac care with a specialist in women’s health,

the hospital is laying the groundwork for

says Dr. Weinberg, who is board-certified in

a multi-specialty valve clinic. The clinic

echocardiography and nuclear cardiology.

will allow “one-stop shopping,” Dr. Pelikan

“We don’t feel like we do cookie-cutter

says. Patients will be evaluated by differ-

cardiology,” she says. “We take the time to

ent practitioners—cardiologists, surgeons,

sift through a patient’s very specific issues

nurse practitioners—and receive needed

and figure out if there is a test for them that

tests, including ultrasounds of the heart

meets their needs or find an explanation for

and CT scans.

something that may be happening. We feel

Importantly, the clinic will allow pa-

we are able to sift through a lot of the minu-

tients with valve disease to be assessed

tia to get to the root of the patient’s issues.”

over time—and treated appropriately. The plan for a multi-specialty valve clinic also

STEMI

calls for a hybrid operating room, which

The Health Center is part of the STEMI

combines the functions of a catheterization

Program—a nationwide initiative developed

breakthroughs FALL 2014

Pioneers in Heart Care by the American College of Cardiology and

the coronary artery is completely blocked.

the American Heart Association to improve

The program is a collaboration among

the treatment of patients with symptoms of

hospital emergency departments, cardiolo-

The Health Center was named one of the

a heart attack. STEMI is an acronym for ST

gists and paramedics to ensure that patients

top 14 hospitals in California for outstanding

segment elevation myocardial infarction, a

experiencing STEMIs are diagnosed, trans-

heart attack outcomes by the Office of State-

severe type of heart attack that occurs when

ported and treated quickly. The patient is

wide Health Planning and Development.

received in the emergency room and transported to a team waiting in the cath lab.

CHANGE OF HEART

BY THE NUMBERS

WHO’S AT RISK

600,000 Annual U.S. deaths from heart disease

$108.9 BILLION Annual cost in health care, medications and lost productivity from heart disease

92%

Americans who recognize chest pain as a symptom of heart attack

U.S. deaths attributed to stroke

1 IN 19 Americans aware of all the major symptoms of a heart attack

27%

Stroke is the leading cause of serious longterm disability

47%

Rate of sudden cardiac deaths that occur outside a hospital

About half of all Americans have at least one of three key risk factors for cardiovascular disease. Other medical conditions and lifestyle factors also can put people at higher risk of heart disease. Key risk factors: • High blood pressure • High LDL cholesterol • Smoking Other risk factors: • Diabetes • Overweight or obesity • Poor diet • Physical inactivity • Excessive alcohol use Source: Centers for Disease Control and Prevention

Source: Centers for Disease Control and Prevention

DID YOU KNOW?

Lifestyle factors have an enormous impact on heart disease. The landmark National Health and Nutrition Examination Survey III Mortality Study, published in 2011, examined the impact of four lifestyle factors in reducing death from cardiovascular disease. People who had these four behaviors had a 65% reduced risk of death from cardiovascular disease: healthy diet, adequate physical activity, never smoked and moderate alcohol consumption.

HEART DISEASE IS THE LEADING CAUSE OF DEATH FOR PEOPLE OF MOST ETHNICITIES IN THE UNITED STATES. African-Americans American Indians or Alaska Natives

24.5% 18.0%

Asians or Pacific Islanders Hispanics

23.2% 20.8%

Whites

25.1%

All

25.0%

Source: Ford ES, Zhao G, Tsai J, Li C. Am J Public Health. 2011 Oct;101(10):1922-9. Source: Centers for Disease Control and Prevention

FALL 2014 breakthroughs

profiles in health

Cameron Hall, a longtime member of the insulin-dependent dtiabetes support group (left) and Dalia Dvoretsky, RD

Lean on Me Members of an insulin therapy support group find help and camaraderie. Written by ZOE SOPHOS | Photographed by REMY HAYNES

aution, concern and constant vigilance are realities of ev-

Feeling connected and being supported is more important than ever

eryday life for individuals living with type 1 diabetes or who

in our high-tech world.”

