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November/December 2012

A bi-monthly update on leading-edge care from

NON-PROFIT U.S. POSTAGE

PAID UNITED MAIL

1850 State Street New Albany, IN 47150

HealthScope is published by Floyd Memorial Hospital and Health Services Marketing & Public Relations Department 1850 State Street New Albany, Indiana 47150 (812) 948-6728 or 1-800-476-8723

Restless Legs Keeping You Up All Night?

Cindy Ferree Editor, writer Angie Rose Director of Marketing & Public Relations, Contributor Angie Glotzbach Writer Stacey Rudy Contributor CUSTOMER SERVICE Floyd Memorial customer service inquires can be made to our Customer Service Hotline at (812) 981-6510. HOW TO HELP HealthScope is designed to support the Healthier Community Initiative by providing up-to-date health tips and wellness information to benefit our community’s health. Through this publication, the Floyd Memorial Foundation hopes to encourage healthier active lifestyles for the residents of Southern Indiana. As a non-profit organization, Floyd Memorial relies on your support of our Foundation to provide health screenings, educational programs and hospital improvements. To learn how to help, visit floydfoundation.org or call (812) 949-5519. CAREER OPPORTUNITIES Visit “Careers” at floydmemorial.com to find out more about exciting career opportunities available at Southern Indiana’s premier regional healthcare provider.

Follow us on Facebook at facebook.com/fmhhs and Twitter at twitter.com/Floyd_Memorial

Without back pain, every day grows better. Connie Pryor’s pain was so bad, she couldn’t do simple things like open the dishwasher or water her favorite flowers. Fortunately, right here in Southern Indiana, we offer care that is as advanced as any in the region, from

812-949-5933

surgical to non-surgical options, with the convenience of everything in one location. Today, Connie’s biggest pain is finding room for all of her flowers. Don’t let back pain steal your life. Call us today for more information.

floydmemorial.com/spine

Diabetes Management During the Holidays

Breast Cancer Patients Benefit from Minimally Invasive Treatment Options

Sleep Disorders Center Physicians Explain Why Sleep & Good Health Go Hand-in-Hand


Dr. Azad Named President-Elect of the ISMA Delegates representing districts across the state have voted Floyd Memorial Medical Group internal medicine and occupational medicine physician, Deepak Azad, MD, Deepak Azad, MPH, FACP, as president-elect MD, MPH, FACP of the Indiana State Medical Association (ISMA). Dr. Azad will serve as president-elect for a one-year term, then take over as president for a one-year term. Dr. Azad has served as ISMA treasurer and assistant treasurer, as well as a member of several important committees, commissions and task forces, including the Commission on Legislation. He currently sees patients at Floyd Memorial Medical Group in Scottsburg and Georgetown. Call (812) 752-0165 for an appointment.

Looking for a Physician? Call Floyd Memorial’s Physician Referral line at 1-800-4-SOURCE (1-800-476-8723) or visit us online at www.floydmemorial.com. We can help you find the doctor that’s just right for your specific needs. New Physicians A. Gregory Deam, MD Cardiology & Electrophysiology University of Louisville, Division of Cardiovascular Medicine 550 S. Jackson Street Louisville, KY 40202 (502) 852-7959 Nicolas Ferro, DPM Podiatry Kentucky Foot & Ankle Specialists 1425 State Street, #200 New Albany, IN 47150 (812) 725-7542 Mark Krakauer, MD Ophthalmology Eye Specialists of Louisville 301 E. Muhammad Ali Blvd. Louisville, KY 40202 (502) 852-7443 Terry Perkins, MD Family Medicine Floyd Memorial Medical Group-Charlestown 9423 Highway 403 Charlestown, IN 47111 (812) 256-6388 Michael Schissler, MD Nephrology Nephrology Associates of Kentuckiana 1919 State Street, #444 New Albany, IN 47150 (502) 587-9660 2

