PRE-INJURY TEST HELPS POST-INJURY RESULTS
ALSO: KIDS NEED THEIR SLEEP LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING HEARING BETTER A MIRACULOUS GIFT
AND MORE! DEFINING MOMENTS
Moments A Women’s Health Magazine from Indiana University Health Arnett FALL 2012 iuhealth.org/arnett
President and Chief Executive Officer
Stories of new life, health, hope and healing— told by your neighbors right here in Greater Lafayette and nearby communities—fill these pages. Read about Jordan Bailey, an 18-year-old swimmer whose shoulder is back in shape. Catch the smile on Robert Newgent’s face as he bikes around the neighborhood, back into full activity with his new hip. Coo over baby William Miguel. And cheer with Rick Young, who is hearing sounds he never could before. You’ll also find tips to keep you and your children well—and rested. And you’ll enjoy reading about exciting innovations in medicine, such as radial catheterization and the linear accelerator. These captivating stories are just a sampling of the profound successes happening every day at Indiana University Health Arnett. Enjoy your reading!
Al Gatmaitan, FACHE President & Chief Executive Officer Indiana University Health Arnett
System Director, Marketing & Communications
Al Gatmaitan, FACHE
Kasey Fuqua Jeanine McGill
Kasey Fuqua Kathy Mayer Jeanine McGill
Photographer Board of Directors
Paul Sadler Scott M. Black Thomas V. Easterday Andrew K. Edwards, MD Daniel F. Evans, Jr Stephen Henson, MD Victor Lechtenberg Michael B. Lockwood, MD Randall R. Mitchell Larry W. Pampel, DDS Kenneth S. Stone, MD
OUR MISSION The mission of Indiana University Health Arnett is to improve the health of our patients and community through innovation and excellence in care, education, research and service. Defining Moments Indiana University Health Arnett P.O. Box 5545 Lafayette, IN 47903-5545 765.448.8000 | 800.899.8448
If you do not wish to receive future mailings from Indiana University Health about events and services that may be of interest to you, please call 765.448.8060 or email email@example.com and leave a message with your name and address.
Moments CONTENTS Orthopedics & Sports Medicine Ehrlich Defies Odds, Retakes the Mound Bicycling, Golfing After Hip Replacement Shoulder Surgery Puts Bailey Back in the Water ACL Repair a Three-Pointer
2 4 8 10
Cardiology Benefits of Radial Catheterization
Cancer Care Outsmarting Cancer Engler Swings Back into Health
ON THE COVER Baseline ImPACT® Testing Helps Monitor Concussions By conducting a simple test before an athlete receives a concussion, Dr. Donald Fahler is reducing long-term effects of concussions and helping athletes heal.
Kids Need Their Sleep
Getting enough sleep can make a huge difference in a child’s grades, behavior and health. Pediatrician Laura Walls explains how to ensure kids get their best sleep.
Laparoscopic Adjustable Gastric Banding
More options and support are now available in Lafayette for patients struggling with weight loss.
Hearing Better a Miraculous Gift
Rick Young thought there was no help for his hearing loss, but is now hearing better than ever with an osseointegrated implant.
Tale of Two Concussions Baseline ImPACT® Testing Helps Monitor Concussions Sweet Dreams: Kids Need Their Sleep Families Gain Power Over Pounds
Obstetrics/Gynecology Urge Incontinence Easily Treated Easy Permanent Birth Control Welcome, William Miguel
30 32 34
Bariatrics Laparoscopic Adjustable Gastric Banding, Your Questions Answered
Ear, Nose and Throat Hearing Better a Miraculous Gift
Kindergarten Countdown Gives Kids an Edge
DEFIES ODDS, RETAKES THE MOUND
After losing movement and muscle in his pitching arm, A.J. Ehrlich returned to the mound through his own hard work, his positive attitude and help from an experienced physical therapist.
One January night during his junior year at Crawfordsville High School, multisport athlete A.J. Ehrlich woke up with extreme pain in his right shoulder. After realizing he couldn’t move his arm at all, he woke up his mother, Susan, who immediately knew something was seriously wrong. “Here was this very strong, 17-year-old boy in tears, in extreme pain, who had no control of his arm,” she remembers. “He couldn’t lift it, couldn’t move it and had total loss of control.” Though he had been to the doctor for a cold and some shoulder stiffness a few days before, Ehrlich couldn’t think of a reason for the pain.
“I had no idea what Parsonage Turner Syndrome was,” his mother, a registered nurse, says. “When I heard the prognosis, my concern turned to A.J. emotionally. He wanted a shot at a college career in baseball. My biggest concern was the mental aspect of never having the opportunity to play college ball.” She quickly started searching for a physical therapist who could help.
PROGNOSIS: PITCHING IS OVER
“My first question was, ‘Do you have a therapist who knows what Parsonage Turner Syndrome is?’ I got multiple ‘no’ answers. I called several places. I was beginning to think we were going to have to go to Cincinnati or Chicago to find someone with experience.”
The next day, Ehrlich visited Dr. Brent Huffman at IU Health West Hospital in Indianapolis. Dr. Huffman instructed him to place his hands against the wall and imitate a standing push-up.
“Finally, I found Courtney Hamilton at IU Health Arnett,” she says. “To my great relief, her answer to my question was, ‘Oh, yes, I treated a guy with that years ago.’”
“I didn’t remember doing anything to strain it,” Ehrlich says. “I was really confused about what was going on.”
“His muscle on the left side was beautiful, bulged out,” his mother recalls. “On the right side, I could not see any muscle. It was all caved in.” Dr. Huffman diagnosed Ehrlich with Parsonage Turner Syndrome, a rare syndrome that weakens the muscle and causes severe shoulder pain and numbness. It was likely caused by a virus, possibly even the cold he’d had a few days before. 2
It looked like Ehrlich would never pitch another game of baseball and maybe never get his full range of motion back. Physical therapy would be key in treating the disease.
REBUILDING STRENGTH, FUNCTION The plan was six months to a year of therapy. “I would like to say it was really complicated,” says Hamilton, IU Health Arnett lead physical therapist in Rehabilitation Services. “However, the truth is that it was quite easy once we established which muscles were weak.”
ORTHOPEDICS & SPORTS MEDICINE “The hardest part for A.J. was recognizing that he could overdo it and slowing himself down,” Hamilton says. Ehrlich’s therapy also involved working out at home. “My husband, Jeff, is a runner, an athlete, so he helped A.J. at home with a lot of therapy and the workout bands,” his mother says. “His father was his trainer at home.” After working to normalize motion, mobilize nerves and build strength, Ehrlich was able to start practicing baseball again, though only in small steps. “We tried to progress him back to sport slowly. First, fielding only. Then, progressing to sub maximal throwing, and, finally, to full-force throwing,” Hamilton says. “His attitude was great. He got back to sport faster than I expected given what his injury was.”
SENIOR YEAR STANDOUT Though he was diagnosed in January, he was able to make the roster for spring baseball. Unfortunately, he was still not on the mound until months later. “He finally got a pitching start in a varsity game late in the season,” says Crawfordsville High School baseball coach John Froedge. “Though much anticipated, it did not go well. A.J. was a little discouraged, but not beaten.” Ehrlich kept working, his coach recalls. “With a great work ethic and even better attitude, he worked extremely hard in the off-season. He came back his senior year and had an outstanding season, leading his team to a 26-7 record.”
“A.J. pitched back-to-back no-hitters in the middle of the season, the first being a perfect game,” Froedge says. “He was named an All-Conference Pitcher and earned the opportunity to pitch in college.” “I’ve been fine ever since,” says Ehrlich, who today plays baseball for the Hanover College Panthers.
“I had no idea what Parsonage Turner Syndrome was. When I heard the prognosis, my concern turned to A.J. emotionally. My biggest concern was the mental aspect of never having the opportunity to play college ball.” -Susan Ehrlich, Mother “Sometimes I notice the muscles on my right are concaved a little, then I have to work extra hard on that. Sometimes I still feel kind of numb in my arm, but not bad, and only for a few minutes.” In 2012, Ehrlich finished his second year playing baseball for Hanover College with impressive statistics: 5 wins, 1 loss, 3.32 earned run average and 46 strikeouts in 57 innings pitched. Now a junior, he’s studying kinesiology and integrated physiology and plans to become a registered dietitian.
About PARSONAGE TURNER SYNDROME Striking relatively rarely, Parsonage Turner Syndrome is a form of brachial plexopathy, a neuropathy that can result from bodily stress. A number of stimuli including viruses, surgery and/or excessive exercise can precede the nerves in your neck or arm becoming inflamed. The exact cause is unknown. The symptoms include shoulder pain, tingling, numbness and weakness and difficulty moving the shoulder. It can also lead to muscle wasting. It is generally treated with gentle and progressive physical therapy, which promotes range of motion and subsequent recovery. With time and therapy some patients return to normal function although there are instances where recovery is limited. DEFINING MOMENTS
Newgent Out Bicycling, Golfing After Hip Replacement For Robert Newgent every day consisted of so much pain, he could barely walk. When he decided to take his life back, he turned to IU Health Arnett Orthopedics & Sports Medicine.
No stranger to work, Robert Newgent, Lafayette, put in 33 years for CSX Railroad, worked a few years for a local retailer after retiring and now spends two days a week caring for his preschool-age grandchildren. In today’s semiretirement, he wants to play a few rounds of golf, ride his bicycle and grow some vegetables.
“I was very apprehensive,” Newgent recalls. He prepared for surgery by watching a video and reading about the surgery. Though he had been worried, the surgery went routinely.
HOMEBOUND WITH PAIN
ACTIVE AGAIN WITHIN WEEKS
But severe hip pain kept him close to home.
Six weeks later, he was riding his bicycle again and using his home gym equipment. At the nine week mark, he was amazed with the difference the surgery made.
“I was limping very badly,” he says. “The last few months I could hardly walk. I couldn’t play golf. I couldn’t even walk the dog.” He saw his primary care physician, Dr. Joel Mulder with IU Health Arnett, who referred him to Dr. Eric Orenstein at IU Health Arnett Orthopedics & Sports Medicine. Dr. Orenstein recommended hip replacement. 4
“Everything went just as he said it would. It was ten times easier than I thought it would be.”
He has no limp. He can walk his dog, Deena. And he and some friends are back to golfing. “The first time I played golf with my friends, I was playing pretty well. They said they were going to get new hips so they could, too.”
ORTHOPEDICS & SPORTS MEDICINE He’s also back to caring for his grandsons two days a week. “It’s the best job I never had,” he says of having cared for his grandchildren. At his last doctor’s visit, he even offered Dr. Orenstein some advice: “You need to advertise this. There’s no need for people to put up with pain.” “If this is the complaint department, I’m in the wrong place,” Newgent says. “I’m elated with this whole situation. I’m very happy.”
“If incapacitating pain is interfering with your quality of life, knee or hip replacement is a very viable option. It eliminates pain and allows patients to be more functional.” - Dr. Eric Orenstein, Orthopedics & Sports Medicine
HELP FOR HIPS, KNEES
MAKING GIANT STRIDES Patients with aching hips and knees are benefitting from numerous advances in treatment options, report Dr. Eric Orenstein and Dr. Joseph Hubbard, both at IU Health Arnett Orthopedics & Sports Medicine. “Sometimes patients think surgery is the only solution, but there are good options before replacement,” Dr. Hubbard says. “I take care of knee patients, and often simpler solutions work pretty well for many people. When all else has failed, replacement is a really good option.” Among the advancements are subchondroplasty injection, patient-specific instrumentation that cuts down on the time under anesthesia, as well as improved plastics and metals used in replacements.
PRESERVING JOINTS Dr. Orenstein has trained and is credentialed on subchondroplasty, a joint-preserving procedure where a cement-like material is injected into the femur or tibia. “About 75 percent to 80 percent of the time, it eliminates or improves pain with early arthritis,” Dr. Orenstein says. “It’s done outpatient and is semi-invasive.”
