Spring 2013
P r o g r a m
P l a n n e r :
P u l l o u t
Saving an 18-year-old stroke victim
Comparing the many types of milk Page 2
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Welcoming a sports medicine expert Page 4
A long climb After almost 20 years of arm and leg pain, Joanne Stiner finally found relief — in surgery that took less than an hour. Page 3
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Health News & Information for Healthy Living
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Healthy Living Altoona Regional’s Healthy Living Magazine is published four times a year by the Marketing and Communications department.
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Milk
...it’s not just from cows anymore
As a child, you probably heard your parents say “Drink your milk!”
It was easy back then. You grabbed the milk from the fridge and poured some on your cereal. Or you filled up a glass to drink with your cookies. It might be more difficult nowadays. There are so many varieties of milk available at the grocery store, how do you know which one to choose? Altoona Regional clinical dietitian Randy Grabill says it really depends on your personal dietary preferences. “Typically, cow’s milk is the best source of calcium, protein and vitamin B,” he said. “But if you’re vegetarian, lactose intolerant or have a milk protein allergy, then you might want and/or need to try a nondairy alternative.” With each alternative, however, comes a different nutritional profile. Randy says that’s something to keep in mind. “Most milk substitutes are fortified with calcium, but cow’s milk provides substantial naturally occurring calcium, which is better absorbed by your body,” he explained. “Nutrition labels for cow’s milk will show it contains sugar, but that sugar is naturally occurring lactose,” he continued. “Lactose is not the same as ‘added sugar,’ which most milk substitutes have, unless you buy unsweetened brands.” To further help you compare, Randy discussed some of the most common milk alternatives. Soy milk Soy milk is the closest alternative to cow’s milk with respect to nutritional value, according to Randy. Soybeans are soaked and ground with water to make the milk. A good source of protein and calcium, soy milk is usually low in saturated fat and calories. It also comes in many flavors. “In addition to skim cow’s milk, I personally drink low-fat chocolate soy milk,” said Randy, “but if you’re a woman with a personal or family history of breast cancer, you might want to check with your physician before choosing soy.
Sizing up today’s choices
unsweetened type,” Randy said. “Almond milk is becoming very popular thanks to its rich, nutty taste, high calcium and low calorie content.” Still, almond milk has very little protein and B vitamins. And it’s not suitable for those with an almond allergy. Rice milk Made from ground rice, rice milk is relatively low in fat and calories. It comes in different flavors and is lactose- and soy-free. “Rice milk falls short in a number of nutritional areas, though,” warned Randy. “It lacks calcium and vitamin A, and is not a good source of protein.” Coconut milk With a rich, creamy taste, coconut milk can be very high in calories and saturated fat. It’s also low in protein, which Randy says makes label-reading even more important. “I’d suggest limiting the use of coconut milk to cooking, where it can provide richness in flavor to recipes,” he said. “Just be sure to check the nutrition label first.” Bottom line? It’s your decision! With so many tasty and healthful choices, Randy believes everyone can find milk that’s not only perfect for their taste, but also right for their body. “Typically, all the plant-based alternatives offer a longer shelf life compared to cow’s milk and are all cholesterol-free,” Randy said. “Still, since cow’s milk offers such a wide variety of nutrients, it may be useful to think of it as the ‘gold standard’ by which to compare other milks. “And as with so many of the foods and beverages we purchase, reading the nutrition labels can really help us make informed decisions.”
“There are studies about soy’s role in breast cancer. Some findings suggest isoflavones in soy act as a hormone in breast tissue, perhaps fueling cancer risk. But nothing is considered conclusive and more research needs to be done in this area.” Almond milk Like soy milk, this type of milk is made by grinding almonds and mixing them with water. But sweetener is often added to the mix, making it important to read the nutrition label. “You don’t want to be drinking something loaded with added sugar, so you might want to choose an
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Program Alert! Don’t Put It on the Table Until You Read the Label See calendar insert for details, date and time
Fixing limb pain Opening narrowed vessels with same-day, minimally invasive procedure For 17 years, Joanne Stiner of Philipsburg dealt with pain and cramping in her left arm and leg.