Floyd Memorial Hospital and Foundation Partner with New Albany Housing Authority to Receive $10,000 Wellpoint Foundation Grant Birthing Center Welcomes Nurse Midwife Carla Layne, ARNP, CNM The Floyd Memorial Birthing Center is proud to announce the newest addition Carla Layne, ARNP, CNM to its family of providers, Carla Layne, ARNP, CNM. Carla has over 15 years experience in OB/GYN nursing care and 10 years of experience in nurse midwifery. She will begin seeing patients at the OB/GYN Associates of Southern Indiana office and performing deliveries at the Floyd Memorial Birthing Center on December 3, 2012. As both an advanced registered nurse practitioner and a certified nurse midwife, Carla is able to provide gynecologic and obstetrical care for patients ranging in age from adolescence through the menopause years. For her pregnant patients, and those trying to conceive, Carla focuses on the entire birthing family. She strives to provide whole-family care, education and support throughout the pregnancy, labor, delivery and postpartum journey to mothers interested in both interventional and natural childbirth options. Call (812) 945-5233 for an appointment.

Cardiac Rehabilitation Program Achieves Re-Certification The Floyd Memorial Heart & Vascular Center’s Cardiac Rehabilitation program recently achieved re-certification by the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR). The AACVPR program certification is the only peer-reviewed accreditation process designed to review individual programs for adherence to standards and guidelines developed and published by the AACVPR and other professional societies. Each program is reviewed by the AACVPR National Certification Committee and certification is awarded by the AACVPR Board of Directors. Certified AACVPR programs are recognized as leaders in the field of cardiovascular rehabilitation because they offer the most advanced practices available.

The Floyd Memorial Foundation and Floyd Memorial Hospital and Health Services have partnered with the New Albany Housing Authority to help low-income, underserved residents of our community. The group received a grant for $10,000 from the Wellpoint Foundation to assist in their efforts. The project is unique because it involves a partnership between an organization that has access to medical personnel, pharmacy and equipment and an agency that has access to underserved individuals. This grant aims to provide pneumonia vaccination to people between the ages of

Floyd Memorial Medical Group Welcomes River Cities Cardiology

Cafeteria Renovation Groundbreaking

On Wednesday, September 19, the Floyd Memorial Foundation held an official groundbreaking ceremony to kick off the cafeteria renovation project. Pictured L to R are: Glenn Smith, Kerry Stemler, Leslie Lewis-Sheets, Bob Shine, Mark Seabrook, Tom Millea, Frank Heinz, Shirley Baker, Dr. James McCullough, Mayor Jeff Gahan, Marc McCormick, Don Gibbons, Mark Shugarman, Mark Truman, Dr. John Crase, Ruth Heideman, John Naville, Lisa Shoopman and Tom Jones. For information on how to donate, contact Ruth Heideman, Foundation Executive Director, at 949-5519 or visit www.floydfoundation.org.

Floyd Memorial is proud to announce that River Cities Cardiology providers M. Saleem Seyal, MD, FACC, FACP, D. Marty Denny, MD, FACC, Christopher Hofelich, DO and Rebecca Di Cicco, PA-C, have joined Floyd Memorial Medical Group. The practice has two locations Jeffersonville and Scottsburg. The providers have expertise in non-invasive and invasive procedures and offer the convenience of diagnostics and cardiac rehab onsite. Call (812) 282-1617 for an appointment.

19 and 64 with underlying medical conditions who would not otherwise have the means to receive the vaccine. It is estimated that in Floyd County alone, there are 3,626 unvaccinated, eligible people. Invasive disease from pneumonia is a major cause of illness and death in the United States. Vaccination is recommended for all adults over 65 and those adults aged 19 to 64 with underlying medical conditions that put them at greater risk for serious pneumonia infection such as smokers, those with asthma, HIV, sickle-cell and immunodeficiency.

Wound Healing Center Welcomes Nicholas Ferro, DPM The Floyd Memorial Wound Healing Center would like to welcome podiatrist, Nicholas Ferro, DPM, to the physician panel. Dr. Ferro received his undergraduate Nicholas Ferro, degree at Ball State, podiatric DPM medical degree at Ohio College of Podiatric Medicine in Cleveland and completed his podiatric surgical residency at St. Vincent Hospital in Indianapolis. He is a member of the American Podiatric Medical Association. Dr. Ferro currently practices at Kentucky Foot & Ankle Specialists, and will see patients in the Floyd Memorial Wound Healing Center Tuesday afternoons from 1- 4:30 pm. Call (812) 949-7964 for an appointment.