BETTER IMAGING, REPLACEMENT PRODUCTS Advances in pre-surgical planning are helping doctors take measurements and make decisions about implant
Joseph Hubbard, DO
Eric Orenstein, MD
sizes ahead of time. “That means less time under anesthesia and less loss of blood,” says Dr. Orenstein. “We’re also seeing improvements in knee metal and plastic implants,” Dr. Hubbard says. “And the plastic pieces are now wearing longer.” “That improvement in durability is a plus,” Dr. Orenstein says. “We’re seeing much better wear characteristics, so replacement joints are lasting longer.” After living with hip or knee pain, then choosing replacement surgery, patients frequently tell Dr. Hubbard: “I should have done it sooner.” “A lot of people worry about pain afterward, but they don’t think about the pain they are in every single day,” Dr. Hubbard says. It’s all about quality of life, Dr. Orenstein says. “If incapacitating pain is interfering with your quality of life, knee or hip replacement is a very viable option. It eliminates pain and allows patients to be more functional.” DEFINING MOMENTS
Answers to Frequent Questions Dr. Eric Orenstein answers questions patients often ask.
Can I get arthritis in that joint after the replacement? No. Arthritis is a wearing away of the cartilage. We remove the cartilage at the time of the surgery, so it’s impossible to get arthritis again.
Will you take my whole knee out and put a new knee in? We only remove 7mm to 10mm of bone on either side of the joint, so patients still have the tibia, femur and kneecap in place. It’s a resurfacing type of procedure, a recapping with a new, smooth surface.
What’s recovery like? We get patients up the same day as their surgery, and they usually leave the hospital three days later, to go home or to a rehab facility for about 10 days. They use a walker or crutches for two or three weeks, then a cane for two or three weeks. Usually by six weeks after surgery, they are doing very well.
Knees Keep Griswold
on the Go Retired after 35 years with the Lafayette Fire Department, John Griswold says it’s a job he loved, despite the hours. “When it came your turn to work, you had to be there. But it was something I wanted to do, and I would still do it if I was able.” Unfortunately, arthritis in Griswold’s knees led to pain so crippling that he could barely walk. “I had bone-on-bone,” he says, “and it was grinding.” Within four weeks of having both of his knees replaced, he was walking like he hadn’t in years and going out to lunch nearly every day. Griswold says he had to have his knees replaced, and now that the surgery is done, he feels great. “I’m going to be out walking and giving these knees some use,” he says. The father of four, Griswold’s joys today are spending time with 10 grandchildren and seven great grandchildren. After his surgery, he’s able to keep up with them like never before and doesn’t have to say no to any games or activities. “We do everything we want to do,” he says.
Coming up Roses for Tevis For 20 years, Joyce Tevis of Wolcott, worked on cement floors at factory jobs, sometimes kneeling during different production steps. Those long hours on hard floors led to lasting knee pain. In February 2012, she decided to end the pain by having her left knee replaced. Within a couple of months, she was heading out to her grandchildren’s softball and baseball games, making crafts, cooking, baking and even working in her garden.
“I was a little skeptical [about the surgery],” she admits. She underwent surgery on Monday, left the hospital on Thursday and went to a rehab center in Monticello for several days. “My recovery went quite well, and I had a good physical therapist,” she says. “There was some pain, but it was what I expected. It was well worth it. I’m very happy I went through with the procedure.” Tevis walks more now and can tend her gardens again without pain. “I always enjoyed walking, but now I’m doing it partly because of my knee.” Thanks to her knee replacement surgery, this lifetime gardener is back to her normal activities and her geraniums couldn’t be happier.
Remove joint pain from your life. From diagnosis to recovery, Indiana University Health Arnett provides exceptional care for your joint pain. The physicians at Indiana University Health Arnett have helped thousands of people overcome painful joint problems so everyday tasks are no longer a chore. Our board-certified, fellowshiptrained physicians provide expert evaluation and diagnosis, and offer the latest non-surgical and surgical treatments. The Indiana University Health orthopedics program is a national leader in helping people regain their mobility and the active life they love. How much pain are you living with? How can you take the next step and remove joint pain from your life?
FIND ANSWERS FOR YOUR JOINT PAIN. Visit iuhealth.org/arnettjointhealth to know your options and take our pain assessment quiz.
©2012 IU Health 08/12
HEART & DIABETES
SHOULDER SURGERY GETS BAILEY
BACK IN THE WATER An aching shoulder took Jordan Bailey out of the race, but only for a while. IU Health Arnett orthopedic surgeon Dr. Peter Seymour spotted the cause between the swimmer’s rotator cuff muscles and fixed the problem. Swimming the butterfly at practice one day at Twin Lakes High School in Monticello, Jordan Bailey was going into his last stroke when he felt something strange happen to his shoulder.
MUSCLE NEEDED SURGICAL REPAIR “He told me what he saw on the MRI looked like hamburger meat, and it shouldn’t,” Bailey says. “He showed me a muscle in my shoulder I shouldn’t be able to see on an MRI. It had ruptured and was falling down.”
“I couldn’t get it above my head,” Bailey says. When he got home, he tried to treat the stiffness. “I iced it and heated it,” he says. “It didn’t get better. But I just swam on it. At the end of the season, I started physical therapy.”
“I was worried,” his mother, Miki Seymour (of no relation to Dr. Seymour), admits. “He’s found a sport he loves, but is he going to be able to swim again? Move his shoulder? Would he have problems for the rest of his life?” Dr. Seymour explained things well, she says.
When there was no improvement after a few weeks of therapy in June 2011, he had an MRI and saw Dr. Peter Seymour, an IU Health Arnett orthopedic surgeon.
“I thought I would hear a bunch of words I didn’t understand and would have to go home and look them up on the Internet. Dr. Seymour was a breath of fresh air.”
On their way to a summer swim league meet, he, his mother and a fellow team member stopped at Dr. Seymour’s office.
Bailey, too, was concerned. “I was terrified I would never get to swim again. I felt upset to my stomach. My friend was
ORTHOPEDICS & SPORTS MEDICINE there, and she said I would get to swim again. That helped a lot.” Shoulder arthroscopy surgery was set for two weeks later.
Swimming has taught him about setting and reaching goals, then setting new ones. One of his greatest achievements was a team feat, when Twin Lakes broke five records at sectionals his junior year.
“I was pretty certain I knew what Jordan had,” Dr. Seymour says. “Usually I know exactly what I’m going to find. I love fishing trips, but I hate fishing in the operating room. So I try to know exactly what I’m going to do and leave as little to chance as possible.”
As for his shoulder challenges, “It taught me to never give up on something I want.”
“Dr. Seymour made two incisions, one in front and one in back,” Bailey says. “He pulled up my muscles and tied them together so they would stay up and heal.”
“Keep your friends around to keep you happy. It will all be okay in the end.”
Bailey wore a sling that summer and began physical therapy about six weeks after the procedure. “Even though we approach it without making a big incision, it’s still surgery,” Dr. Seymour says of the arthroscopic procedure. “There’s still recovery time. You have to wait for biology to heal whatever we put back in its place. But with arthroscopy, it may be less painful and you return more quickly to more normal function.”
He has advice for other athletes that are facing similar recoveries.
“Usually I know exactly what I’m going to find. I love fishing trips, but I hate fishing in the operating room. So I try to know exactly what I’m going to do and leave as little to chance as possible.” - Dr. Peter Seymour, Orthopedics & Sports Medicine
SENIOR YEAR SEASON A SUCCESS By fall, Bailey was cleared to swim, in time for his senior year season and post as team captain. “It’s been great. I swam all season,” he says. “My goal was to get under a minute in the 100-yard butterfly. This year at sectionals I got :59.64. It was pretty awesome.”
HEALING SHOULDER PAIN Shoulder arthroscopy surgery is used to treat a variety of shoulder problems. With a fiber-optic lens connected to a digital video camera, surgeons scope out the area and make the repairs. “The shoulder is a very complicated, very complex joint,” says Dr. Joseph
THE FUTURE IS NOW Bailey spent the summer of 2012 league swimming and has continued to help the Twin Lakes coach with the high school team. He enrolled at Ivy Tech Community College in the fall and later plans to attend St. Joseph’s College in Rensselaer to major in special education.
Hubbard, an IU Health Arnett orthopedic surgeon. “Patients can experience overuse injuries or traumatic injuries from a fall or sliding into a base, for example.” “We are using arthroscopy to address whatever shoulder pathology patients have,” says Dr. Peter Seymour, also an IU Health Arnett orthopedic surgeon. “It encompasses taking care of the whole shoulder.”
“Through arthroscopy, we are finding new ways to make smaller incisions with less trauma and less soft tissue injury.” Techniques for treating shoulder pain and injuries continue to evolve, Dr. Hubbard says. “We’re getting stronger repairs with less invasive techniques and higher success with rotator cuff healing. This is a pretty progressive field.”
“And new developments are being made all the time,” Dr. Seymour says. DEFINING MOMENTS
ACL Repair a
THREEPOINTER for Kendall Sadler When Kendall Sadler ruptured his ACL playing basketball, he was determined to return to the court. He did, thanks to a skilled surgeon, savvy physical therapist and his own hard work.
After watching Michael Jordan play basketball on television one day, Kendall Sadler, then age 4, told his father, “That’s what I want to do.” The next day, his dad got him a Little Tykes basketball set and soon after a standup goal.
“I felt my left knee pop,” he says. But he was able to walk, run and do a little jumping, so he didn’t seek medical care. “It just kind of hurt. I didn’t think it was anything serious,” he says.
“I would play all day and night, in rain and snow,” recalls Sadler. The practice paid off. As number 21 for the Rossville High School Hornets, he achieved a long-time goal his senior year, breaking the school’s 23-year record for the most assists in any game—a whopping 16.
A couple of weeks later, his basketball buddies headed to the Harrison High School courts.
“It was a record I wanted to break. I’d been staring at it all year,” Sadler recalls. “With four minutes left in the game, I made a pass, we scored and there was a timeout. Then I heard ‘Congratulations to Kendall Sadler. He just broke the assist record.’”
It was a ruptured ACL, a common injury, he learned.
The love of playing still keeps the Purdue University student, now 22, on the court in games with friends. The usual group was shooting hoops at the university’s co-rec facility during spring break in 2011 when Sadler drove to the base line, jumped up, tried to pass the ball and came down. 10
“I went for a lay-up, came down on it and heard something pop. That time I knew something was really wrong.”
MORE ACTIVITY, MORE INJURY “Kids are playing more sports, and they’re playing all year round,” Dr. Peter Seymour, IU Health Arnett orthopedic surgeon, says of the high incidence of ACL tears he sees. He repaired Sadler’s ACL arthroscopically. “Even if they are focusing on one sport, they are playing longer seasons,” Seymour says. “That increases the number of exposures and fatigue. The more risk you take, the more you can get an injury.”
ORTHOPEDICS & SPORTS MEDICINE FULL RECOVERY WITH HARD WORK Physical therapy follows the surgery, and that’s key to a good recovery, Seymour says. “My work ends when the last stitch goes in, then it’s up to the patient to work hard.” Sadler worked with Courtney Hamilton, lead physical therapist with IU Health Arnett. Sadler was “a real work horse” about his recovery, Dr. Seymour says. “ACL recovery takes time, three or four months of rehab and home exercise,” says Dr. Joseph Hubbard, an IU Health Arnett orthopedic surgeon. “We focus on getting muscle strength back, and motivated patients do very well.”
“ACL recovery takes time, three or four months of rehab and home exercise. We focus on getting muscle strength back, and motivated patients do very well.” - Dr. Joseph Hubbard, Orthopedics & Sports Medicine His work paid off. He’s back on the court—frequently, and reports, “My ACL feels so much stronger than it ever has. It feels like nothing happened.” His current goal: “I want to stay in shape and keep playing the game until the game won’t let me play anymore.”
Sadler was indeed motivated. “I told my physical therapist from day one, I don’t care how hard you push me. I want you to.”