Arthur J. DeMarsico, D.O., medical director of Altoona Regional’s Vascular Institute.
“Those sensations were basically constants in my life,” she said. “My leg would hurt when I walked or climbed the stairs. My arm would cramp while I was crocheting.”
“Joanne came in with highgrade stenosis in both her left common iliac artery and left subclavian artery,” he explained. “In layman’s terms, the vessels that supply blood to her left leg and arm were severely narrowed because of substantial plaque buildup.”
Joanne, 54, sought help from several physicians, near and far, all of whom recommended two things: increase her potassium intake and have major surgery. “I ate so many bananas,” she recalled lightheartedly. “There was no relief, but I wasn’t convinced I needed a big operation.” Finds Dr. DeMarsico Eventually, Joanne found herself in the office of vascular surgeon
It didn’t take long for him to make the case for action.
“Stenosis is a very serious problem,” Dr. DeMarsico said. “Left untreated, it can cause complete vessel occlusion, or closure, which can result in the loss of limbs.” Stents open blockages Dr. DeMarsico performed a minimally invasive, catheter-based procedure from Joanne’s left groin. He inserted balloonexpandable stents (tiny metal cylinders) in each location to push back the blockages and allow blood to flow normally.
“It took him less than 45 minutes to fix 17 years of pain.”
Joanne works, pain-free, on her latest crochet project.
“It took him less than 45 minutes to fix 17 years of pain. I couldn’t believe it,” Joanne said. “Tests immediately showed normal blood flow to my arm and leg, and I was allowed to leave the same day. “Before I left, I grabbed Dr. DeMarsico and gave him a big hug. He truly gave me the best, albeit early, Christmas gift.” Dr. DeMarsico says success stories like Joanne’s are not uncommon at Altoona Regional, thanks to the many peripheral
endovascular procedures that are available. ‘Transforming patient care’ “At Altoona Regional, we’re doing what we’re supposed to be doing,” he said, “and we’re doing it well.” The robust procedures Dr. DeMarsico speaks of include treatments for disorders affecting blood flow through the veins and arteries that are farthest from the heart. “These procedures are quality procedures. They’re already transforming patient care,” he said. “We can offer many patients the full treatment benefits of surgery with far smaller incisions, less tissue damage and faster recovery time.”
Dr. DeMarsico practices with Cardiothoracic & Vascular Surgery of Altoona Inc., 620 Howard Ave., Altoona; phone 889.2328.
Program Alert! Vascular disease program and screening See calendar insert for details, date and time
Peripheral artery disease (PAD) develops from stenosis Stenosis is what happens when peripheral artery disease (PAD) is left untreated and continues to progress, explained Dr. Arthur J. DeMarsico. PAD is a common circulatory problem in which narrowed arteries reduce blood flow to your limbs. When you develop PAD, your extremities — usually your legs — don’t receive enough blood flow to keep up with demand. This causes symptoms, most notably leg pain when walking. Those with the highest risk for developing PAD are people who: • are older than 50 • have high cholesterol • use tobacco • are overweight • are diabetic • are physically inactive • have high blood pressure • have a family history of PAD or other cardiovascular diseases
Offering vascular training Not only does Altoona Regional offer state-of-the-art treatment options, but its physicians are providing the next generation of physicians with knowledge and skills, all the while emphasizing a collaborative and team approach. “We’re doing some procedures that are not being done at other places,” said Dr. Arthur J. DeMarsico. “Physicians come from different parts of the country to watch us perform minimally invasive procedures to learn how to do it themselves so they can expand their practices.” In addition, Altoona Regional has hosted multiple nationally recognized courses in physician education.
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Joint pain or injury? Fixing knees, shoulders and ankles with the newest techniques
After making the winning shot at Friday’s high school basketball game, a teenager lands awkwardly and hears a “pop” in his left knee. He can’t put weight on it but decides to tough it out overnight and see what happens. Early the next day, his 45-year-old father is splitting wood in preparation for winter. His right knee collapses as he carries logs to the wood pile. He also hears a “pop” and can hardly walk. By mid-morning, the two are making a father-son trip to the local emergency room, where MRI scans find torn anterior cruciate ligaments, or ACLs, a major ligament in the knee. This type of injury is often remedied by surgery, so the duo is referred to an orthopedic surgeon.