On the cover... Floyd Memorial Sleep Disorders Center physicians pictured left to right include: Azmi Draw, MD, FCCP, Satish Rao, MD, MS and Nuzhat Hasan, MD.

Floyd Memorial Medical Group Welcomes Terry Perkins, MD Floyd Memorial is proud to announce that board certified family medicine physician, Terry Perkins, MD, has joined Floyd Memorial Medical Group- Charlestown. Dr. Terry Perkins, Perkins received his medical MD degree from Uniformed Services University School of Medicine and then worked as a Navy Flight Surgeon until leaving active duty in 1993. In 1998, Dr. Perkins completed his family medicine residency at Ball Memorial Hospital in Muncie, Indiana. He then spent several years working as an Emergency Department physician throughout Indiana before settling down in Campbellsburg, where he has practiced primary care for the past 11 years. Call (812) 256-6388 for an appointment.

Guardian Angel Congratulations to Floyd Memorial’s recent Guardian Angel recipients: The Guardian Angel program offers patients and visitors a way to say thank you to a special associate, physician or volunteer who has made a positive difference in their hospital experience by making a donation in their honor to the Floyd Memorial Foundation. For more information, call (812) 949-5803. Michael Doyle, MD Neurosurgeon/Spine Center Karen Lopp Spine Center Melissa Denny, RN Michelle Duckworth, RN MIPS Cam Graves, MD Emergency Medicine Karen Meyers, RN, CDE Joslin Diabetes Center Affiliate Syed Ahmed, DPM Podiatrist/Wound Healing Center Julianna Pavey, RN Wound Healing Center Chelsea Bone, RN Courtney Kellihan, RN PICC Team Cindy Stillman, RN Outpatient Cardiovascular Rachael Green, RN Andrea Pate, RN Fernanda Tripure, RN PCU Lauren Eurton, RN CTU

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Sick and Tired of Always Being Tired? Sleep Issues Are a Serious Concern. Effects of sleep deprivation According to the American Academy of Sleep Medicine, there is a direct connection between sleep disorders and heart disease, high blood pressure, coronary artery disease, heart attack, congestive heart failure, stroke, depression and diabetes. Board certified pulmonologist, Azmi Draw, MD, FCCP, explained, “Sleep affects every system in the body and sleep deprivation can have detrimental effects on your overall health. Sleep deprivation causes slower metabolism, weight gain, mood swings, depression, anxiety and affects memory loss and concentration, especially in younger people.” Pulmonologist, Nuzhat Hasan, MD, added, “Many patients are too quickly diagnosed with depression, but are actually suffering from a sleep disorder. That is why a sleep study to diagnose a sleep problem is so important. It can get to the actual root of the problem.” “The required number of sleep hours is based on a bell curve. The average is eight hours, but many can remain healthy with fewer hours or may need as many as nine to ten hours. You should know your number and strive to reach it every night,” said board certified neurologist, Satish Rao, MD. “A good way to determine how much sleep you need is to pay attention to how long you sleep when there is no pressure to wake up at a certain time, such as while on vacation. That number is what your body ideally needs and what you should strive for on a regular basis.” Naps are only effective for certain populations. Scheduled naps are recommended for Narcolepsy and shift workers (limited sleep hours), but not for insomnia – it can make the sleep cycle worse. Getting to the root of the problem Primary care physicians are often the first line of defense for sleep-related complaints. Board certified family medicine physician, Mike Bittenbender, MD, explained, “I remind the patient that obesity and smoking have an