What’s Your ACL? How is it Fixed? The ACL, anterior cruciate ligament, is one of the four main ligaments in your knee that connect your femur to your tibia. Your ACL runs diagonally in the middle of your knee. Its job is to prevent your tibia from sliding out in front of your femur and to keep you stable when you rotate. The procedure to repair your ACL restores the torn ligament and stabilizes your knee so you can return to full activity.
REAPING the BENEFITS of RADIAL CATHETERIZATION Using a wrist artery rather than accessing the circulatory system from a groin artery offers patients a safer procedure with fewer chances of complications and a much quicker recovery.
After reporting shortness of breath and heaviness in her chest, Patricia Tyson of Lafayette was scheduled for a cardiac catheterization to check for blockages in her arteries.
compression are needed after this type of catheterization. Patients must lay on their backs for a few hours after the procedure, and they can experience bruising and soreness at the access site.
Though she’d been through this procedure before to place two stents, IU Health Arnett cardiologist Dr. Michael Hogan decided to use a new, different method of catheterization.
The radial artery, located on the underside of the wrist, is supported by a bone underneath it rather than soft tissue. Because the vessel is not as deeply embedded, there’s little risk of bleeding. If there is bleeding, the radial artery is easily compressed and quickly responds to pressure.
Rather than the traditional method of catheterization which enters the circulatory system through the femoral artery in the groin, he instead chose to insert the catheter into Tyson’s wrist through the radial artery. While the radial artery is smaller than the femoral artery, he was able to use the newer method, called transradial catheterization, because catheters are now made smaller than ever before.
LESS RISK OF BLEEDING, BRUISING, PAIN “Patients benefit in multiple ways from a transradial catheterization,” Dr. Hogan says. “There are fewer chances of complications, and the recovery is much faster.” A femoral artery in the groin is a deeply embedded vessel, with only soft tissue under it. Often, several hours of 12
QUICK RECOVERY “Patients return to their daily activities much faster after a transradial catheterization,” Dr. Hogan says. “They do not have to lie still for hours afterward and typically experience much less pain and bruising at the site.” That suited Tyson, of Lafayette, just fine. She likes to keep busy. Her love of children and interest in needlework come together nicely in the crocheted toys she likes to make. “I make afghans, doilies, long-legged clowns, toys and whatever strikes my fancy,” she says of her hobby. “It keeps me calm when I get frustrated.”
CARDIOLOGY The crocheted toys she makes, usually animals, are her favorite creations. The transradial catheterization was good news for Tyson because she was able to get back to crocheting quickly. The even better news was that the procedure did not find additional blockages in her arteries.
“Patients return to their daily activities much faster after a transradial catheterization. They do not have to lie still for hours afterward and typically experience much less pain and bruising at the site.” - Dr. Michael Hogan, Cardiology
Indiana University Health Arnett is proud to bring the
American Heart Association’s Go Red for Women Program to the Greater Lafayette Area.
Go Red For Women encourages awareness of the issue of women and heart disease, and also action to save more lives. The movement harnesses the energy, passion and power women have to band together and collectively wipe out heart disease. It challenges them to know their risk for heart disease and take action to reduce their personal risk. It also gives them the tools they need to lead a heart healthy life.
What is Go Red For Women? In 2004, the American Heart Association (AHA) faced a challenge. Cardiovascular disease claimed the lives of nearly 500,000 American women each year, yet women were not paying attention. In fact, many even dismissed it as an “older man’s disease.” To dispel the myths and raise awareness of heart disease as the number one killer of women, the American Heart Association created Go Red For Women – a passionate, emotional, social initiative designed to empower women to take charge of their heart health. Begin Your Heart Health Journey Today – www.goredforwomen.org
D EDFEI N M OMMOEMNETNST S13 13 F I N IGN G
Outsmarting Cancer IU Health Arnett Cancer Services is the largest collection of cancer specialists and innovators in the region using new technologies, clinical expertise, clinical research options and a multi-disciplinary team approach to care. Our unique partnership with IU Health Simon Cancer Center means more treatment options for patients and a better chance of recovery, thanks to our internationally-renowned researchers who use new thinking and leading edge procedures to pioneer innovative therapies. IU Health Arnett Cancer Services treats a wide spectrum of different cancers, striving to bring the newest and most innovative treatments to the region. Patients have many options for their cancer care and they work with their physicians as an active participant in directing care. The needs of a person with cancer change throughout the cancer experience. IU Health Arnett Cancer Services provides convenient, expert services and resources to meet these changing needs.
OUR TEAM We use an integrated approach to cancer care. Primary care physicians, radiologists, general and plastic surgeons work with oncologists and radiation oncologists to provide you with a personalized treatment plan. Each physician plays an important role in achieving the best possible outcomes. Our medical and radiation oncologists meet weekly with other specialized experts to evaluate patient diagnoses and plan effective treatments. Our team approach to care ensures that patients benefit from a highly-skilled team of experienced professionals from a range of healthcare and related disciplines. Furthermore, all of the care provided within the IU Health Arnett system is tracked in a robust, secure electronic medical record, allowing physiciansâ€™ instantaneous viewing of your chart, including labs, allergies, admissions and outpatient notes.
IU Health Arnett PROVIDES NEW CANCER TREATMENT using Varian’s RapidArc® radiation therapy IU Health Arnett is offering a new cancer treatment option using the latest technology from Varian Medical Systems – The Trilogy Linear Accelerator with RapidArc® Technology. The new accelerator, located at IU Health Arnett Cancer Care, Lafayette, significantly shortens treatment time. It is two to eight times faster than other conventional radiation delivery options, while improving the precision of the radiotherapy. “With this new technology, we are able to shape the radiation beam with much better precision to target cancerous tissue and avoid damage to surrounding normal tissue or organs with unprecedented speed,” said Arthur Ko, MD, PhD, radiation oncologist at IU Health Arnett Cancer Services. “Increased precision is achieved through high-
definition beam shaping with a multileaf collimator built in this new radiation treatment machine. It also minimizes the impact on our patients’ daily lives because it only takes a few minutes to undergo the treatment.” “Rapid Arc’s improvement over prior technologies rests in its ability to deliver IMRT treatment while the machine rotates around the patient, delivering a homogeneous dose to the tumor more precisely than before, and in less time.” RapidArc® can be used to treat different types of cancer, including prostate, skin, breast, brain, head and neck, throat, larynx, thyroid, bone, ovarian, lung, pancreas, esophagus, anorectal and uterine.
IU HEALTH ARNETT CANCER TEAM
Wael A. Harb, MD Medical Oncology & Hematology Medical Director: Cancer Services Director: Clinical Research
Thomas Jones, MD, FACP Medical Oncology & Hematology
Vijaya Kakani, MD Medical Oncology & Hematology
Arthur Ko, MD, PhD Radiation Oncology
Ajita Narayan, MD, PhD Medical Oncology & Hematology
CANCER CARE always IMPROVING IU Health Arnett medical oncologist Dr. Wael Harb, who treats all types of cancer, says, “This is a very exciting time for fighting cancer. We are making a lot of progress.” He cites recent research in understanding why cancer happens and why it behaves as it does. “And there are over 1,000 drugs in the pipeline for biologically-targeted
therapies that are more specific, more effective and have less side effects.” Already, some patients can be treated with very personalized, targeted treatments, he says. “And a lot of people are enjoying their lives and families because of the treatments available.” DEFINING MOMENTS
Swings BACK INTO HEALTH
Faced with bladder cancer, John Engler’s attitude was, “Let’s get on with it.” He did, developing a treatment plan that allowed him to see the best experts, but receive care close to home.
Life has come full circle for John Engler, who grew up in the Land of Lakes, as Wisconsin is nicknamed. Today he’s spending retirement by the twin lakes and enjoys boating on Lake Freeman and golfing in Monticello. “Boating is a good part of it in the summertime,” he says of his retirement years, which began in 2004. “We have a lot of summer company and get a lot of friends up here for a weekend or a few days.” A bump in the road derailed him for several months, but by summer 2012, he was back on course.
“I was pretty scared and nervous about the surgery. I was worried about the future and what the diagnosis meant,” Engler says. “This kind of news is very scary for a person and for a family,” Dr. Wael Harb, Engler’s oncologist at IU Health Arnett, says. “We do make a difference. We do have a lot of success stories, but that doesn’t make it easier on the person.” In the meantime, Engler participated in a 30-day clinical trial with Dr. Noah Hahn at the IU Health Melvin and Bren Simon Cancer Center.
BLADDER CANCER SURGERY In March 2011, Engler noticed blood in his urine. “That’s what led me to the doctor, some tests and a biopsy,” he says. The diagnosis was locally advanced bladder cancer. He was scheduled for surgery with Dr. Richard Foster at Indiana University Health Melvin and Bren Simon Cancer Center in Indianapolis. 16
“I did that to be of help,” Engler says. “It was something to try. It might not be of great benefit to me; it might shrink the tumor a little, but it could be beneficial to other people.” The clinical trials at IU Health Melvin and Bren Simon Cancer Center help cancer experts advance treatment in many different types of cancer, but without people like Engler, they can’t make these breakthroughs.
CANCER CARE “The trial was to give an oral drug for a month before surgery to decrease the size of the tumor and improve the chance of eradicating the cancer,” Dr. Harb says. “This would help optimize treatment for future bladder cancer patients as we learn how well the drug works.”
“I was pretty scared and nervous about the surgery. I was worried about the future and what the diagnosis meant.” - John Engler, Patient
Engler’s surgery went well, and he spent 12 days at IU Health Melvin and Bren Simon Cancer Center. “The roughest part was not eating anything for 10 of those 12 days,” he says. “Chicken broth was the first thing I had.” As for his care, he says, “I can tell you the people are fantastic—all the doctors, nurses, nurses’ aides, even the lady who came in to clean the room. They were all friendly and helpful.” After his procedure, Dr. Foster told him he believed he got all the cancer, and the lymph nodes were clear. “He told me it was up to me if I wanted to have chemo, but he didn’t know if I needed it. He encouraged me to talk to my oncologist.”
OPTED FOR CHEMOTHERAPY After consulting with Dr. Hahn and Dr. Harb, Engler opted for chemotherapy. “They both recommended it, to be on safe side.”
Dr. Harb says having treatment closer to home can be very beneficial to patients. “It is best from quality of life and outcome perspectives to spend more time surrounded and supported by family and friends,” Dr. Harb says. “We are able to deliver most advanced standard chemotherapies to cancer patients at IU Health White Memorial Hospital and we work closely with IU Health Arnett Cancer Services and IU Health Melvin and Bren Simon Cancer Center. Engler’s treatments began in August and ended near Thanksgiving. “It went very well. I really had minimal side effects,” he says. “I was a little tired, a little weak, but that was the extent of it. I never got sick. I never lost my appetite.”
CANCER-FREE TODAY Since then, three PET scans have shown he’s cancer free.
Engler was able to continue getting care from the same IU Health doctors, but received his treatment close to home by going to IU Health White Memorial Hospital in Monticello. “It’s a great facility. You have a private room, your own TV and it’s quiet. There’s a healing garden outside your room; it’s convenient and the nurses were fantastic.”
“I’m feeling good. I have my strength back,” he says. Engler is back to an active retirement that includes golf, planting a vegetable garden, traveling with his wife, Pat, and boating on Lake Freeman.
Having survived bladder cancer, John Engler offers these tips to others:
Pointers from a Patient
• Don’t use tobacco. He used to smoke and quit 37 years ago. He’s since learned that smoking is one of the greatest causes of bladder cancer. • Take early detection seriously. See a doctor as soon as you see any type of symptom. “I did, which I think helped.” • Eat a healthy diet. Although making healthy choices at the grocery store and at mealtimes can’t guarantee cancer prevention, it may help reduce your risk. • Stay active. Maintain a healthy weight and include physical activity in your daily routine. DEFINING MOMENTS
Show support for our community by shopping.
When you shop at The Orchard Gift Shoppe, all proceeds benefit the Friends of Arnett Auxiliary. Friends of Arnett is a group of committed community members who raise money to support IU Health Arnett through education, fundraising and community outreach. Money spent in the gift shop helps ensure that our community gets the best healthcare and best health education.