“[Dr. Junkin] is eager to … develop a firstclass sports medicine program for our community.”
Many people can relate to knee pain and injuries, as well as trouble with shoulders and ankles. The problem may be sports-related, work-related, or from “overdoing it” on the weekend. Regardless, the team at Elite Orthopedics has the unique experience and skills needed to find and fix the problem. The newest member of the team, David M. Junkin Jr., M.D., is a board certified orthopedic surgeon specializing in general orthopedics and sports medicine, with a focus on the treatment of injuries and disorders of the shoulder, knee and ankle. “Not only is Dr. Junkin an experienced surgeon, he is also well-versed in the newest sports medicine techniques,” said Charles Harvey, D.O., medical director of Elite Orthopedics. “He’s eager to collaborate with all the health care professionals within the Altoona Regional system to develop a first-class sports medicine program for our community. ‘Unparalleled credentials’ “He has a congenial personality coupled with unparalleled credentials. We’re extremely fortunate he’s joined our team.” After earning a master’s degree in Medical Sciences from Drexel University in Philadelphia, Dr. Junkin received his medical degree from Temple University School of Medicine. He completed his residency in orthopedic surgery at Temple University Hospital. “I’m often asked why I chose medicine, and specifically orthopedic surgery,” Dr. Junkin said. “The answer is simple: It’s all I’ve ever known. My father is an orthopedic surgeon. I couldn’t envision doing anything else with my life.”
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Following his residency training, Dr. Junkin completed the Sports Medicine Fellowship at the University of Kentucky’s Albert Chandler Medical Center in Lexington. During his fellowship training, he served as team physician for three universities in Kentucky. It was his interest in minimally invasive surgical treatments that directed Dr. Junkin into sports medicine. Using small incisions “Arthroscopy uses a small, thin, flexible fiber-optic scope for insertion into a joint through a small incision to perform diagnostic and treatment procedures or repairs,” he explained. “The use of small incisions reduces recovery time and minimizes damage to surrounding tissues.” Noting that ACL reconstruction is one of his favorite procedures, Dr. Junkin has authored articles in several journals, as well as a chapter on ACL reconstruction in a professional publication. He has presented lectures on sports medicine and medical therapy for the injured knee. Dr. Junkin is a fellow in the American Academy of Orthopaedic Surgery and is an instructor for the Arthroscopy Association of North America, teaching orthopedic residents arthroscopic skills and procedures. His philosophy of care is simple, regardless of the patient’s age, or whether he or she is an athlete or “weekend warrior.” “Whether the problem is new or has been a bother for years, I want to return my patients — athletes or nonathletes — to their previous level of athletic performance or their desired level of daily activity,” he said. Contact information: Southern Alleghenies Elite Orthopedics, an affiliate of Altoona Regional Health System, Gateway Centre, 601 Hawthorne Drive, Hollidaysburg; phone 889.3600.
Special specialist
Neuro-ophthalmologist saves teenage stroke victim from blindness
Liz Hoerath at Juniata College with some of her artwork. The piece closest to her reflects her emotions during her medical crisis.