“Many patients fear having a sleep study, but sleep deprivation can have tremendous effects on your health. It’s important to talk to your physician about the problem and have a screening.” Azmi Draw, MD, FCCP Sleep Medicine Specialist & Board Certified Pulmonologist, Critical Care and Internal Medicine Physician Floyd Memorial Sleep Disorders Center Lung and Sleep Specialists, PLLC impact on all aspects of their health, including sleep, and recommend that they lose weight and stop smoking. If a patient shows signs of a possible sleep disorder, I recommend a sleep study to address the cause.” How a sleep study works A sleep study, or polysomnogram (PSG) is a comprehensive set of tests that electronically transmits and records specific physical activities while you sleep that can determine if a sleep disorder is present. A sleep study is most valuable in evaluating sleep apnea, breathing disorders, seizures and parasomnias – nocturnal events such as sleepwalking. The equipment for a sleep study in the lab includes: • Electroencephalogram (EEG) uses electrodes to measure the electrical activity of the brain and can detect seizures. “Unfortunately, today’s technology has moved tablets and phones into the bedroom, allowing people to work when they should be getting vital sleep. Sleep is one of the most undervalued and necessary functions of the body. ” Satish Rao, MD, MS Board Certified Neurologist/Sleep Specialist Floyd Memorial Sleep Disorders Center Floyd Memorial Medical Group-Neurology

Signs of Sleep Disorders in Adults: • Not sleeping well • Waking up several times at night • Consistently feeling tired • Inability to function during the day time • T aking a long time to get to sleep, then waking up all night • S leeping 10-12 hours or more and not feeling rested • Consistently bad nightmares 4

•W  alking or talking in sleep and awakening outside of the bedroom • Periodic leg movements • S leep partner tells you about movements of arms and legs, and sometimes being hit in the night and you have no recollection • Depression • Falling asleep at the drop of a hat • Feeling unusually emotional or anxious

• Electrocardiogram (EKG or ECG) uses electrodes that are placed on the chest to record heart rate and rhythms. • Electromyogram (EMG) records muscle activity such as face twitches, teeth grinding and leg movements. It also helps determine the presence of REM stage sleep. • Electrooculum (EOG) measures eye movement and can identify REM sleep. • Chest band measures respiratory effort. • Nasal airflow sensor consists of two transducers that are placed over the mouth and nose to measure temperature and air flow. • Pulse oximeter measures oxygen saturation and can detect sleep apnea. • Snore channel measures volume. • Video monitor to view positioning during sleep. “For those who have severe sleep apnea, we can make it a split-night study. If we see that a patient stops breathing several times, we wake them up and put a continuous positive airway pressure (CPAP) machine on them to see how it makes a difference – and watch them go into rapid eye movement (REM) sleep,” said Dr. Rao. A CPAP is a sleep apnea treatment that delivers air into the airways through a specially designed nasal mask. Dr. Rao continued, “The split-night protocol is used for severe cases and can help save a second overnight study to set the appropriate air pressure for a CPAP. CPAPs have come a long way in the last few years. Technology has made it more user-friendly. Some physical problems that are found to interfere with breathing during sleep can be corrected surgically, and mild cases of OSA can be treated with an oral appliance.” Dr. Hasan added, “Patients are able to bring their own pillows, comforter and sheets with them to a sleep study. We have fans and white noise machines if requested, and use queen and king-sized beds. We want to make the experience as comfortable as possible.

“So many patients don’t realize how bad their symptoms of sleep deprivation had become. It is very rewarding to see a patient’s entire outlook and well being change when they are getting a full night’s sleep.” Nuzhat Hasan, MD Pulmonologist, Critical Care, Internal Medicine & Sleep Medicine Physician Floyd Memorial Sleep Disorders Center Midwest Internal Medicine, PSC

“When performing a yearly physical, I ask the patient if they are fatigued, have low energy or depression, and get a list of medications they are taking that could be affecting their sleep. I also stress the importance of losing weight and quitting smoking to help with these symptoms.” Mike Bittenbender, MD Board Certified Family Medicine Physician Floyd Memorial Medical Group-New Albany The patient is not constantly interrupted as many may think when envisioning sleeping in a hospital bed.” In-lab sleep study vs. home sleep study Home studies can pinpoint some problems, but aren’t as comprehensive as a sleep study in a sleep lab. And many do not have a technician present to monitor sleep activity. Dr. Draw explained, “There are many situations where we perform inpatient studies at the bedside, in nursing homes, etc. Bedside studies use the same device that is used in home studies, which is a scaled down version of the in-lab study device.” He added, “There is a certain population who shouldn’t have an unattended home study. Patients with severe lung disease or those on oxygen should not be left unattended during a sleep study. Heart patients who need to be monitored for abnormal heart arrhythmias are not candidates for a home study. Patients with neurological diseases like sleep walking, seizure disorders or leg movements need to be monitored to ensure accurate results. Also, if the physician expects hypoxia, the patient should not be left unattended. In these situations an in-lab study is necessary.” Because of the rate of false negatives in an unmonitored home study, the American Academy of Sleep Medicine recommends that a home test should be followed up with a full in-laboratory sleep study under certain conditions.