depend on insulin pump therapy. One Thursday evening

Unlike type 2 diabetes, type 1 cannot be prevented and is most

each month, Providence Saint John’s Health Center hosts a special

commonly diagnosed in adolescents rather than in adults. Individu-

support group for these patients, providing comfort and common

als with type 1 diabetes are completely unable to produce their own

ground amid their daily struggle.

insulin, a hormone responsible for regulating sugar and energy lev-

“This support group provides an opportunity for patients to foster new relationships with others who may share the same concerns and struggles,” says Dalia Dvoretsky, RD, coordinator of nutrition and

els. Without insulin, the body cannot absorb glucose—energy stored in food—and the patient’s cells quickly starve. Individuals with type 1 diabetes combat this deficiency by giving

diabetes education at the Health Center. “It’s meant to empower and

themselves insulin, either through injections administered through-

encourage patients to manage their diabetes while promoting health.

out the day or through an electronic pump that provides the body

breakthroughs FALL 2014

profiles in health with a continuous supply of insulin. Some people with type 2 diabetes find more flexibility using insulin pump therapy and are welcome to join the group. Because the body’s response to insulin varies based on a number of factors, including food, exercise, stress and emotions, knowing exactly how much insulin to take at a given time can be a challenge. Every hour of the day, patients must perform a complicated balancing act with their immediate and long-term health at stake. “Diabetes has the ability to really dictate your lifestyle from beginning to end,” says Cameron Hall, a member of the support group since its inception and a patient at the Health Center for nearly four decades. “You can find yourself having a lovely day, but you may have forgotten to eat, and all of a sud-

sleeping, highs and lows of the day, stress,

No matter how many or how few people

den you’re having a hypoglycemic incident

and the fact that you cannot ever be without

show up on Thursday nights, the meetings

where your blood sugar level drops. You are

your insulin supplies because a disaster or

still go forward. Hall attributes the longevity

literally unable to function properly, and it

accident could occur,” Hall says. “These are

of the support group—nearly eight years—to

puts you at a serious disadvantage.”

people who are experiencing the same things

this type of dedication and attention to the needs of patients.

These are people who are experiencing the same things you are. It makes you very comfortable to know that it’s not just you.” All type 1 diabetes patients who use traditional insulin injections, as well as all

“We will provide continuing education so that patients can learn about different aspects of managing diabetes—from new products on the market to carbohydrate counting

you are. It makes you very comfortable to

that’s specific to type 1,” Dvoretsky explains.

know that it’s not just you.”

“The group is growing, and we are inviting

patients with either type of diabetes who

At these regular meetings, patients can

people from the community to check it out.

use insulin pump therapy, are welcome to

bring their questions, problems and feelings

The fact that the group has been around for

attend the two-hour-long meetings. Partic-

to people who will understand. “They live

so long means it works.”

ipants include men and women, ages of 17

with diabetes day in and day out. They only

and 70. While their perspectives are unique,

see the physician every few months,” says

these patients are united in their common

Dvoretsky. “It’s good to know what other

Thursday each month, but the schedule can

concerns and their determination to live life

people are doing and not feel isolated.”

vary during the holiday season. For more

The support group typically meets the last

In addition to providing a forum for open

information on this support group for peo-

“We’ve talked about exercise, eating

discussion, the Health Center also brings in

ple with type 1 diabetes and those who use

during the holidays, preparing to travel

guest speakers such as nutritionists, physi-

insulin pumps, contact 310-829-8077.

either domestically or internationally,

cians or diabetes device representatives.

to the fullest.

FALL 2014 breakthroughs

GAINING GROUND ON LUNG CANCER

Advances in both screening and surgery can mean much-improved odds for those with this devastating cancer. Written by LORIE A. PARCH

irst the bad news: Lung cancer is

cancer. (Secondhand smoke, though, can be

ly,” says Ali Mahtabifard, MD, a thoracic

still a really big killer. It’s the #1

an important risk factor as well, particular-

surgeon at the Health Center. “A lot of those

cause of cancer deaths in the world.

ly if your parents smoked indoors when you

patients don’t even see a thoracic surgeon

were young.)

like myself because it’s already too late.”