After seven visits to various medical facilities and multiple examinations of her daughter by several physicians in two counties — all in five days — Connie Sweat had seen her 18-year-old rapidly decline due to a severe headache, vomiting and partial vision loss. “Lizzie’s never been one to take pills, and here she was begging for something to take the head pain away and make the vomiting stop,” Connie said, reflecting on those awful days in February 2011 when her motherly instinct
knew that her daughter, Liz Hoerath, was ill with something more than a virus. When Altoona Regional emergency physicians determined that Liz had suffered a stroke due to a blood clot in her brain, she was put under the care of the system’s Regional Stroke Center, where a multidisciplinary team converged to save her life and her eyesight. Feeling reassured Connie remembers Wen-Ying “Helena” Wu-Chen, M.D., the physician on duty for Blair Medical Associates Neurology, greeting them upon her arrival. Immediately, she felt reassured. “Dr. Wu-Chen made me feel she knew what she was doing and she was confident in what she was doing right from our first meeting,” Connie said. “I was under a lot of pressure from many people to take Liz out of the area and even out of state for care. “But Dr. Wu-Chen was excellent at
explaining what was going on, personable, and was very knowledgeable. Later, when I researched her credentials, I was impressed.” Dr. Wu-Chen is one of only 24 neuroophthalmologists in the state. She specializes in visual problems related to the nervous system. As a neuro-ophthalmologist, she trained first in diseases affecting vision, then in neurology, and later did subspecialty training and fellowships — a total of 10 years of training beyond medical school. Challenging cases “I enjoy working with general neurology patients,” Dr. Wu-Chen said. “And neuroophthalmology is a subspecialty that I have a passion for. It is the challenging part of my career because the cases are more complicated. Usually they come to me because no one can figure out what the problem is.” As was the case with Liz. No one suspected an
18-year-old’s symptoms would be stroke-related. Dr. Wu-Chen saw that Liz had optic nerve swelling, a sign of life-threatening increased pressure on the brain and behind her eyes. If the pressure was not released, it would cause blindness.
end of my day at work, I feel happy I have helped someone,” she said. “I chose neurology because the brain is the most important part of our body. It keeps us alive and active with our friends, family and surroundings.”
Liz’s hospital stay lasted six days. Today, a sophomore at Juniata College, she is pursuing a degree in visual promotions, advertising/ marketing, with a second major in German. Had she lost her vision, her future would have changed drastically. That it didn’t, she knows, is due to both her mother’s tenacity in pursuing a solution to her problem, and Dr. Wu-Chen’s ability to find and fix it.
Due to her illness, Liz withdrew from her 2011 spring semester. Today, she is back on schedule to graduate and is studying in Germany.
Her dream career And that is why Dr. Wu-Chen chose a career in medicine, her dream since third grade when her beloved grandfather in Costa Rica answered her wish for a toy doctor’s bag. “I like medicine because I feel I can make a difference in someone’s life. At the
“This will be my third and longest stay (in Germany) at five months,” Liz said. “Throughout my life, and especially through my medical difficulties when I was in excruciating pain and couldn’t speak for myself, my mother was there. She wants to visit me here and I hope to show her the beauty of Germany and, in particular, the Rhine River, specifically Königswinter by the Drachenfels (the dragon wine fields). “Without her, I may not have the gift of sight to see the Rhine again and all of its glory.” Contact: Wen-Ying “Helena” Wu-Chen, M.D. Blair Medical Associates, Neurology Station Medical Center 946.1655
“I was under a lot of pressure from many people to take Liz out of the area...for care.” — mother Connie Sweat 5
A day in the life of Observation Unit nurse Lindsay Suter.
Observation Unit built for patient comfort while doctors seek answers
The ‘typical’ patient
Although they could have other problems, patients in Altoona Regional’s Observation Unit most typically have these conditions or illnesses: • Acute coronary syndrome (heart’s blood supply impaired) • Asthma or chronic obstructive pulmonary disease (COPD) • Pneumonia • Congestive heart failure • Gastroenteritis/ esophagitis • Renal colic/urinary tract infection • Hypo/hyperglycemia • Dehydration • Abdominal pain
“The patients seem to like the new unit … [they know] we are working fast to find out what is going on with them.”