Is Restless Leg Syndrome Keeping You Up at Night? While trying to sleep, have you ever felt a tingling, itching, irresistible urge to move, and do you kick or stretch your legs? Has your partner’s sleep been affected by your constant movement and kicking? If you answered yes, you may have a common sleep disorder called Restless Leg Syndrome, or RLS. Who is affected? Restless Leg Syndrome affects an estimated 10 to 15 percent of the U.S. population. This neurological disorder occurs more frequently in women than in men, regardless of race or ethnicity. RLS is common in pregnant women - usually occurring during the last trimester, but typically goes away within four weeks of delivery. It can be diagnosed early in life, and those patients usually have a family history of the disorder. Most cases are diagnosed after age 40, which could be due to the fact that the severity of the condition increases with age. Symptoms of RLS Many people with RLS report that their job, personal relations and activities of daily living are strongly affected by their lack of sleep. Additionally, concentration is affected, and many have impaired memory or cannot accomplish daily tasks. There are four criteria for diagnosing Restless Leg Syndrome: 1. An irresistible urge to move the legs due to an unpleasant feeling/sensation 2. The urge to move the legs worsens when you are at rest 3. The unpleasant sensation in the legs is relieved during movement such as walking or stretching 4. The urge occurs in the evening and at night RLS is categorized as either primary or secondary. Primary RLS is the most common type. There is no known cause, but it can be hereditary, with a parent usually experiencing the condition. Secondary RLS is caused by another underlying condition, or can be a side effect of certain medications. The most common causes include:

• Iron deficiency • Anemia • Kidney failure • Electrolyte or potassium level imbalance • Diabetes • Peripheral neuropathy • Thyroid disorders • Pregnancy • Arthritis/joint pain • Alcohol withdrawal • Diuretics/water pills • Certain cold and allergy medications • Anti-seizure medicines • Antidepressants Over 80 percent of people suffering from RLS also experience a more common condition known as periodic limb movement of sleep (PLMS). Dr. Draw explained, “There is a difference between RLS and PLMS. It is necessary to perform a sleep study to diagnose PLMS.” PLMS is characterized by involuntary leg twitching or jerking movements during sleep that typically occur every 15 to 40 seconds, sometimes throughout the entire night. The symptoms cause repeated awakening and severely disrupted sleep. Dr. Rao added, “RLS is not diagnosed with a sleep study or an MRI, but sitting down with a physician and answering questions. After giving your complete medical history and discussing lifestyle changes, a set of blood tests for pregnancy, thyroid problems, renal failure, and most commonly, ferritin and electrolyte levels will be administered. Ferritin levels check the amount of iron stored in the body. Ferritin levels can be low if a patient is low on iron from blood loss due to heavy menstrual flow, GI tract blood loss or donating blood too frequently. Replacing iron can sometimes help alleviate the symptoms of RLS, but iron should only be taken under the supervision of a doctor. A sleep study is suggested if there is potential for sleep apnea or possibly overlapping disorders.” There is no cure for RLS, but there are prescription medications available. Talk to your physician about the best options for you.

Types of Sleep Disorders: Insomnia is the most common sleep disorder. It is the inability to fall asleep or stay asleep at night and/or waking up earlier than usual. Daytime fatigue is a major indicator. Obstructive Sleep Apnea (OSA) is described as excessive daytime sleepiness accompanied by snorting, snoring or gasping sounds while sleeping. OSA sufferers stop breathing

multiple times during sleep. Sometimes morning headaches are present. Severe OSA can cause serious health issues. Restless Leg Syndrome is the irresistible urge to move the legs shortly after getting into bed, in the middle of the night or after waking. Many complain of a twitching feeling

in the legs, calves, feet, thighs or arms. Many times periodic limb movement is present. Narcolepsy is thought to be a nervous system disorder that causes excessive sleepiness and frequent daytime sleep attacks, or short naps. Symptoms usually start to occur between the ages of 15 and 30.