“Lung cancer deaths exceed those of

breast, colon and prostate cancers com-

However, “Smoking cessation doesn’t

bined,” says Clark Fuller, MD, a thoracic

make you immune,” notes Dr. Fuller. “The

Dr. Mahtabifard, most malignancies don’t

surgeon at Providence Saint John’s Health

latency period between stopping smoking

produce any obvious symptoms, so they’re

Center. “It also used to be a disease almost

and the appearance of a first cancer is about

found by accident. “Someone may cough

entirely of men; that’s completely untrue

15 to 20 years.”

or see a doctor for an unrelated reason,

now. Women now exceed men in new cases of lung cancer.”

Like any kind of cancer, the earlier you

To make matters more complicated, says

and they get an X-ray and the doctor says,

detect it, the better your odds of survival.

‘We saw this on your X-ray.’ They may pick

That’s the main reason that survival rates

up lesions on your lung that turn out to be

among men has dropped 21% over the last

remain so poor for this type of cancer. More

lung cancer.”

35 years, it’s jumped 116% among women,

than half of people die within a year of

reports the American Lung Association.

being diagnosed; we’re simply catching the

the bright side is getting brighter all the

Stopping smoking—or not starting—

great majority of cases far too late.

time. For starters, there’s now a significant-

While the death rate from lung cancer

remains the single best thing you can do to avoid developing this often devastating 22

breakthroughs FALL 2014

“Most lung cancers are found in the late stages—Stage III or Stage IV unfortunate-

So if that’s the dark side of lung cancer,

ly better way to screen for this cancer. “The lungs are a part of the body that’s

Gaining Ground on Lung Cancer not easily examined, and a chest X-ray

a minimally invasive surgery that has

going to do, and this is the order that we’re

gives a false sense of security,” because it’s

numerous benefits for patients.

going to do it in.’ That takes a lot of the fear

not very accurate at detecting lung cancer,

“We can now do the exact same operation

says Dr. Fuller. But the recent introduction

through three little incisions,” Dr. Fuller

of low-dose CT screening, which allows

says. “The hospital stay is cut down by

for multiple, highly detailed images of the

one-third, and recovery and return-to-work

chest using minimal radiation, should help

times are greatly accelerated. So it has truly

improve doctors’ ability to find lung cancer

changed the landscape.”

much sooner, when it’s far more curable.

During a VATS procedure—currently per-

“The results of recent studies show that

formed in only about one-third of hospitals

low-dose CT scans may reduce deaths due

in the U.S., including the Health Center—a

to lung cancer by 20%” among current and

thoracic surgeon uses a tiny camera to

heavy former smokers, adds Dr. Fuller.

obtain a better, more detailed, view of the

“This is probably going to represent our

chest and lungs when removing the cancer.

main weapon in the arsenal to shift that

“It’s like arthroscopic surgery, but it’s in

paradigm to earlier detection and thus

the chest. So if someone needs radiation or

better outcomes.”

chemotherapy after surgery, they also get

When lung cancer is caught at its earliest

to that faster because they recover from the

stage (when it’s still just in the lungs), the

operation faster,” adds Dr. Mahtabifard,

five-year survival rate is nearly 75%—a vast

who is co-author of a leading medical text-

improvement over the 4% survival rate

book on VATS.

when the cancer is diagnosed at its most

Lung cancer surgery at the Health Center

advanced stage. Lung cancer surgery is

can also be done with the help of robotics,

improving as well.

adds Dr. Fuller, who came to Saint John’s

Traditionally, an operation required a

in 2010 and has been doing robot-assisted surgery for a couple of years.

The lungs are a part of the body that’s not easily examined, and a chest X-ray gives a false sense of security.”

ization, instrumentation and accessibility

large incision called a thoracotomy that

VATS, this surgery offers a shorter hospital-

meant cutting through muscle and spread-

ization, lower risk of complications and an

ing the ribs, explains Dr. Fuller. “Then the

earlier return to full function.”

“Surgical robots used to fill a room, and now they’re much smaller and the visualhave been dramatically improved,” he says. “It’s becoming a useful adjunct to chest surgery at Saint John’s as well, and as with

patient would spend six months recovering

Such big improvements in surgery can

from that. It’s a big deal; it’s the most pain-

go a long way toward making a diagnosis of

ful incision we do in medicine.”

lung cancer less overwhelming for patients.