Get a 10% off coupon to The Orchard Gift Shoppe instantly by scanning the QR code and filling out the entry form or going to iuhealth.org/arnett/ definingmoments. You will also be entered to win a $50 gift card to The Orchard Gift Shoppe.
Scan to Register or visit iuhealth.org/arnett/definingmoments
For more information about the Friends of Arnett Auxiliary or volunteer opportunities, please call 765.838.6288 or visit iuhealth.org/friendsofarnett.
To empower you to take charge of your health. Indiana University Health Arnett is proud to offer MyChart, a secure, online patient portal that allows you instant, access to your health records. Now you can review test results, ask about prescription renewals, even request an appointment. Ask about registering for MyChart during your appointment or visit iuhealth.org/mychart. Scan the QR code to sign up for MyChart or visit iuhealth.org/mychart
MyChartÂŽ licensed to Epic Systems Corporation, ÂŠ 1999-2012. Patents pending.
Adult Preventive Health Plan One of the most important things you can do for your health is to schedule regular checkups with your primary care provider. Use these preventive care guidelines to help keep you and your family on the road to good health. Bring this plan to your next checkup or office visit, and discuss with your physician. Remember people at high risk for certain diseases may need earlier or more frequent screenings. Which tests you should have depends on your family history, age, sex and other factors. Talk with your doctor to learn more about the type and frequency of screening that is right for you.
TYPE OF SCREENING
WHO NEEDS THE SCREENING
WHEN, HOW OFTEN OR HOW MANY DOSES
CERVICAL CANCER Pap Test
Women beginning 3 years after becoming sexually Every 1 to 2 years, depending on active, but no later than age 21 type of test used
BREAST CANCER Breast self-exam
Women ages 20 and older
Breast clinical exam
Women ages 20 to 39
Every 3 years
Women ages 40 and older
Women ages 40 and older
Digital rectal exam
Men ages 50 and older
Discuss with doctor yearly
Prostate-specific antigen test
Men ages 50 and older
Discuss with doctor yearly
Adults ages 50 and older
Every 5 to 10 years, depending on the procedure
Skin examination by physician
Adults ages 20 and older
Periodic, as part of a routine cancer-related checkup
COLON AND RECTAL CANCER Preferred: Flexible sigmoidoscopy, colonoscopy, double contrast barium enema, CT colonography*
OTHER RECOMMENDED SCREENING PROCEDURES Blood pressure monitoring
Adults ages 20 and older
Each regular healthcare visit or at least every 2 years
Blood cholesterol measurement (fasting lipoprotein profile)
Adults ages 20 and older
Every 5 years; more often for those at higher risk
Weight and body mass index
Adults ages 20 and older
Every regular healthcare visit
Blood glucose test to screen for diabetes
Adults ages 45 and older
Every 3 years
Glaucoma screening (comprehensive eye exam with dilated pupils)
All adults ages 60 and older
At least every 2 years
Bone mineral density (BMD) test to screen for osteoporosis
Women ages 65 and older
Check with your healthcare provider
* Other less invasive tests are available but are often less reliable. Talk with your doctor about the best option for you. Sources: American Cancer Society, American Heart Association, Centers for Disease Control and Prevention, National Institutes for Health
More than 250 physicians and healthcare providers to care for you. Allergy & Asthma Donald E. Clayton, MD, FAAAI Jay Prochnau, MD Anesthesiology C. Merrill Ashby, MD Anne-Marie Avallone, DO Vinayak C. Belamkar, MD Mark Buono, MD, PhD Mussart Chaudhry, MD Thomas Gallen, MD, MPH Zumran Hamid, MD Tanmay Panigrahi, MD Paula Rawls, MD Gabe Salamie, MD Dmitriy Sintsov, MD Stanley Weber, MD Adejare Windokun, MD John Allen, CRNA James Bartu, CRNA Hugh Brooks, CRNA Terri Curtis, CRNA Karen Marsh, CRNA Jamie McLaughlin, CRNA Georgia Montgomery, CRNA Sherry Motto, CRNA Stephanie Preston, CRNA Elaine Randall, CRNA Tom Runyon, CRNA Vesna Watters, CRNA Susan Wodrich, CRNA Gob Worstell, CRNA Audiology & Hearing Aid Services Carol Downard, AuD Andrea Gray, MS Bariatrics Ruban Nirmalan, MD, FACS Cancer Services Wael A. Harb, MD Thomas I. Jones, MD, FACP Vijaya Kakani, MD Song-Chu (Arthur) Ko, MD, PhD Ajita Narayan, MD, PhD Gilbert Almanza, AOCNP Nadine L. Bruns, ANP Karen Jaworski-Semyen, RN, MSN, CNS, AOCN Cardiovascular Timothy Cordes, MD (Pediatrics) Robert Darragh, MD (Pediatrics) Eric Ebenroth, MD (Pediatrics) Anne Farrell, MD (Pediatrics) Michael Hogan, MD, FACC
Roger Hurwitz, MD (Pediatrics) Priit Jaagosild, MD Tiffanie Johnson, MD (Pediatrics) Philip C. Krause, MD Jacqueline Maiers, MD (Pediatrics) Charan Mungara, MD Jeetendra Patel, MD Sirumugai Saravanan, MD Marcus Schamberger, MD (Pediatrics) Kenneth S. Stone, MD, FACS, FACC, FCCP Igor Tubin, MD Bing Wu, MD, PhD Alicia Pate, PA Patricia A. Fischer, FNP Kelly Manicke, CANP Jamie Rudicel, ANP Child & Adolescent Psychiatry Elizabeth Kowal, MD Dermatology Joseph Fruland, MD Ghada K. Kassab, MD Robert W. Martin III, MD Ear, Nose & Throat J. William Bremer, MD, FACS Timothy Cupero, MD Stephen L. Henson, MD Endocrinology Dona Gray, MD, FACE, FACP Shannon K. Oates, MD, FACE Richard Jones, PA Julie A. VanMatre, CANP Sue Robbins, CDE Family Medicine Peter R. Ansorge, MD Sarah Antalis, MD Leslie Bentinganan, DO Victor Bentinganan, DO James L. Blumling, MD James Croner, MD Alfie Diamond, MD Brian L. Doggett, MD, FAAFP Jordan Dutter, MD Tamara Hazbun, MD Jason P. Hendrick, MD Amber Hussain, MD Philip Keller, MD Adel Khdour, MD William Y. Li, MD Lisa M. McTavish, MD Mark A. Meyer, MD Joel Mulder, DO Chirag Patel, MD
David P. Regnier, MD Martin Scheidt, MD Thomas Stolz, MD, CMD, FAAFP John M. Thomas, MD Amy V. Villavicencio, MD Jeffrey Wang, MD Keith R. Whitesides, MD Stacy Eldridge, CFNP Patricia R. Hoyer, CFNP Thomas C. Kerr, FNP Judith Anne McIntosh, ANP-BC Kimberly Rogers, ANP Warren Root, FNP Barbara Salem, CFNP Terah Sproule, CFNP Deb G. Weirick, CFNP Anne W. Zahnke, CANP, FNP Gastroenterology Naveed Ahmad, MD Stephen Deutsch, MD, FACP, FACG, AGAF Ikenna Egbuna, MD Rama Marepally, MD Don F. Shook, MD General Surgery Roger G. Bangs, MD, FACS Richard C. Berg, MD, FACS Richard Carson, MD Jack L. Kelley, MD, FACS Charles Leys, MD (Pediatrics) James Maresh, MD, FACS Ruban Nirmalan, MD, FACS Frederick Rescorla, MD (Pediatrics) Gynecology Joel B. McCuaig, MD, FACOG Hand Surgery Gregory Merrell, MD, FACS Mollie Hanlon, ANP Hospitalist Saeed Ahmad, MD Zarah-Ann Alba, MD Jeffrey P. Brown, MD Usman Y. Cheema, MD Carmen Davis, MD Nazir Delawar, MD Ryan Deweese, MD J. Brooks Dickerson, MD Gary W. DuprĂŠ, MD Femi Lasisi, MD Cherie Lhungay, MD Chris Mansfield, MD Christopher Marino, MD Nabia Noman, MD
Discover the strength at iuhealth.org/arnett To schedule an appointment call: 765.448.8100 or 800.542.7818
Falguniben A. Patel, MD Kaushal Patel, MD Radomir Piwko, MD Bryant Pryor, MD Jeremy Remus, MD Arnold Requierme, MD Randall Riley, MD Jacob Thomas, MD Kim Tyus, MD Shiqing Yan, MD Infectious Diseases Barbara G. Bielska, MD Mitchell Krathwohl, MD Thomas L. Meyer, MD Internal Medicine Garland Byron, MD Jeffrey L. Duvall, MD Timothy D. Fisher, MD Marcella Gibbs, MD Sarah Hallberg, DO Andrew R. Hart, MD Ritu M. Kalwani, MD Scott C. Miethke, MD Esteban Ramirez, DO Kevin D. Schendel, MD Julie P. Schleck, MD Kurt J. Schleck, MD Sarah Sutton, MD Monica Keyes, ANP Janelle Potetz, APN Megan Rowe, ANP Candice G. Walker, CANP Anne W. Zahnke, CANP, FNP Neonatology Derrick Rollo, DO Abhay Singhal, MD Sara Herrman, PA Audra Armstrong, NNP Amanda Ferguson-Macy, NNP Laura Ellen McDaniel, NNP Casie Miller, NNP Jennifer Myers, NNP Brandi Vandivier, NNP Courtney Wolf, NNP Stacy Yeo, NNP Nephrology Akram Al-Makki, MD, FACP, FASN Stephen R. Ash, MD, FACP Rabih Kalakeche, MD James M. Sutton, MD Amy Allspaw, CNS Neurology Cheng Du, MD Scott W. Hoyer, MD Sara Huffer, MD Margaret Laycock, MD Patsy R. Hoyer, CFNP Obstetrics & Gynecology Mariam Eid, MD, FACOG Meenu Goel, MD Brianna Haab, MD Debra J. Madura, MD Howard L. Schafer, MD Noel Wallace, MD
Anne Mishler, CNM Sharon Smith, CNM Laurie Gee, MSN, WHNP Dianne L. Tao, MSN, WHNP, ANP Occupational Services S. Douglas Greeson, MD, MPH Carl D. Griffin, MD Ed Scott, DPT Ophthalmology Robert L. Larew, MD, FAAO Alvin H. Tao, MD, FAAO Orthopedics & Sports Medicine Joseph Hubbard, DO Eric M. Orenstein, MD, MBA, FACS, FAAOS Peter Seymour, DO Jeffrey Wang, MD Megan Martin, ANP Pain Medicine Ryan Loyd, DO Leta Bennison, CFNP Pediatrics Michael J. Beardmore, MD, FAAP Donald Fahler, MD Chester M. W. Ho, MD, FAAP Sabeena Hubbard, DO (Hospitalist) Michael M. Hunter, MD, FAAP Steven R. Lipp, MD, FAAP Johari N. Miller, MD, FAAP Laura Walls, MD Linnette Woodman, MD, FAAP Theresa A. Woods, MD, FAAP Mary Lou Ertel, CPNP Noelle Lottes, CPNP Anna Musser, CPNP Marcia A. Stroup, CPNP Plastic Surgery Ayaz Shaikh, MD, FRCSC, FACS, ASPS Allyn Farmer, PA Pulmonary Diseases & Critical Care Mazen Alakhras, MD, FCCP Muhammad Ali, MD Tasbirul Islam, MD Adil Keskin, MD, FCCP Mallory Hoy, PA Radiology Mark C. Arvin, MD Jeffrey S. Cahoon, MD John R. Carney, DO Douglas M. Dunco, MD Rodney A. Dunseath, DO D. Makana Edwards, MD, MS Katharine Krol, MD Kenneth Marnocha, MD Phyllis Martin-Simmerman, MD Neil Mascarenhas, MD Paul E. Timperman, MD Erika Ugianskis, MD Rehabilitation Services PHYSICAL THERAPY
Patrick Adsit, PT
Ronaldo Austria, PT Electry Baguio, PT Vicki Diehl, PT David Dye, PT Cynthia Gibson, PT Loudyfel Go Soco, PT Courtney Hamilton, PT Patrick Hayes, PTA Abbey Hutton, PTA Lynn Nelson, MHS, DPT Jenelle Owens, PTA Tom Ragle, PTA/ATC Carla Rock, DPT Marke Schuldt, ATC Melissa Schussman, PT Malcolm Sison, PT Jim Starkweather, ATC/L, CSCS, LMT Sharlyn Tolentino, PT Bill Waggoner, PT Sarah Wardwell, ATC Erin Wohlfert, PT/ATC Lisa Wilder, PTA/ATC OCCUPATIONAL THERAPY
Toni Davisson, OTR Alfredo Enriquez, OTR Jessica Herceg, OTR Jody Lee, OTR-CHT Ryan Lee, OTR-CHT Stacy Lokke, MS, OTR Mukesh Malhotra, OTR Kristen Mears, OTR Anne Mummert, OTR-CHT Stefanie Peregrin, OTR SPEECH THERAPY
Emily Bauman, MS, CCC-SLP Abby Burcham, MA, CCC-SLP Megan Darling, MS, CCC-SLP Lauren Lowrey, MA, CCC-SLP Nikki Melchi, MA, CCC-SLP Claudia J. Mornout, MS, CCC-SLP Michelle Morgan, MA, CCC-CLP Barbara Solomon, MA, CCC-SLP Dawn Wetzel, MAT, CCC-SLP Rheumatology Artur Kaluta, MD Michael B. Lockwood, MD, FACR Mala Natarajan, MD Sleep Medicine Mazen Alakhras, MD, FCCP Muhammad Ali, MD Scott W. Hoyer, MD Adil Keskin, MD, FCCP Urgent Care Andrew Edwards, MD Salman M. Husain, MD George Karagory, MD David Mitchell-Flynn, MD Kishan Patel, MD Lori Pekarek, MD Margo A. Taylor, MD Gordon D. Welk, MD, CMD, FAAFP Urology John D. Reisman, MD, FACS Norbert M. Welch, MD, FACS Doug Doll, PA
For the most up-to-date listing of providers, visit iuhealth.org/arnett/find-a-provider D E F I N I N G M O M EÂŠ2012 NTS 21 IUHealth
Pediatric Preventive Health Plan Childhood is a time of rapid growth and change. Regular well-child examinations by your child’s doctor are essential to keep your child healthy and up-to-date with immunizations against many serious diseases. A checkup also gives your child’s doctor an opportunity to talk to you about developmental and safety issues and gives you an opportunity to ask any questions you might have about your child’s overall health.