For more information on sleep disorders or to schedule an appointment with a sleep specialist, call the Floyd Memorial Sleep Disorders Center in New Albany or Corydon at (812) 949-5550. 5


“Breast cancer treatment is not ‘one size fits all.’ Every cancer is different, and with recent advancements in genetic testing and tumor pathology, we can tailor therapies to the biology of each woman’s individual cancer, which means better results and fewer treatment-related side effects.” Anthony Dragun, MD Board Certified Radiation Oncologist Floyd Memorial Cancer Center of Indiana Assistant Professor & Vice-Chairman of Radiation Therapy University of Louisville School of Medicine “There are many different combinations of drugs and therapies that can be utilized based on the type of breast cancer present and the patient’s personal preferences. Having a say in treatment choices makes women feel empowered during a time when everything else feels out of their control.” Yosoda Devabhaktuni, MD Board Certified Medical Oncologist/ Hematologist Floyd Memorial Cancer Center of Indiana

Watch Floyd Memorial’s Pink Glove Dance video in honor of breast cancer awareness. Visit floydmemorial.com/cancer to view.

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Individualized, Minimally Invasive Treatments Have Become Standard of Care for Breast Cancer At the Floyd Memorial Cancer Center of Indiana, our multidisciplinary team of breast cancer experts focuses on providing each patient with the most up-to-date, advanced care available. From diagnosis in our Women’s Imaging Center, an American College of Radiology Breast Imaging Center of Excellence, to surgery, treatment and rehabilitation in a comprehensive program that is on its way to becoming the first American College of Surgeons’ Nationally Accredited Breast Center in Southern Indiana, patients who choose Floyd Memorial for their breast cancer care are in great hands. Treatment planning with a multidisciplinary panel of experts At Floyd Memorial, a multidisciplinary panel of breast cancer experts review cases and make treatment recommendations for every breast cancer patient. This gives patients access to input from multiple specialists at one time, simplifying the treatment planning process, and providing several viable options to choose from, each tailored to their unique needs. It includes representation from: • Medical oncologists • Radiation oncologists • General surgeons • Plastic and reconstructive surgeons • Pathologists • Radiologists • Physical therapists • Dietitians • Social workers • Oncology nurses • Diagnostic imaging technologists Minimally invasive breast conservation surgery Julie Hutchinson, MD, board certified general surgeon with Floyd Memorial Medical Group-Surgery, explained that utilizing minimally invasive surgery whenever possible is the standard of care for breast cancer today. “Breast conservation surgery is the best option we can offer for patients with early stage, non-aggressive breast cancer. It’s the least invasive approach with a shorter, less painful recovery while still achieving a symmetrical, pleasing cosmetic result,” said Dr. Hutchinson. She continued, “There are a lot of myths out there about breast conservation (lumpectomy), versus total breast removal (mastectomy). Many women think that

their breasts will no longer be symmetrical after lumpectomy, but we actually incorporate some aspects of plastic surgery into the procedure, such as re-centering the breast and the nipple to ensure that the breasts still align well.” “The biggest myth that I encounter is that choosing lumpectomy over mastectomy means there’s more of a chance the cancer will come back,” added Dr. Hutchinson. “This is not true. Recurrence rates for lumpectomy with subsequent radiation therapy are equivalent to mastectomy. And just because mastectomy is chosen doesn’t mean radiation won’t be necessary. It depends on the size of the tumor and the number of lymph nodes involved. I would encourage anyone who is facing breast cancer surgery to consider all of their options before deciding on breast conservation or removal. I see a lot of patients who have their mind set on mastectomy before knowing the particulars of their specific cancer, and it leads to unnecessarily invasive procedures and long recoveries.” Shortened radiation treatment timeframes are another trend making lumpectomy an excellent choice for women today. Anthony Dragun, MD, board certified radiation oncologist with the Floyd Memorial Cancer Center of Indiana, noted, “The rationale behind the push for early detection in breast cancer is to give women options for treatment that leave as little of an impact on their body as possible. Long-term evidence shows that the overwhelming majority of women diagnosed with early stage breast cancer will not have a recurrence with lumpectomy and radiation. With advancements in radiation technology such as Floyd Memorial’s newest linear accelerator, we can reduce treatments from six weeks to as few as possible, making it more tolerable and accessible to patients.”