Quite a few patients would end up with

“My experience is that it’s not so much

post-operative pneumonia, he adds, further

cancer that people are frightened of; it’s

lengthening their recovery time. Now,

what’s going to happen next,” Dr. Fuller

though, there’s a procedure called video-as-

says. “When a hospital has a good lung

sisted thoracic surgery (nicknamed VATS),

program, you can say, ‘This is what we’re

out of it and people take encouragement from that.”

Should You Be Screened for Lung Cancer? Catching lung cancer early is the key to survival, and now there is a reliable way to do just that. In 2011 a landmark study called the National Lung Screening Trial was published, showing people at high risk for developing lung cancer who got low-dose CT had a 20% lower chance of dying from the disease than high-risk individuals who got chest X-rays. According to December 2013 guidelines from the U.S. Preventive Services Task Force, you should be screened annually for lung cancer with a low-dose CT scan if: you’re between the ages of 55 and 80 and are a current smoker; have quit smoking in the past 15 years; or have a 30-pack-year smoking history. (Pack years are computed by multiplying the number of packs of cigarettes you smoked per day by the number of years you smoked. So if you smoked three packs per day for 10 years, that would equal 30 pack years.) Right now Medicare and most insurance companies don’t cover screening, so you will likely have to pay out-of-pocket for the test. However, a decision on Medicare reimbursement is expected soon. Low-dose CT scanning to screen for lung cancer is available at Providence Saint John’s Health Center. For more information call: 310-829-8000, option 2. November is Lung Cancer Awareness Month. To find out more about screening, smoking cessation and other types of lung disease, go to the American Lung Association at lung.org.

FALL 2014 breakthroughs

Emma Register (right) and Karen Register

profiles in health

A FAMILY VALUE Seventeen years after Karen gave birth to Emma, both return to the Health Center to serve others. Written by ZOE SOPHOS Photographed by LAUREN PRESSEY

aren and Peter Register of Santa Monica brought their two children, Emma and John, into the world at Saint John’s Health Center. Today, nearly two decades later, Karen and

Emma are right back where they started—but this time as hospital volunteers. “I knew immediately that Karen and Emma were special,” says Grenda Pearlman, director of volunteer services at the Health Center. “They are warm, genuine and friendly. We are really blessed to have them here.”

breakthroughs FALL 2014

profiles in health Inspired by Karen’s younger sister, who volunteered as a candy striper in the 1970s, Emma attended a volunteer meeting at the Health Center in September 2013, hoping to get involved. Even

itates to go above and beyond to meet the needs of people who approach the Information Desk.” Just like her mother, Emma also goes above and beyond as

though she had already fulfilled her high school’s volunteer

a volunteer in the postpartum unit. Her responsibilities in-

requirement, the 11th-grader was considering a career in health

clude passing out hats and booties, making name bracelets and

care and enjoyed working with people. She thought the Health

checking on new moms. The nurses who work with Emma are

Center might be a good fit.

most impressed by her ability to read people and quickly size up

Karen accompanied Emma to the meeting, but once she got to the hospital and listened to Pearlman’s presentation, something

any situation—skills that help keep the patients comfortable and content, Pearlman notes.

clicked. “It was like a lightbulb going off,” Karen says. “I had this ‘ah-ha’ moment, and I thought, ‘Wow, this sounds amazing.’ I asked Grenda if she could put me down as a volunteer, too, and it just snowballed from there.” The mother-daughter duo soon after received their assignments: Emma in the postpartum unit and Karen as a greeter at the front desk. Even though they don’t work together directly, they received training for each other’s roles so they can cover for one another in a pinch. “It’s something we can bond over,” says Emma. “I think it’s a nice time to set apart where my mom can help me or I can help her.” Karen agrees that there is something special about volunteering with her daughter. “A lot of folks are surprised that we volunteer together. It’s rare to find a 17-year-old and her mom doing that. It’s nice that Emma sort of puts up with me,” she says, laughing. “The times that we do overlap, it’s really fun.” Together, mother and daughter make a one-of-a-kind team, but it’s their unique personalities that make them ideal volunteers. As the first person who patients and family members see when they enter the Health Center, Karen plays a key role in directing individuals to the proper place. She volunteers one morning a week and sometimes works with up to 200 people over the course of her four-hour shift.