Registered nurse Lindsay Suter checks her 83-year-old patient’s heart rate and heart rhythm against medication dosage instructions and uses her portable computer to enter the data into the woman’s electronic medical record. She does all this at a heart monitor in the hallway outside the room of her patient, who is in a co-ed, four-room pod. The monitor indicates by bed number each patient’s critical information. The monitors, the pod concept, the blend of state-of-the-art technology with practical, handwritten white boards and vigilant, hands-on nursing care make the 6F Medical/Telemetry Observation Unit a one-of-a-kind world. Altoona Regional’s 24-bed Medical/Telemetry Observation Unit provides an alternative to the traditional inpatient units for patients seen in the Emergency department who need further monitoring, testing and/or treatment, but do not meet admission criteria, said Kelly Brunhuber, R.N., unit nurse manager. Most come from ER The typical patient is an adult with noncritical medical or surgical needs who may require cardiac monitoring. Ninety percent of observation patients come from the Emergency department, and the rest directly from physician offices. Kelly, who has additional education and training in progressive care nursing, said the expected length of stay is 24 hours or less. At 24 hours, if the patients are not ready for discharge, they are placed in extended observation care, if their insurance permits. The date and time each patient enters the unit is critical and is handwritten on an observation board. A handwritten communication board documents interactions between a patient’s
nurse and his or her hospital caseworker, who will assist with discharge planning. “This unique unit was developed to help move our observation patients out of our Emergency department and into a more comfortable setting while they receive testing,” said Kelly. “Our unit specializes in prompt testing, receiving results quickly and frequent communication with your physician — all to get the patient home sooner.” ‘Very unique’ Lindsay calls the unit “very unique.” “You not only have to know about this unit but also everything else about the hospital, in the sense of where do you go for this service, and how do we get that for the patient,” she said. “It takes knowing all the resources. And you know them through training, teamwork and Case Management’s help. We all work together.” The day Lindsay is being followed for this story is typical, she says. She has five patients (the maximum per nurse) — one full four-person pod and one patient in a pod across the hall. She is in constant, purposeful motion, a natural multitasker who rotates easily between patients, addressing each by name, answering questions, assuring a visitor that her relative is off the unit for tests and would be back within the hour. By the end of her shift, she expects to have a new set of five patients. “I like this because no day is the same — every day I have different patients with different conditions,” Lindsay said. “The patients seem to like the new unit and processes because they see we are working fast to find out what is going on with them and act on it.”
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Palliative Care Suite getting facelift
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Sav e dat the e!
The Bernard A. Rosch Palliative Care Suite at Altoona Regional will undergo renovations to rejuvenate and renew the homelike setting for terminally ill patients and their families. In 1986, Helen Rosch made a contribution to help create the Palliative Care Suite in memory of her husband, Dr. Bernard A. Rosch, who died of cancer in June 1983.
Foundation for Life
Golf Classic
Through Helen’s donation, the suite was specially designed to provide privacy and comfort in a relaxed environment. Each room has been decorated with homelike furniture, wall coverings, curtains and bedspreads. All rooms are adjoined by a common living, dining and kitchen area where patients can relax with family members.
Monday, June 24, 2013 Scotch Valley Country Club
Since Helen’s passing in 2008, her generosity has lived on to allow the Palliative Care Suite to be upgraded with new chairs, furnishings, handrails, window coverings, wall coverings, a television, kitchen renovations and signage. The suite provides supportive care and comfort for patients and their families faced with a terminal illness. The goal of palliative care is to improve the quality of life and provide the patient comfort care rather than curative care.
Aeropostale donated 24 teddy bears to Altoona Regional’s Maternity department recently. The bears will be given to parents of newborns delivered at the hospital. Presenting the donation to Shirley Hoyne (center), acting coordinator of the Foundation for Life, are Ann Kowalski (left), assistant manager of the Logan Valley Mall store, and Theresa Koch, store manager.
Holiday Splendor funds aid nursery The Foundation for Life’s annual Holiday Splendor Gala and Auction raised $53,250 to help fund the purchase of newborn cardiac monitors, sleeper chairs and IV pumps for the newborn nursery. Holiday Splendor is a fundraising gala that includes both a silent and live auction, featuring gift items, baskets, gift certificates, art pieces, holiday gift items and beautifully decorated holiday trees. “We sincerely appreciate all Holiday Splendor attendees, as well as the numerous businesses and individuals who sponsored the event, contributed auction items and made donations,” said Shirley Hoyne, coordinator. “Thanks to their dedication and contributions, everyone was able to enjoy a beautiful evening in support of our nonprofit community health care system.” Friends of Altoona Regional, the health system’s auxiliary, donated $4,000 and was the major supporter of Holiday Splendor. Gold sponsors included Altoona Center for Nursing Care, Altoona OB/GYN Associates, HealthSouth Rehabilitation Hospital of Altoona, Holliday Corvette, Paris Healthcare Linen Services, S&T Bank, Southern Alleghenies Elite Orthopedics and UPMC. In addition to sponsorship support, Holiday Splendor was a big success due to the time and talents of volunteers, committee members and the staff of The Calvin House.