“It is a myth that having a mastectomy eliminates the chance of recurrence while lumpectomy does not. Studies show that cancer is no more likely to come back in patients who have undergone lumpectomy with radiation than in patients who have had total mastectomies. They are equivalent treatments.” Julie Hutchinson, MD Board Certified General Surgeon Floyd Memorial Medical Group-Surgery

Genetic analysis leads to more targeted treatments and reduced recurrence rates Tailored therapy based on the biology of each woman’s individual cancer is the new standard in breast cancer treatment today. Genetic analysis of tumors allows for tailoring of chemotherapy and radiation therapy based on the genetic makeup of the tumor and the level of aggressiveness that the makeup is known to demonstrate. As Dr. Dragun explained, “Two of the biggest issues in the battle against cancer are over treatment and under treatment. When you don’t know how the cancer will behave, you risk giving patients with aggressive cancer too little treatment, or those with slow-growing disease too much. Genetic analysis gives us a window into the biology of each patient’s specific disease, so that we can tailor their treatment to exactly what’s needed.” Yasoda Devabhaktuni, MD, board certified medical oncologist/hematologist with the Floyd Memorial Cancer Center of Indiana,

added, “Systemic treatment after breast cancer surgery, be it a lumpectomy or mastectomy, benefits some patients in terms of decreasing the chance of cancer recurrence. Breast cancer has a wide range of pathology and there is no one chemotherapy that fits all patients. Knowing the tumor’s genetic makeup allows us to make treatment decisions and gives the woman help making informed decisions as well.” She continued, “Through pathological and genetic testing we can determine if the cancer is hormone receptor positive or was growing independent of hormones. After systemic chemotherapy some patients will benefit from anti-hormonal treatment for a total of five to seven years. Anti-hormonal treatment is the standard, but choosing systemic chemotherapy treatments involves putting together multiple factors before deciding if the patient will benefit from treatments, and there is no ‘one treatment fits all’ approach in this setting.”

Schedule Your Mammogram at Floyd Memorial’s Women’s Imaging Center The Diagnostic Breast Center is open extended hours with evening and Saturday appointments available. Call (812) 949-5570 for an appointment.

Services offered include: • Digital mammography featuring complimentary soft mammopads • Breast MRI • Stereotactic breast biopsy

Breast Cancer Nurse Navigator Guides Patients Along Path to Recovery No one should fight cancer alone. And at the Floyd Memorial Cancer Center of Indiana, our breast cancer nurse navigator is right by your side through the entire journey. Her services are offered free of charge, she can help you ask the right questions and more importantly, remember and understand the answers. She’ll help you develop a treatment plan that you feel comfortable and confident with. And then she’ll take care of all the details, like coordinating appointments and explaining procedures and treatments. So you can focus on getting well, not making to-do lists.

“Breast cancer treatment can be very involved and overwhelming. My goal is to be my patients’ advocate and point person from the moment of diagnosis, so they never feel lost or unsure of their next step. Knowing someone is there to help guide them along the way is important, because they should be focused on winning the battle, not fighting it.” Kristy Helm, RN, OCN, Breast Cancer Nurse Navigator Floyd Memorial Cancer Center of Indiana

• Ultrasound guided breast biopsy • F irst in Southern Indiana to be recognized as an American College of Radiology Breast Imaging Center of Excellence

Breast cancer patient Lori Fitzsimmons and Breast Cancer Nurse Navigator Kristy Helm, RN, OCN, discuss treatment options.