It’s something we can bond over.”

“It’s very busy, which I love, and it’s all about helping people figure out where they need to be and calming their nerves,” Karen

“I’m learning how to approach people, and it’s definitely helped

says. “You feel like you made a lot of people’s visits better just by

my conversational skills,” Emma says. “I think the reason the moms

being there.”

enjoy it here is the same reason I enjoy it: the all-around vibe that

Pearlman emphasizes the positive role Karen plays at the Health Center’s Information Desk, a job she does with just the

you get from the people who work at the Health Center.” For Karen and Emma, the Health Center and the people who

right mix of kindness, patience and empathy. “Karen’s warm

work there will always be an important part of their lives. “I feel

smile and greeting are a treat for all who enter the Health Center.

like I get so much more out of volunteering than the hospital

She happily escorts visitors to their destinations and never hes-

does for having me there,” Karen says. “It’s very rewarding.”

FALL 2014 breakthroughs

The

Big

Hurt

Rheumatologists have answers for the aches of arthritis. Written by DAWN HOFFMAN | Photgraphed by MICHAEL NEVEUX

When Aimee Bower’s feet started hurting during her recreational hikes in the fall of 1999, she didn’t take it too seriously–and neither did her primary care physician. She was diagnosed with metatarsalgia, a sports-related condition marked by inflammation in the balls of the feet. Her doctor said the pain would go away with the help of foot soaks, well-padded shoes and some Advil. But over the next few months the pain spread far beyond Bower’s feet, to her knees, arms, elbows, shoulders, fingers and jaw. “My symptoms were just getting worse and worse,” says Bower, 44, of Venice, who works in data analysis. “Everything was hurting. I couldn’t turn the key in my car ignition. I couldn’t walk upstairs. It hurt to lift my arms to wash my hair. It hurt just to roll over in bed. It was very scary and extremely painful.” Bower didn’t get any relief until the following spring when, due to the severity of her symptoms, she finally was referred to Orrin M. Troum, MD, a rheumatologist at Providence Saint John’s Health Center. He immediately began treating Bower for rheumatoid arthritis, an autoimmune condition that attacks the joints and affects an estimated 1.5 million Americans, mostly women. The disease usually strikes between the ages of 40 and 60, but it can appear in people of all ages, even children, according to the Arthritis Foundation. If not detected early, rheumatoid arthritis can be an extremely painful and debilitating condition. Without treatment, patients have a 50% chance of total disability within 10 years, says Dr. Troum, who is a member of the Doctors of Saint John’s medical group. But through early diagnosis and proper care with the range of effective tools and powerful treatments available today, patients like Bower can maintain active, healthy lives with remarkably little or no pain. Overall, the prognosis for today’s patients getting the standard of care is excellent, Dr. Troum says. “My goal as a doctor is to get all of my patients in remission or at the point of

breakthroughs FALL 2014

FALL 2014 breakthroughs

The Big Hurt

low disease activity.” Much to her pleasure, Bower is now back to hiking and more. “I can go play volleyball on the beach for hours and go backpacking too,” she says. “I’m as active as I’ve ever been, with no pain or impairment.” It’s critical for people who suspect a joint problem to seek early treatment with a rheumatologist. Many people make the mistake of brushing off recurring aches, pains and joint stiffness, especially those that occur in the mornings, as mere annoyances that simply will go away on their own. “Recognize that it’s not just a little stiffness or a little arthritis,” Dr. Troum says. And make sure your doctor isn’t hastily ruling out more serious issues either. “Don’t let your symptoms be dismissed.” The pain and suffering of rheumatoid arthritis results when the immune system goes haywire and starts attacking the synovium, the thin membrane that lines the joints. No one knows the cause of rheumatoid arthritis, though doctors suspect that genetics plays a role, as well as smoking and poor dental hygiene. When the joints are attacked, fluid can build up and cause pain, inflammation and swelling, progressively damaging the cartilage and bone, decreasing mobility and potentially causing joint deformities. In some patients, symptoms may periodically improve, with periods of mild disease activity followed by “flares” of increased disease activity and more symptoms. Eventually, poorly controlled disease can affect other areas besides joints, including the heart, lungs and skin. The ultimate goal with treatment is to eliminate disease activity or reduce it to very low levels. Thankfully, physicians now have

breakthroughs FALL 2014

The Big Hurt

an arsenal of medications to help do just

tenderness or any problems,” she says.