Well Child Visits
Influenza (Sep-Apr only)*
Screening Metabolic & Hearing
2 Week 1 Month 2 Month
12 Month 15 Month
DTaP & HIB
Screen for TB & Developmental
Lead & Anemia
Developmental & Autism
Hearing & Vision
Hearing & Vision
Hearing & Vision
Hearing & Vision
DTaP & IPV
*will need 2 vaccines 4 weeks apart if under 9 years of age the first year that the Flu Vaccine is given to ensure protection.
Influenza (Sep-Apr only)
Annual Visits Recommended
Hearing (at 10 years old) & Vision
Annual Visits Recommended Vaccines: Meningitis (MCV-4); Tetanus/Pertussis Booster (Tdap); HPV vaccine
Annual Visits Recommended Vaccines: HPV #1, 2, 3 if not already received; Meningitis (MCV-4) Booster at 16 years and older
Tale of Two Concussions “Sam got hit. She seems to be okay, but I wanted to let you know I’m taking her to the emergency room.” That October 2011 call from Jim Scott alerted his wife, Chris Scott, that their daughter, Samantha, then 16, had been hit in the head with a bat during an out-of-town softball game. “I didn’t feel like myself. I felt like I wasn’t even there, like I was talking real slow and moving real slow,” says Samantha. A CT scan showed there was no bleeding, and she returned to the game. The following morning, Samantha was still feeling out of it.
“When Dr. Fahler said ‘concussion,’ I didn’t really know what a concussion was, so I didn’t know how serious it was,” Samantha says. “My dad had played football, and he said that back then, concussions weren’t a big deal. Now I guess they are.” Her treatment was rest—complete rest. “No texting. If she watched TV, it had to be very calming. She stayed down an entire week,” her mother says. Although Samantha had not had a baseline ImPACT® test—to establish pre-injury function, she did have one after her brain had rested enough following the concussion.
HIT AGAIN “I had a bad headache when I woke up, but I thought, ‘Well, you got hit in the head with a bat, you have to at least have a headache.’”
The following January, Samantha took another hit to the same spot on her head during practice. It, too, was a concussion.
She played two games that day, then they drove back to West Lafayette.
And the earlier ImPACT® test proved valuable in assessing her recovery the second time around with a repeat test.
The next day, her mom called their pediatrician, and he referred her to Dr. Donald Fahler, an IU Health Arnett pediatrician who has been specially trained in treating concussions. “I could tell she wasn’t herself at all,” her mother says of their appointment that day. “She was seeing dots and stars and had a massive headache.” Dr. Fahler confirmed that Samantha had suffered a concussion—an injury that shakes the brain and bangs it against the skull.
Today, her mom says, “I feel all athletes should go through baseline ImPACT® testing as part of a physical. I’m a believer. Because we didn’t have that, our child was at a disadvantage and so were the doctors. I am an advocate for the baseline.” As for keeping her head safe in future games, outfielder Samantha says, “If I played infield, I would wear a facemask. I wear my helmet whenever I’m around bats. And I keep my glove in front of the ball.” DEFINING MOMENTS
HEART & DIABETES
BASELINE ImPACT TESTING ®
helps monitor concussions As knowledge increases about the severity and possible long-term effects of concussions, researchers and physicians are searching for effective precautions and treatments. The ImPACT® Testing Program evaluates post-concussion tests against pre-concussion tests to determine when it’s safe to return to full activity without the danger of a cumulative effect. When the brain—a soft organ surrounded by protective spinal fluid—slams against the skull, it results in a concussion, a serious issue. “It can lead to devastating problems,” says Dr. Donald Fahler, IU Health Arnett pediatrician. Dr. Fahler is specially trained in treating concussions, and he works with researchers at Purdue University as they explore ways to prevent head injuries and new methods for managing them when they do occur. While playing football seems to be blamed for most concussions, “Kids from every sport are getting concussions,” he says. “I never count out any sport that has moving people and a moving object.”
PRE-INJURY TEST HELPS POST-INJURY He recommends a baseline ImPACT® test for youths age 11 and older before any injury occurs. 24
It is best administered one-on-one to avoid distractions. The computer-based test evaluates reaction time, concentration and memory. Having that information on file in case of an injury later is valuable when testing post-injury. Results of a post-injury ImPACT® test can tell how badly the brain has been affected and how much more rest the brain may need before activity is resumed. “The test is helpful in managing the injury, and it might speed up the process of getting a kid back to full participation in athletics and academics,” Dr. Fahler says. “It’s been used by professional sports players for years and is well-validated,” he says. “It isn’t perfect, but it helps determine and manage head trauma and concussions to the best of our ability using today’s best tools. Now parents and coaches are getting more in tune with doing a baseline.”
PEDIATRICS REST CRITICAL IN CONCUSSION RECOVERY Should a child get a concussion, the brain needs absolute rest, he says. “If your eyes are open, if you are thinking, your brain is working, and sometimes even simple tasks trigger worsening concussion symptoms.” Dr. Fahler prescribes complete rest. “Only do what you absolutely have to do—eat and go to the bathroom. If you’re not bored when you’re recovering from a severe concussion, then you are not doing what you are supposed to be doing. If symptoms worsen during any normal daily activities, avoiding these activities can be crucial to a safe, efficient and complete recovery.” Symptoms of a concussion are not always apparent, so any blow to the head should be checked out by a physician.
“I feel all athletes should go through baseline ImPACT® testing as part of a physical. I’m a believer. Because we didn’t have that, our child was at a disadvantage and so were the doctors.” - Chris Scott, Mother When there are symptoms, they might include headaches, blurry vision, vomiting, fatigue, highly emotional reactions, sleeping too much or too little, feeling fuzzy or being unable to focus or remember new things. Though many people feel that people make too big a deal out of concussions, Dr. Fahler disagrees. “On a scale of 1-10 for seriousness, a concussion rates an eight or a nine,” he says.
To keep athletes on top of their game. 1 in 10 student athletes will suffer a concussion this season. Approximately 10 percent of all athletes involved in contact sports suffer a concussion each season; some estimates are as high as 19 percent. IU Health Arnett Physicians is proud to offer ImPACT® testing to student athletes in our community. Having a baseline test now can be a game-changing decision if your child suffers a concussion this season. Baseline testing is available for children ages 11-18 at a cost of $20.
Call 765.448.8100 or 800.542.7818 to schedule a baseline test for your child today. iuhealth.org/arnettsportsmed
©2012 IU Health 08/12
“As a teacher, I agree on the MOTHERHOOD
utmost importance of sleep. Not just to stay healthy, but to stay alert and focused in the classroom.” - Aaron Hamilton, 4th Grade Teacher
KIDS NEED THEIR SLEEP Bedtime can be a fight, prompting some parents to let it slide. However, enough sleep has everything to do with health, attention, learning and behavior, report Dr. Laura Walls, an IU Health Arnett pediatrician, and Aaron Hamilton, a 4th grade teacher at Wyandotte Elementary School. What’s all the fuss about bedtime and sleep? What if kids don’t get the recommended amount of sleep? Is TV okay at bedtime? Two professionals share their insights and recommendations.
HOW MUCH REST SHOULD CHILDREN GET?
HOW MUCH SLEEP DO NEWBORNS NEED?
DR. WALLS: Newborns can sleep anywhere from 16 to 20 hours a day. In the very beginning, it is normal for newborns to sleep for anywhere from 30 minutes to 4 hours at a time. Sometimes their day and night cycles are reversed and they have long stretches of sleep during the day and more restless, shorter naps during the night. It is important to keep their environment as dark and quiet as possible at night to help them learn that night time is for sleeping. It can take 2-3 weeks for a baby to reverse his day/night cycle.
DR. WALLS: Infants: By the time a baby is six months old he or she should have most of his sleep consolidated to the night time hours, about 10-12 hours at night is recommended along with approximately 3 hours of sleep during the day, typically divided between 2 or 3 naps the first year of life. Age 1 to Preschool: 11.5-14 hours in a day. Naps are usually consolidated to one afternoon nap between 12 and 18 months. Routine and consistency will help you find the best pattern for your child. Follow their cues: eye rubbing, yawning or grumpiness are signs that your child is ready to nap.
Preschool: 11-12 hours School age: 10-11 hours Teens: About 9 hours
PEDIATRICS HOW IMPORTANT IS ENOUGH SLEEP?
dreaming, tends to make the reason for being at school nearly worthless. The student’s personal best dwindles. There is little or no involvement, and he or she may learn nothing.
AARON HAMILTON, 4TH GRADE TEACHER: There has been a lot of research on how much sleep kids need to stay healthy. As a teacher, I agree on the utmost importance of sleep. Not just to stay healthy, but to stay alert and focused in the classroom.
IS TV OKAY AT BEDTIME?
DR. WALLS: Children need sleep for all aspects of growth. It is a time for their body to rest and restore. It is a time for brain development and physical growth. Children without appropriate sleep often have behavioral problems, difficulties controlling their emotions and poorer attention spans. Behavior is significantly affected by sleep at any age and should be a priority starting from the newborn period throughout life.
WHAT ABOUT BEDTIME SNACKS?
DR. WALLS: Exposure to any media (TV, computer or video games) requires a lot of brain activity and should be stopped at least one hour before bedtime to be sure the mind has time to slow down before going to bed. Falling asleep with the TV on in the background disrupts a person’s sleep cycle and does not allow for them to get restful, restoring sleep.