HOW to give To make a gift in love, tribute or remembrance, contact the Foundation for Life at 889.6406, or send a check with a note providing background on the reason for your gift. You can also make your gift at www.altoonaregional.org/gift giving. The Foundation will notify the person of your tribute gift with an appropriate card, and you will receive a receipt and letter thanking you for your generosity and thoughtfulness. 7
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AS K T H E S P ECIALIST Roberto Gonzalez, M.D., is a plastic and reconstructive surgeon who practices with Blair Medical Associates, Plastic & Reconstructive Surgery, Station Medical Center, 1414 Ninth Ave., Altoona. Phone 947.5030. You perform a “breakthrough” outpatient breast reconstruction procedure for women who have had breast cancer surgery called “autologous fat grafting.” What makes this a breakthrough? It is revolutionary. It provides new hope to women of all ages with breast cancer, no matter how newly diagnosed or how long post-surgery or cancer treatment. When diagnosed, a woman rides a roller coaster of emotions
and simultaneously makes life-altering health decisions. For most, breast reconstruction isn’t on the priority list — survival is. I trained with the surgeon who developed the technique, using a device called the “Brava,” and he achieved stunning results with women up to the age of 75, who had varying needs in reconstruction.
How does the technique work?
First, the majority of breast reconstructive surgeries I do here are still traditional approaches, where tissue is created from either being stretched with a device or grafted from another part of the body. A silicone implant is inserted in the pocket, and the breast and a nipple are sewn together. While the results satisfy patients visually, it is major surgery with potential risks and a painful recovery from
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two surgical sites, coming on the heels of an often lengthy cancer treatment. And, for some women, they say, it falls short afterward as well. The breast, or breasts, look real to others but don’t feel real to them. The fat grafting technique restores near-normal sensation to new breasts, including the nipple area. Fat grafting allows plastic surgeons to rebuild women’s breasts with no implants, no major surgery, no incisions, no new scars and, most important, allows near-normal sensation. Are all women seeking reconstruction eligible for fat grafting?
No. First, a woman must have enough extra fat on her body to be able to relocate the fat to the breast area. And depending upon the size of the breast restoration, two or three outpatient procedures are
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usually needed and are done at Altoona Regional’s Same Day Surgery unit. (Patients receive the additional benefit of body contouring from excess fat removal.) So, success relies more on the patient than on the surgeon. She has to be very motivated and dedicated to following the correct protocol in using the Brava tissue expander. The device is worn continuously for 12 hours daily to create edema so tissue expands more quickly. Most women wear it after work and sleep in it until the next morning. Why does this technique work so well? Fat naturally contains stem cells. When the patient’s own fat is purified into tiny beads and is placed at the mastectomy site, the body re-establishes blood flow at the incision site better and faster as blood vessels
regenerate to the new tissue. This helps return near-normal sensation.
Does insurance pay for this?
Insurance will not pay for the Brava device, which costs about $1,800, so this and the commitment to wearing the Brava turn some patients away. For others, they want the natural breasts this procedure provides regardless of cost. Other costs are covered by most insurances.
How else is fat grafting being used?
Fat grafting is being used to fix breast scarring caused by lumpectomies or congenital abnormalities, and in tandem with traditional breast reconstructions. For more information, visit the American Society of Plastic Surgeons at www.plasticsurgery.org and www.brava.com.
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Roberto Gonzalez, M.D., is board certified by the American Board of Plastic Surgery in Plastic & Reconstructive Surgery. This credential means he has advanced skills, demonstrated through written and hands-on testing, which meet the highest national standards. He received his medical degree from Ignacio S. Santos I.T.E.S.M. He graduated from the residency program at West Virginia University in Morgantown and received his fellowship training in Plastic and Reconstructive Surgery at the University of Louisville.