their disease progression. In the past, doctors

that, including newer medications called

Like many patients, Bower initially used

have used X-rays to view joint damage.

disease-modifying antirheumatic drugs, or

nonsteroidal anti-inflammatory drugs

But X-rays aren’t as good at revealing all of

DMARDs, that inhibit inflammation and

and the corticosteroid prednisone to help

the signs of rheumatoid arthritis—such as

work to alter the course of the disease and

control joint inflammation.

inflammation and bone erosion—compared to

prevent joint destruction.

Over the years, she also found that Iyengar

For the last few years, Bower has been in

ultrasounds and MRI, and additionally expose

yoga has helped. “It felt good, especially in

patients to a small amount of radiation, notes

remission while on a treatment regimen of

the beginning when I was really in a lot of

Dr. Troum.

methotrexate, a DMARD, and etanercept

pain,” she says. “It just felt good to stretch

(brand name Enbrel), a drug in a subset

and do something healthy for myself.”

of DMARDs called biologic response

Along with the introduction of the powerful

Dr. Troum, current president of The International Society for Musculoskeletal Imaging in Rheumatology (ISEMIR), is a

modifiers, or biologics. Bower also takes fish

disease-modifying medications for rheumatoid

big advocate of the newer imaging scans for

oil supplements for their purported anti-

arthritis, doctors today also are using newer

rheumatoid arthritis treatment, especially

inflammatory properties.

imaging technologies to better assess the

in the early stages. Ultrasound and MRI

health of joints in order to specifically tailor

imaging show how active the disease is in a

treatments to individual patients and monitor

patient and how much damage has occurred,

She couldn’t be happier with her treatment results. “I feel fine, with no pain,

FACTS ABOUT RHEUMATOID ARTHRITIS

1.5 million

Nearly Americans have RA.

The disease affects nearly three times as many women as men.

RA usually develops between the

ages

of and in women and later in life in men.

severity of RA can vary widely among individuals. The

no cure

There is for , but there are many medications that help ease symptoms.

Early diagnosis

is important to prevent joint damage.

HOW RHEUMATOID ARTHRITIS ATTACKS JOINTS (1) The ends of the bones in the joints are covered by a tough, elastic tissue called cartilage. A capsule surrounding each joint is lined with a type of tissue called synovium, which produces synovial fluid, a clear substance that lubricates and nourishes the cartilage and bones inside the joint capsule. (2) Rheumatoid arthritis is an autoimmune disease which means the immune system, that normally helps protect the body from infection and disease, attacks joint tissues for unknown reasons. White blood cells travel to the synovium and cause inflammation. The synovium thickens and makes the joint swollen, painful and sometimes warm to the touch. (3) As rheumatoid arthritis progresses, the inflamed synovium invades and destroys the cartilage and bone within the joint. The surrounding muscles, ligaments and tendons that support and stabilize the joint become weak and unable to work normally.

Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases FALL 2014 breakthroughs

The Big Hurt

Recognize that it’s not just a little stiffness or a little arthritis,” Dr. Troum says. And make sure your doctor isn’t hastily ruling out more serious issues either. “Don’t let your symptoms be dismissed.”

says Dr. Troum, who has published review

rheumatoid arthritis, Bower is very thankful

articles on the subject. When doctors see

that she found the care she needed with Dr.

the extent of the disease, they can better

Troum at the Health Center.

determine whether medications are working and how aggressive to be with future

and scared and wondering, ‘What’s wrong

treatments, he says.

with me?’” Bower says. “I would go online

In a study published last year in the

tears reading about people being completely

instance, Dr. Troum and his colleagues

debilitated. I feel so fortunate to have Dr.

used MRI to gauge the effectiveness of the

Troum as my doctor. He’s provided such

biologic drug tocilizumab (Actemra). The

good care and is so kind. I feel incredibly

MRIs reliably revealed reductions in joint

lucky and grateful to have him as my

inflammation and bone erosion that would

rheumatologist.”