HAMILTON: The eyes droop, the head bobs or they sit upright with eyes wide, but glassed over. Even though the morning math lesson is going on, they are oblivious to the new information being presented.
WHAT IS A GOOD BEDTIME ACTIVITY?
WHAT ARE THE TELL-TALE SIGNS OF NOT ENOUGH SLEEP?
HOW DOES TOO LITTLE SLEEP AFFECT A CHILD?
DR. WALLS: We know that too little sleep can lead to poor behavior, shorter attention spans, poor learning and more defiant behaviors in children. We are also learning more and more about the physical effects of not enough sleep. In adults, there are intriguing associations between shorter sleep durations and higher risks of heart disease and diabetes. There is also evidence suggesting children who get more sleep at night are less likely to be overweight and obese. Sleep is important for every aspect of our day-to-day functioning.
HAMILTON: Responsibility, personal best, attentiveness and involvement are just some of the things I ask from my students as they work to better themselves each day at school. If a student comes in after a late night, he or she usually brags about how late they got to stay up, but then, once the learning starts, the focus is gone (usually completely absent). Daydreaming, or actually
Set the Stage for
DR. WALLS: Most children do not have a nutritional need for latenight snacks, and this is a habit that could lead to obesity. If you think they nutritionally need a snack closer to bed, maybe a small glass of milk, a cheese stick or half an apple with a little peanut butter.
DR. WALLS: Taking a warm, soothing bath, reading bedtime stories or singing lullabies are nice activities that can quiet energetic minds and help them get to sleep.
WHAT ARE THE BENEFITS OF GOOD REST FOR CHILDREN? HAMILTON: I can expose a student to all the knowledge in the world, but I cannot make him or her listen to it, retain it or use it, especially if that student has chosen a late night over a restful one. Rested children are in better shape to learn.
DR. WALLS: A good night of sleep is part of a healthy lifestyle and allows children to function at their best during the day. Just like you teach your children about fruits and veggies and good eating habits, you also need to teach them about good sleeping habits, something they will need their entire lives.
Dr. Laura Walls, a pediatrician at IU Health Arnett, offers these tips for getting children to sleep so they get sufficient rest: • Keep your children from watching scary movies or adult TV shows that can prompt fears or nightmares at bedtime. • If your child is worrying about something that keeps him or her awake, talk with the child about any fears or concerns. Make sure their emotional health doesn’t affect their sleep. D E F I N I N G M O M E N T S 27 • Provide the right sleep environment: dark, cool and quiet. Laura Walls, MD
Families Gain Power Over Pounds Nutrition lessons, tips to modify your eating habits and fun exercises and games add up to Power Over Pounds, a popular, four-session program that’s free for families.
With video games drawing children to sedentary activities and fast food proving more tantalizing than healthy meals, it’s difficult for families to embrace good nutrition and physical activity. The Indiana State Department of Health reports that 30 percent of children ages 10 to 17 are overweight or obese. In Lafayette, families have a free option to help their family develop healthy behaviors.
“We are more into making sustainable, healthy changes, as opposed to overhauling your life in a few weeks.” - Dr. Linnette Woodman, Pediatrics
FREE PROGRAM Power Over Pounds, a free, four-week family program offered by IU Health Arnett and Lafayette Parks and Recreation focuses on changing lifestyles by adding healthy habits to everyday life. Families with children from age 5 to 15 may attend.
SIGN UP FOR
Power Over Pounds Upcoming classes, which are free, meet from 6 to 7:30 pm on Tuesdays:
• January 8 to 29, 2013 • April 9 to 30, 2013 • September 10 to October 1, 2013
To register your family, contact the Power Over Pounds Coordinator, Joy Vanderweilen-Roach at 765.491.9469.
The program covers three areas: • Nutrition, with education from a registered dietitian and taste testing of healthy foods • Exercise, both structured and free play, led by representatives from Purdue University’s Department of Health and Kinesiology • Behavioral modification, where families get tips for lifestyle changes from a licensed psychologist “The dietary part is the most important,” says Dr. Linnette Woodman, an IU Health Arnett pediatrician and member of the program’s steering committee.
LEARNING TRICKS, TOOLS “A lot of parents have problems getting their kids to eat healthy because the kids resist. That’s where the behavioral component comes in. That includes goal setting, short-term and long,” she says. Families also learn ways to make exercise fun. “Our instructors get the kids moving,” Dr. Woodman says. “It’s
PEDIATRICS not about doing pushups. It’s about getting them to see that being active can be fun.” Good candidates for the program are families interested in and motivated to make some changes. Dr. Woodman especially encourages parents to enroll if one or more of their children is rapidly gaining weight or has an elevated body mass index, high blood sugar, glucose intolerance or high cholesterol. “We encourage the whole family to come,” she says. “We don’t want to single out a child with a weight issue, and we do want the whole family to make healthy changes.” It’s not an overnight, drastic change that families are asked to make, she says. “We are more into making sustainable, healthy changes, as opposed to overhauling your life in a few weeks.”
THUMBS UP FROM TOMAS FAMILY
When she learned about the program, Gianna Tomas, 9, now a 4th grader, says, “I wanted not to go because I would miss my TV shows.” “She gave me a hard time at first,” says her father, Ivan Tomas. That soon changed. “By the second session, she was saying, ‘Let’s go to our class.’” Her brother Ivan, 7, also participated. As a family, sometimes with their grandmother attending, too, they learned about nutrition, exercise and healthy habits.
PRIZES, HEALTHY TREATS POPULAR “Sometimes we got prizes. I enjoyed that,” Gianna says. “I ate yogurt, and, yes, I liked that. And we learned not to eat junk food and not to eat so much.” Today, Gianna lists a litany of favorite vegetables—carrots, cauliflower, peas and green beans. “I like them more with the class,” she says. Reading and playing video games are among her pastimes. When she’s ready for active play, she likes softball, soccer and swimming. “I think the program is wonderful in every aspect,” her father says. “It’s well thought out and well organized.”
EASY-TO-MASTER LESSONS The family learned about measuring foods, about high-sugar cereals to avoid and high-fiber cereals to try. “They taught us about exercise and made it fun at the same time,” Tomas says. And relating exercise to calories helped influence better choices, he says. “With exercise, you can say, ‘Wow, I worked this much and burned this amount of calories.’ Then if you eat a chocolate bar, you say, ‘Oh, man, I didn’t do anything.’” A three-dimensional house created by the Stop Taking on Pounds Program at Reid Hospital in Richmond, Indiana, illustrating the right foods and amounts—with candy, donuts and cake banned to the attic—helped the children understand the nutrition lessons. “They have something really good going there,” Tomas says. “They work with the children and educate the parents at the same time.” Despite her initial hesitancy, “It’s not so bad,” Gianna now says. “You get snacks and prizes. You learn what to eat and what not to eat and to try to not be non-healthy. It’s fun, actually.”
Tasting healthy foods, playing in the gym together and getting fun prizes like a jump rope, kickball and water bottle topped the list of fun things the Tomas family enjoyed in the Power Over Pounds program.
The program teaches tips such as these: • Eat more fruits and vegetables • Balance your meals throughout the day • Keep portions to recommended sizes • Drop juice, sweet drinks and soda pop from your beverage list • Participate as a family D E F I N I N G M O M E N T S
“Most people are embarrassed. They say, ‘Oh, no, I wouldn’t tell my doctor. Oh, no.’ But I had the courage to do it, and the medication works.” - Sharon Wood, Patient
URGE INCONTINENCE easily TREATED If you’ve been running to the bathroom a dozen times a day—and even then sometimes experiencing a little leakage—there’s help for you. And it’s simpler than you might think. That’s what Sharon Wood wants all women to know. You break a leg. You get it treated. You call friends and family to tell them about your misfortune. You experience urge incontinence. You wouldn’t think of getting help for it. You don’t tell a soul, not even your doctor.
information whenever I see women for any appointment, and sometimes they will say, ‘Oh, yes, I do have those symptoms.’” “This is fairly easy to treat,” Dr. Goel says.
MEDICATIONS CAN HELP Unfortunately, that’s true for many women. They are missing out on help that could be easy and effective. Fortunately for Sharon Wood, Lafayette, she did mention it to her doctor. Today, she doesn’t experience urge incontinence, and she’s even sleeping straight through most nights without having to get up to go to the bathroom. After experiencing two instances, Sharon Wood sought help. “It’s so frightening when you think, ‘Oh my gosh, am I going to be able to control it?’ I was mortified,” she says. She spoke with her primary care physician, who referred her to Dr. Meenu Goel, an IU Health Arnett obstetrics & gynecology provider.
NO NEED FOR EMBARRASSMENT “A lot of patients are embarrassed to say they have these symptoms, or they are so used to putting off complaints, they don’t mention them,” Dr. Goel says. “I give routine 30
When Wood came to her, she told her there were several things to try and suggested a medication first, prescribing an anticholinergic medicine that reduces bladder muscle contraction. There are several available and even some generic brands. “I took the pill,” Wood says. “It was like magic. It worked.” Response varies depending on the patient, Dr. Goel says. She also works with patients to retrain the bladder, giving them information on how to do that. “Biofeedback and electric stimulation also can be done,” Dr. Goel says. “Treatment has evolved so much.” “Generally, patients take a medication for a couple of years, at least,” she says. “But some may be able to go off it.” Wood is eager to tell other women that help is available.
OB/GYN “Most people are embarrassed. They say, ‘Oh, no, I wouldn’t tell my doctor. Oh, no.’ But I had the courage to do it, and the medication works,” Wood says.
In retirement, she enjoys hosting guests. “We have a pool, and family and friends come over. We sit in the pool and talk for hours. We have great fun.”
As she shares her story, she’s convincing some friends to find out about treatment. “Several friends have said, ‘I’ll check next time I go to the doctor. I’m going to ask.’”
She’s also active in several Red Hat Society groups, women’s groups inspired by two lines in Jenny Joseph’s poem, “Warning”:
WOOD ENJOYING RETIREMENT The mother of three daughters and six grandchildren, Wood hails originally from Wisconsin. She first lived in Lafayette from 1975 to 1985, then her husband, who worked for an airline, was transferred. When he retired seven years ago, they moved back. Besides being a homemaker, Wood enjoyed a variety of jobs over the years. “My kids were so close together, it was like having triplets,” she recalls. Her outside-the-home posts included working for a government health department, television station, hospital and group that helped lowincome families.
“When I am an old woman I shall wear purple With a red hat which doesn’t go, and doesn’t suit me.” “Some groups go to lunch, and that’s all. Another one I’m in takes trips. We’ve gone to Columbus, Ind. and Champagne, Ill., Avon Gardens. We’ve had Hawaiian luaus, Woodstock parties, fancy teas, a Mardi Gras, ‘50s party and gone line dancing,” she says. “The fun part is getting ready to go, getting your outfits for the events and looking for things at Goodwill,” she says. “I love being part of these groups.”
STRESS INCONTINENCE also TREATABLE Many women suffer from a different type of incontinence called stress incontinence. Stress incontinence occurs during physical activity such as coughing, sneezing or heavy lifting that can put pressure on the bladder and cause leakage. “Stress incontinence is caused by pelvic floor muscle weakness that can no longer provide adequate support for the urethra,” Dr. Goel says. The urethra is a tube through which urine flows and is controlled. While usually the urethra remains closed until you reach a bathroom, weak muscles might not be able to withstand pressure, causing urine release. Stress incontinence occurs more often in women because the stress of
childbirth can lead to weaker bladder muscles. Other risk factors include obesity, smoking, age, previous pelvic surgery such as a hysterectomy and diabetes.
The procedure uses only one 1.5 centimeter incision and a small needle to insert the sling, reducing the risk of infection and leading to a quicker recovery.
“It can only be treated successfully by surgery,” Dr. Goel says. “Lifestyle changes and medication do not improve those symptoms. Pelvic floor muscle exercises may prevent future worsening of symptoms; however, they would not cure the actual condition.”
Though local, regional or general anesthesia may be used, the procedure is done on an outpatient basis in a matter of minutes and you can return home within a few hours. Because it is only one small incision, you can also return to normal activity within one to two weeks.
Dr. Goel performs a minimally invasive procedure in which a mesh sling is used to support the urethra. “The sling cradles the urethra and mimics normal anatomy to give more support and prevent accidental urine leakage,” Dr. Goel says.
“There is minimal pain and discomfort post operatively,” Dr. Goel says, “and 12 month prospective data indicates that it is effective over 90% of the time.”
Easy Office Procedure
PROVIDES PERMANENT BIRTH CONTROL When women are happy with the size of their family and no longer wish to have children, they have a few options for permanent birth control. Hysteroscopic tubal ligation, a nonsurgical, hormone-free option, can be done in office, saving women time, pain and money. Choosing the right birth control option takes a lot of discussion between a woman, her spouse and her physician. When women want a permanent option, hysteroscopic tubal ligation is a safe and effective option with a quick recovery time. “Hysteroscopic tubal ligation is an absolutely permanent procedure with a very low failure rate,” Dr. Joel McCuaig, a gynecology provider at IU Health Arnett. “It’s well tolerated and doesn’t require any anesthesia or abdominal incisions.” “Because it’s not a surgery and there’s no incision, women have no scars or pain to recover from,” Dr. Meenu Goel, an obstetrics and gynecology provider at IU Health Arnett says. Dr. Goel is fellowship-trained in minimally invasive gynecological surgery.
Meenu Goel, MD
Joel McCuaig, MD
Both Dr. McCuaig and Dr. Goel perform the procedure in their offices, a plus for many patients. “The benefits of having it in office are being able to avoid anesthesia and the cost of the procedure is much lower,” Dr. McCuaig says.
WHO IS A good candidate FOR HYSTEROSCOPIC TUBAL LIGATION? Before choosing permanent birth control, women should make sure that they are ready by discussing the issue with their physician and their spouse. “It’s a hard discussion to have sometimes,” Dr. McCuaig says. “What I tell patients is to ask themselves if something happened to the other spouse, would they want to have more children? If one of them says absolutely not, that’s the one that should have a procedure done.”
“I have had patients who chose this method, did extremely well with the procedure and are happy they do not have to use other forms of birth control.” - Dr. Meenu Goel, OB/GYN
The procedure works by placing a small spring into each of the fallopian tubes. These springs will cause tissue to grow around them, effectively blocking the fallopian tubes and preventing an egg to pass through into the uterus. After deciding to have hysteroscopic tubal ligation, patients receive a contraceptive injection a few weeks before the procedure that helps thin the lining of the uterus and makes it easier for physicians to place the springs. The entire visit to undergo the procedure takes an hour or less. “The procedure itself really only takes a few minutes. It takes several minutes to prepare for the procedure, but the act itself is short,” Dr. McCuaig says. Prepping for the procedure includes numbing the cervix so that there is no pain experienced. After the numbing
According to Dr. McCuaig and Dr. Goel, good candidates include: • Women who do not want to have any more children • Women who have given birth • Women who are comfortable in normal pelvic exams • Women with no abnormalities in the uterus or cervix • Women with normal Pap smears
medication has taken effect, a small camera inside a thin, flexible tube is inserted through the cervix into the uterus. The physician will then place the small springs. The procedure is then complete without any incisions, anesthesia or blood loss. “There’s a very short recovery,” Dr. McCuaig says. “The day you go home you might have some cramping, but I wouldn’t expect you to have to take anything for pain the day after. You can return to normal activities in a day, except that you should allow a while for vaginal rest, meaning no intercourse and no tampons.” Following the procedure, women need to continue using short-term birth control methods for three months, as new tissue grows around the inserts and blocks access to eggs released by the ovaries. After three months, an X-ray is taken to assure that blockage is complete and short term birth control is no longer needed. “Once we’ve confirmed the blockage, it is quite effective. Hysteroscopic tubal ligation is as effective as the more invasive, traditional tubal ligation,” Dr. Goel says. “I have had patients who chose this method, did extremely well with the procedure and are happy they do not have to use other forms of birth control.” DEFINING MOMENTS
TAKE CARE ALL YOUR LIFE
Welcome, William Miguel
Alexandra Hidalgo and Nathaniel Bowler planned on natural childbirth, assisted by a midwife and a doula. With their baby facing up toward his mother’s belly and her cervix unable to fully dilate, however, they chose another option to bring their healthy son into the world. Alexandra Hidalgo and Nathaniel Bowler, who met as undergraduates, married 11 years ago and came to West Lafayette for Hidalgo’s doctoral studies in Rhetoric and Composition. He works for Follett Bookstores and is a writer; besides an academic, Hidalgo is also a documentary filmmaker. After a decade together, the couple decided they were ready to become parents. They studied hypnobirthing and created their birth plan, which included a midwife and a doula.
CHOSE MIDWIFE, DOULA “I always wanted a midwife because I felt it was important to have someone who would share information and really listen, someone who would answer my questions,” Hidalgo says. “But I didn’t want to have the baby at home—my dad’s a doctor, and I’ve always had good experiences at hospitals.” Two of her colleagues recommended Sharon Smith, an IU Health Arnett certified nurse midwife. “We have a little 34
Sharon fan club in the Rhetoric department at Purdue,” Hidalgo says. She asked Emma Bertolaet to be her doula. All the grandparents came for the birth—Hidalgo’s parents, Antonieta and José Cardier, from Venezuela, and, in spirit, her father, Miguel Hidalgo, who died when she was six. Nathaniel’s parents, Jean and Mike Bowler, came from Akron, Ohio.
45 HOURS OF LABOR Mild labor began late on November 4, 2011. After a day and a half, the contractions intensified, and it was clear that the baby was coming. At 4 am on November 6, the family arrived at IU Health Arnett Hospital. “They led us to the beautiful and spacious birthing suite, where the tub was waiting,” Hidalgo says. “The suite had hardwood floors, large windows and sofas for the family to sit on. I was very happy and excited to be there.” But the baby took his time. The couple walked the floors. Eventually, Hidalgo got into the water.
OB/GYN “I started to push and push, but nothing seemed to be happening,” she recalls. Throughout the labor, she had the support of her midwife, doula, husband, parents and in-laws. Her father’s voice was especially reassuring, telling everyone that the baby had a strong heartbeat. Eventually Smith explained that the baby was facing forward and that Hidalgo’s cervix could not fully dilate. Their many attempts to get the baby to change position did not work. “When I have a patient in labor and start to see signs of things not progressing well, I will typically go to the obstetrician on call and go over the patient’s history and labor course,” Smith says. “Then I keep the obstetrician updated. Sometimes things progress, and we don’t need the obstetrician. At the point that I have exhausted everything I can try with the patient, I have the obstetrician come in and evaluate the patient.” That’s what she did with Hidalgo, consulting with Dr. Howard Schafer, an IU Health Arnett obstetrician. When the birth did not progress, Smith brought him in. After consideration, Hidalgo opted for a C-section.
friendly and nice. He has a strong reputation, so I felt happy to be with him. And he was very competent.” “Our goal is to have a healthy mother and baby, trying to respect the couple’s goals and wishes as much as the situation will allow,” Schafer says. Some 45 hours after labor began, William Miguel was born at 8:43 pm on November 6, 2011.
“I wouldn’t have a birth story I’d be happy with if I hadn’t had a midwife. We did everything, and then we had to get the baby out. I gave it my all. I fought with everything I had. I’m very happy with my birth in spite of the fact that I ended up having a Cesarean.” - Alexandra Hidalgo, Mother/Patient
“I was glad to have Sharon and my husband by my side throughout the whole procedure,” Hidalgo recalls. When the decision is a C-section, which “overall is quite a low rate,” Smith says, “I go with the patient to the operating room and follow her through to the recovery room. During the C-section, I am there to support the patient and her partner, trying to keep them informed. Knowing I have this kind of support from the obstetricians is one of the great things about my practice. I feel like I can truly offer women safe care. If a higher level of care is needed, it is always available, and there is a smooth transition.” That’s by design, Schafer says. “When a C-section becomes necessary, the midwife is still involved every step along the way—as we discuss the problem, risks and expectations, and during the actual delivery. We feel this fosters trust and helps relieve anxiety. Following the C-section, my only involvement is to make sure there are no complications from the procedure. Otherwise, the nurse midwife continues her plan of action.” By the time Hidalgo met Dr. Schafer, “I had been in labor for two days,” she says. “I was exhausted. But he was very
HIDALGO HAPPY WITH BIRTH STORY “It’s been more amazing than I ever could have imagined,” Hidalgo says of having William. “One of the birthing books I read said you have to have a birth story you can own. Whatever happens, you have to be happy with your birth story. I took the option for the most natural birth I could have given the circumstances. I wouldn’t have a birth story I’d be happy with if I hadn’t had a midwife.
OB/GYN “We did everything we could, and then we had to get the baby out. I gave it my all. I fought with everything I had,” she says. “I’m very happy with my birth in spite of the fact that I ended up having a Cesarean.” One worry remained, however. Hidalgo had read that it could be difficult to get a Cesarean-born baby to breastfeed. She was concerned, but not for long. “He latched on immediately, with no delay.” At six months old, “He’s the easiest baby and a great nurser. Always sweet and happy,” Hidalgo says. “He has been from the beginning. He’s delightful. He loves the world.”
A BIRTH STORY TO HER BABY Excerpts from William Miguel’s Baby Book by Alexandra Hidalgo, his mother
Your dad was with me through all the contractions, caressing my back and neck, supporting me physically, talking me through them. Your Grandma Antonieta would come over sometimes and also help me with her hands and her voice. Both their touches were vital, Grandma Antonieta’s because it reminded me of my childhood and your dad’s because it’s my life now. Your dad says that the first words I said to you were, “Hola, papito. Hola, mi rey.” I don’t remember this, but it is exactly
‘The McBonerito’ Excerpts from a blog by Nathaniel Bowler, about the birth of his son, William Miguel, nicknamed the McBonerito
There is no surge of euphoria comparable to seeing a head emerge from the womb, cough up some goo and unleash that first phlegmatic howl. He cried as technicians cleaned
what I would say. You were so close that I could only see a fraction of your face—an eye, your nose, your lips. You had finally joined us after months and months of dreaming of you. For the first couple weeks of your life we did what they call skin-to-skin. I would nurse you in your diaper and open my robe so you could be against my skin as I held you. That is the best way to keep babies warm, but it also helps with bonding, and it’s all together wonderful because you have the softest skin in the whole world. Running my hand down your back is the loveliest of feelings.
him up, but he calmed when I said his name. Perhaps he knew my voice from those daily, post-dinner conversations we had. The official baby statistics: 8 lb., 4 oz., 21 inches, born 8:43 pm, 11/6/11. William Miguel is one week old today. To this blinded parent, he is, of course, handsome, brilliant and defect-free.
LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING:
HOW DOES THE LAPAROSCOPIC GASTRIC BANDING SURGERY WORK TO HELP PATIENTS LOSE WEIGHT? Laparoscopic adjustable gastric banding squeezes the upper part of your stomach and slows the progression of food from the upper stomach to the rest of your stomach. This helps increase your sense of fullness and decreases your hunger to help prevent you from eating too much. It is tightened or loosened in the office to optimize weight loss and minimize side effects. The band is not a magic bullet and will not work alone. You have to commit to following a strict diet and exercise program guided by our multidisciplinary team. Surgery is only 5 percent of your weight loss journey. Close follow up and making lifestyle changes based on our guidance is 95 percent of the battle. We are here to help patients achieve their weight loss goals.
WHY SHOULD I GET A LAPAROSCOPIC GASTRIC BANDING SURGERY AND NOT ANOTHER PROCEDURE? Laparoscopic gastric banding surgery is the safest bariatric procedure available at this time. The mortality rate for this procedure is ten times less than other procedures. Laparoscopic gastric banding surgery is completely reversible. The bowel is not stapled or removed, which eliminates the risks of vitamin deficiency that patients undergoing other bariatric procedures face.