Unlike ultrasounds, MRIs can look

breakthroughs FALL 2014

Dr. Troum says top-notch care is the standard for all patients at the Health

inside bone to reveal inflammation that can

Center. That’s why in addition to being on

lead to bony erosions. But MRIs also are

the medical staff since 1986, he’s a patient

more expensive and may not be as readily

there, too—with his own personal doctors

available to rheumatologists, Dr. Troum

on staff.

notes. Both ultrasounds and MRIs can play

and get information, and I would end up in

Annals of the Rheumatic Diseases, for

not have been seen on X-ray.

Orrin M. Troum, MD

“When I was first diagnosed, I was in pain

“The patient care here is superior,” says

an important role in helping patients get

Dr. Troum. “It’s a very unique hospital.

their disease under control and their lives on

The vast majority of the physicians have

track again. Patients should ask their doctors

been trained locally at USC or UCLA.

about the need for imaging scans, he advises.

It’s an extremely high level of care for a

Looking back at her early struggles with

private hospital.”

happenings Providence Mission and Values Dedication Ceremony A ceremony to unveil and bless the core values and Mission of Providence Health & Services was held September 23 in the Tarble Atrium. Providence Health & Services assumed sponsorship of Saint John’s Health Center earlier this year, and the ceremony was conducted for the Health Center staff to formally accept and adhere to the Providence Mission and values. New Chief Executive Marcel Loh participated in the dedication by singing “You’ll Never Walk Alone.” The day was part of Mission Week, which included a Living Our Values picnic for all caregivers and Health Center employees and a Table of the King day where soup and salad was provided free of charge to all Health Center staff and visitors.

FALL 2014 breakthroughs

happenings Your Heart and Stayin’ Alive The Health Center hosted the Your Heart and Stayin’ Alive CPR training event September 7. The Santa Monica Fire Department, Bowers Ambulance and Health Center physicians and staff participated in the education and training of the 160 attendees in compression-only CPR. John M. Robertson, MD, medical director of cardiothor-acic surgery, moderated the event and served as honorary chair. Heart health educational sessions were given by Providence Saint John’s cardiologists Nicole Weinberg, MD, and Shephal Doshi, MD. Chief Jeffrey Furrows of the Santa Monica Fire Department presented information about the need to call 911 immediately when a cardiac event is suspected and to begin CPR if the person is in cardiac arrest. Survivors of cardiac arrest and family members celebrated life with remarkable accounts of heroic efforts and the power of prayer. Supported by Saint John’s Health Center Foundation, this program was planned for Grandparents Day to encourage the entire family to attend and learn compression-only CPR.

Front row, from left: Ryan Sevy, a cardiac arrest survivor; Peter Pelikan, MD; Russ Kino, MD; battalion chief Michael McElvaney; John M. Robertson, MD; Robert Klein; Sister Maureen Craig, SCL; Nicole Weinberg, MD; Irene Bristol, RN; battalion chief Jeffrey Furrows; Debbie Licht, RN; Jeff Arnett, a cardiac arrest survivor.

Dr. Russ Kino on Larry King Now Russ Kino, MD, director of emergency services, appeared on the Larry King Now show on October 11 to discuss how hospitals can prepare for patients possibly infected with the Ebola virus and the precautions and training he helped implement at Providence Saint John’s.

breakthroughs FALL 2014

happenings

NICU Reunion After caring for an ill or premature baby for many days, weeks or months, it can be hard for caregivers and families to say good-bye to each other. The biannual Neonatal Intensive Care United (NICU) reunion allows doctors, nurses, parents and babies to become reacquainted. The NICU reunion was held on September 26 at the Health Center and featured a festive afternoon of music, crafts, food and clowns. Members of the Fancy Fleet Dance Studio performed, as did magician Mark Paskell.