HOW DO I KNOW IF BARIATRIC SURGERY IS RIGHT FOR ME? We ask all patients to attempt to lose weight without surgery. If you can succeed at weight loss without surgery, that is the best way. If you are unable to sustain your weight loss, then a surgical option should be considered. If you have a body mass index of greater than 35 with obesity-related health problems, or a body mass index of greater than 40 and have attempted and failed non-surgical weight loss, then bariatric surgery may be a wise consideration.
ARE PREGNANCY AND BREASTFEEDING AFTER THE LAPAROSCOPIC GASTRIC BANDING SURGERY SAFE? Yes, but not for 18 months. If you become pregnant after that time frame, the band will not affect the pregnancy as long as you and the baby are gaining weight appropriately. If there is a problem, the band can easily be deflated in the office.
WHAT HAPPENS IF I GET PREGNANT BEFORE THE GASTRIC BANDING DEVICE HAS BEEN IN PLACE FOR 18 MONTHS? We would consider loosening the device and follow you closely to ensure both you and your baby are safe. We ask patients to wait to become pregnant not because it is unsafe for the mother or child, but to help women approach their target weight through diet, lifestyle changes and adjustments as needed before pregnancy factors into the equation.
WHERE CAN I LEARN MORE ABOUT IU HEALTH ARNETT BARIATRICS? Visit: iuhealth.org/arnettbariatrics Call: 765.448.8143 to speak with our nurse coordinator Attend one of our upcoming seminars at IU Health Arnett Hospital Saturday, November 10 at 10 am Tuesday, December 11 at 6 pm
IU Health Arnett BARIATRIC SERVICES • Laparoscopic adjustable gastric banding • Supervised weight loss for program participants • Nutritional counseling • Psychological assessments and additional counseling as needed • Weight loss support groups • Insurance support • Bariatric fitness services – optional exercise program
A Miraculous Gift FOR RICK YOUNG Rick Young’s early, chronic ear infections and the greatly diminished hearing that resulted seemed to be a life sentence of too much quiet -- until he learned about osseointegrated implants for hearing amplification. Today, at 56, he can hear birds, children on the playground and people across the room.
Books about history, World War II, Navy SEALs and other nonfiction titles line the shelves at Rick Young’s home. “I have always been interested in history,” he says. “And I have a thing for the SEALs because my brother was a SEAL before they were called that.” His brother, Jim Young, who served in Vietnam, died three years ago. While Young’s interest in history isn’t likely to diminish, his reading time may. That’s because he’s now hearing better than he ever has, which makes being out and about more pleasant. Even more significant, his newfound hearing has given him greater confidence and a new comfort in public, which has led to better things, such as his dream job as a machinist at a local manufacturer. “I never considered it a handicap. I thought it was a disadvantage,” he says of his previously limited hearing. “Now, it’s opened up so much. I’m equal. I can walk on the same ground as someone who has good hearing. It gave me a spiritual lift.” Young first learned about the possibility for improved hearing in 2009, when he visited Dr. Stephen Henson, IU Health Arnett otolaryngologist, who had been his doctor since 1976. “I had a lot more ringing in my left ear, and I was losing more of my hearing.” 38
IMPLANT IMPROVED HIS HEARING Dr. Henson told him about osseointegrated implants for hearing amplification. In July 2011, Dr. Tim Cupero, also an IU Health Arnett otolaryngologist, performed the boneimplant procedure. Young then worked with Dr. Carol Downard, an IU Health Arnett audiologist for the second step, using the external processor. “The processor brings in the sound and conducts it through the skull to the good side,” she explains. “The first time I put the processor on him, he welled up in tears, and that made me well up in tears.” His life was forever changed, Young says. “It is a new excitement to be able to hear. I was about 70 percent deaf in that ear before the procedure.” Soon after getting the device, he and his girlfriend, Marisa Steelman, went out to dinner. “I could hear the server clearing two tables behind us. She said ‘I can’t even hear that.’” “The benefits include improving speech understanding in noise, as well as minimizing the negative effects from head shadowing in patients that are not candidates for traditional
EAR, NOSE AND THROAT amplification,” Dr. Cupero says. Head shadowing occurs when the head blocks sound from the better ear. Young views those at IU Health Arnett who helped him as his family. “It’s not ‘Yes, sir,’ ‘No, sir,’ it’s ‘How you doing, Rick?’ It’s family.”
EASY TO CARE FOR Maintenance of the hearing system is easy, Young says.
“I never considered it a handicap. I thought it was a disadvantage. Now, it’s opened up so much. I’m equal. I can walk on the same ground as someone who has good hearing.” - Rick Young, Patient
“I keep the area where the implant is clean and use a baby toothbrush to clean the abutment and a baby wipe to clean the connecting part.”
The rest of the time, the processor is in place, turned on and he’s tuned in to the world, which he’s finding is a whole lot noisier than he ever realized.
Because of airborne coolant blowing off parts at his manufacturing job, he doesn’t wear the processor at work, but caps the abutment. “I don’t want to take the chance,” he says.
He still enjoys reading. “I like nonfiction. It tells people’s stories.” Now he’s got his own to tell, and he’s especially eager to share it with others who could be helped. “I want to pass that on to people thinking about the procedure. I want to be there if they want to utilize my experience.”
Osseointegrated Implants Also known as a bone-anchored hearing system, osseointegrated implants may offer hope to people who thought there were no options available. Here’s what it involves: • While you are under anesthesia, a tiny, titanium implant—like a small, inverted screw—is permanently placed in the bone behind your ear. The outpatient procedure takes about an hour. • Over the next few months, your bone grows around the implant, securing it in place. An abutment of about quarter inch around sticks out about quarter inch from your scalp. • Once the implant is secure, you can begin using the external sound processor that snaps on to the part of the implant that is outside your skin. The battery-powered processor is about three quarters of an inch thick and one and a half inches long. “This is the Bluetooth alternative, only it’s planted in your head,” jokes Rick Young, who has such a hearing system. “But you can’t get long distance.”
Will Osseointegrated Implants
Work for You?
A bone-anchored hearing system can help certain people, depending on the type of hearing loss. “In general, patients with conductive hearing loss, mixed hearing loss or those with single-sided deafness are potentially good candidates for boneanchored hearing amplification,” says Dr. Tim Cupero, IU Health Arnett otolaryngologist. “Patients with chronic otitis media that has been resistant to medical therapy, such as Rick Young, may also be candidates.” Once Dr. Cupero evaluates the potential success a patient might experience, he has patients go through a preoperative trial with a simulated implant. “This is an important part of picking ideal candidates,” Dr. Cupero says. “They generally will wear the ‘test band’ for a few days to simulate what an actual implant will do. If they respond well, their experience with an implant will be even better.” DEFINING MOMENTS
“Autumn learned stuff she hadn’t learned from me—how to count higher, more of her alphabet, colors. She had a smile on her face every day.” - Jennie Graves, Mother
Kindergarten Countdown Gives Kids an Edge
“I got to do puzzles. I’m good at them,” Autumn Graves says of her summer 2011 Kindergarten Countdown Camp experience at Miller Elementary School, funded by IU Health Arnett to help youngsters get ready for kindergarten. When Jennie Graves learned that her daughter, Autumn Graves, was invited to participate in a four-week summer program to help her get ready for kindergarten, she was all for it. “I thought it was a really good idea for kids,” she says of Kindergarten Countdown Camp, a 2011 morning program at Miller Elementary School sponsored and coordinated by IU Health Arnett and United Way of Greater Lafayette. “Autumn learned stuff she hadn’t learned from me—how to count higher, more of her alphabet, colors,” her mom says. “She had a smile on her face every day.” “The Mickey Mouse puzzle was my favorite,” Autumn says. “I did math worksheets, too.” And, yes, the introduction to school “made it easier” when she headed to kindergarten in the fall, she says. 40
Luckily, Autumn reports, she got the same teacher for kindergarten that she had in the summer. “I had Ms. Fleury. I love her,” Autumn says. “She has brown hair, the same color hair as I do, only she has straight hair and I have curly hair.”
GETTING KIDS READY FOR SCHOOL Autumn’s kindergarten year went well, her mother reports. “She is a really good reader. I’ve never seen a kid read as much as she does. And she goes around adding all the time, saying ‘Two plus two is four. Thirty plus 30 is 60.’ My other kids never did that. She had the advantage of this Kindergarten Countdown Camp and she was able to learn more. It helped ease her way into kindergarten.” When Autumn’s brother, Brandon Starrett, received the same invitation for the summer 2012 session, it was an easy “yes” for their mother. “I really like the program.”
COMMUNITY GIVING Children are recommended to participate after a short assessment during kindergarten roundup, says Rhonda Fleury, Miller Elementary teacher. “Generally, students have not had any formal pre-schooling,” she says. “Essentially, the inclusion of academically at-risk students is the foundation of the program.”
“IU Health Arnett was a tremendous help. Each day volunteers worked along with us to provide students extra support to be successful in the tasks at hand. The volunteers were dependable and would do whatever was asked in the classroom. They were key players in the program.”
UNITED WAY EXPANDS ITS SCOPE For four weeks, they head to school Monday through Friday. In 2012, the program expanded to a second site in Tippecanoe County at Klondike Elementary. The program was also expanded to North White Primary School in Monon, thanks to collaboration between IU Health White Memorial Hospital and United Way of White County. The camp, which hosted 16 students, successfully wrapped up on August 3, 2012.
The United Way of Greater Lafayette modeled the program after another United Way in Indiana. Chief executive officer of United Way, James Taylor, says, “Education is one of our three big pillars, along with income and health. When kids come into school ready to succeed, they have a much better opportunity to learn. Just being in the classroom setting was helping them adjust.”
HALF-DAY, 4-WEEK PROGRAM
The summer youth opportunity fits with United Way’s expanded scope beyond fundraising, he says.
The day begins at 8:30 am. “They learn about the alphabet and other phonemic skills through games, hands-on activities and songs, to name a few,” Fleury says.
“This is a way to provide targeted interventions that have impact,” he says.
“The students are also learning what it is like to be in school and a structured environment. They are learning how to socialize with their peers as well as working cooperatively in a school setting.”
“We understand that raising money and providing services are critical, but not sufficient. We are trying to leverage a variety of activities and target ways to prevent the root causes of children not doing well in school,” he says.
Activities run until around the noon hour and also include recess and a healthy snack or lunch, depending on the camp’s length. And every Friday, “They receive a book to take home and share with their family to encourage family involvement,” Fleury says.
“We’re looking at what we can do not only with funding, but with human power—more volunteers and education and awareness in the community about what is important. We’re moving beyond giving to volunteering and advocating.”
“Students are given a ‘jump start’ to help them catch up to their peers who have already obtained the skills necessary to become a successful kindergartener,” Fleury says.
IU Health Arnett’s sponsorship was a significant investment, Taylor says. But it pays off. “We had an incredible return on the investment. The skills went up for 95% of the kids. And that was just the first year.”
“It gives them an opportunity to get a feel for school and learn rules and procedures. When they come back at the start of kindergarten, they display more self-confidence and show a sense of belonging. These two factors alone provide a firm foundation in the child’s educational experience.”
IU HEALTH ARNETT FUNDS, PROVIDES VOLUNTEERS Besides assisting to fund the program, IU Health Arnett provides volunteers. And they are much-appreciated, Fleury says.
TOO MUCH FUN FOR JUST FIVE DAYS For Autumn, the only drawback to the program was that she didn’t get to go on the weekend. “On Saturdays, she’d say, ‘Oh, man, I want to go,’” her mom says. “She was always so excited about going.” “I felt good there,” Autumn says. “I liked it.”
P.O. Box 5545 Lafayette, IN 47903-5545
Providing you with better healthcare in West Lafayette. In Summer 2013, a new healthcare facility in West Lafayette will make it easier for you to get the care you need, closer to home. The new facility, located in the old Kmart site, will provide care for the whole family, from pediatrics to internal medicine to obstetrics and gynecology. With new expanded laboratory services and an outpatient imaging center, youâ€™ll be able to receive all your care in one convenient place.
Discover the strength at iuhealth.org/arnett