Avon Walk for Breast Cancer Staff members of the Health Center and the John Wayne Cancer Institute participated in the 12th annual Avon Walk for Breast Cancer on September 6â&#x20AC;&#x201C;7 in Santa Barbara. A portion of the proceeds helps support innovative breast cancer research at the Institute. At the closing ceremonies, Avon Walk leaders announced that Delphine Lee, MD, PhD, director of translational immunology at the Institute, will receive funding for a study to investigate microbial communities in the breast ducts of women. Microbes and chronic inflammation have been linked to some cancers, and Dr. Leeâ&#x20AC;&#x2122;s group has evidence of specific viruses or bacteria associated with breast cancer. In collaboration with Maggie DiNome, MD, and Susan Love, MD, Dr. Lee and her co-principal investigator Peter Sieling, PhD, will further investigate the association of microbes in the breast and breast cancer

Dr. Lee with Cheryl Heinonen, senior vice president of corporate relations and chief communications officer for the Avon Foundation, and Kevin Honeycutt, executive director for marketing, Avon Foundation

Dr. Delphine Lee receives a check from the Avon Foundation to further innovative research on the influence of microbes on breast cancer development.

FALL 2014 breakthroughs

shout outs

The caregivers at Providence Saint John’s Health Center pays close attention to feedback from our patients and visitors. We are proud to share some of the wonderful comments we’ve received in the past few months.

“The Caritas nurses were fantastic. I cannot say enough about Amelia, Laura, Melissa and Trish—so onthe-ball and truly caring. Guillermo was always so very attentive. Please thank them from the bottom of my heart. I have never felt as physically vulnerable and emotionally broken as I did. I’m finally starting to feel better.”

“Thank you, Dr. Faries,

“I love Saint John’s. This is my third stay in 2.5 years—two hips and one spine surgery. It’s a great hospital with great care and a fabulous staff. I am coming back for my knees.” “A most excellent

for being the best

health care facility.

oncologist and surgeon.

Quick triage and, at

Thank you, Rob, for all your help and prompt

most times, a short

return of calls even in

wait to be seen

the evening. You are all

[in the Emergency

making this much more tolerable.”

Department].”

By far the best hospital I’ve ever encountered. The entire staff was nothing but awesome! Didn’t mind being here at all. Thank you!”

breakthroughs FALL 2014

I was in the hospital July 5th for a hysterectomy. I’d never had major surgery, and it was my first time at Saint John’s. I must tell you, the nursing staff was superb. I’ve never seen such caring, wonderful people. I want to commend all of them. The pre-op nurse was kind and attentive and answered all my questions. My gynecologist insisted on Saint John’s, and now I know why. I would choose Saint John’s any day.” “Riza, Martha and Gracia are super. Elsie and nurse Maki are amazing. Xiomara is awesome. Dr. Bilchik is great. Debora, Sara, Martha and Marisol are great. Deborah and Kim in ICU are great. Nurses Helen, Marvina and Melissa are angels. Jamica, Kevin and Maria are fabulous. Shawn and Beck are wonderful. Adrianna and Maria are excellent.”

“I was here for bilateral hip replacement surgery last week. The hospital and staff were stellar! Thank you so much!”

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PAID LOS ANGELES, CA PERMIT NO. 31327

2121 Santa Monica Boulevard Santa Monica, CA 90404 USA

310.829.5511 | 1.888.healing www.providence.org/saintjohns

A family shares a love of volunteering.

Saint John’s doctors pioneer advances in cardiovascular care.

Since its founding in 1942 by the Sisters of Charity of Leavenworth, Providence Saint John’s Health Center has been providing the patients and families of Santa Monica, West Los Angeles and ocean communities with breakthrough medicine and inspired healing. Saint John’s provides a spectrum of treatment and diagnostic services with distinguished areas of excellence in cancer, spine, orthopedics, neurosurgery, women’s health, cardiac and specialized programs such as the internationally acclaimed John Wayne Cancer Institute. Saint John’s is dedicated to bringing to the community the most innovative advances in medicine and technology.