Mastectomy vs. Lumpectomy: Which is the Best Decision for You? Mastectomy Lumpectomy Aggressive breast cancer

Non-aggressive breast cancer

Advanced disease with multiple tumor sites in breast

Early stage disease with one tumor site

Large tumor size

Small tumor size

Two to three surgeries with inpatient hospital stays

One outpatient surgery

Total surgical and recovery timeframe of eight to 12 months with possible concurrent radiation therapy depending on lymph node involvement

Two to four week surgical recovery followed by one to six weeks of radiation therapy

Major invasive surgery

Minimally invasive surgery 7


‘Tis the Season to be Healthy: Don’t Let the Holidays Get Your Diabetes Management Off Track Staying healthy with diabetes is all about knowledge and self-control. You have to understand the disease and how your actions affect it, and then use that knowledge to make the right decisions for your health. The Joslin Diabetes Center Affiliate at Floyd Memorial’s board certified endocrinologist and medical director, Vasti Broadstone, MD, and registered dietitian/certified diabetes educator, Margaret Graves, RD, CDE, weighed in on their tips for staying on track with diabetes during (and after) the holidays. Keep your eye on the prize: good health “Self management techniques are the hallmark of staying healthy with diabetes,” Graves explained. “But when people get stressed out and overwhelmed, which runs rampant during the holidays, they fall into a pattern that we call ‘Diabetes-Related Distress,’ in which outside pressures and negative feelings begin to affect their healthy lifestyle behaviors that are essential to self-care. This is why it’s doubly important for people with diabetes to be proactive about managing their stress and focusing on what’s truly important - their health.” “I like to encourage my patients to use the holidays as a time of reflection,” added Dr. Broadstone. “Ask yourself what legacy you’re leaving for your loved ones. You can buy them things and spend all your time decorating the perfect holiday home and cooking, but if all you’re leaving them with at the end of the day is an unhappy, unhealthy and exhausted person, what was the point of it all? Being healthy is the greatest gift you can give to yourself and your loved ones.”

“The holidays are the perfect time to reflect on your lifestyle over the last year and make a conscious decision to get your priorities in order. Good health and family should always be at the top of that list. If you focus your efforts on the things that really matter, you’re less likely to be led astray by the stress and temptations that abound during this time of year.” Vasti Broadstone, MD Board Certified Endocrinologist & Medical Director Floyd Memorial Joslin Diabetes Center Affiliate 8

Take control of depression by focusing on others “Depression is a common concern for people with diabetes, especially during the holidays,” said Dr. Broadstone. “At its most basic level, depression is an excessively inward focus, so if you can change your focus to others instead, you’re well on your way to winning the battle.” Dr. Broadstone offered some advice for managing typical holiday stressors: • Remember. Start a tradition of sending a year-in-review letter after the holidays are over instead of a traditional card. It takes the stress off the looming end-of-year deadline and is more meaningful than a card. It also acts as a memory book when looking back at them years later. • Share. Invite people who have families far away to share in your celebrations. “Studies show that your degree of contentment increases when you’re doing something for others instead of yourself,” said Dr. Broadstone. • Inspire. Instead of getting down about the loved ones you’ve lost, think of the positive impact they had on your life and ways you can pay that forward to others. • Donate. Does the idea of a holiday season not spent cooking traditional goodies get you down? You can still make those items, just donate them to those less fortunate instead of eating them yourself. • Sleep. Make sleep a priority. “Too many people don’t get enough sleep during the holidays because they’re so busy with all the things they think are important. But sleep is absolutely critical,” explained

“Holiday foods tend to have more calories than normal, and holiday meals tend to have more food than normal, so you end up with a double whammy of excess. Keep it simple by remembering the most basic concept in weight management: calories in, calories out. When you eat more, you need to move more. Take the opportunity to make exercise a family affair by planning something active before and after each meal.” Margaret Graves, RD, CDE Floyd Memorial Joslin Diabetes Center Affiliate Dr. Broadstone. “Lack of sleep causes weight gain, increased blood pressure and blood sugar, insulin resistance and exacerbates feelings of depression. Getting plenty of sleep is one of the most important things you can do for your health and wellbeing.” Get moving Exercise goes hand-in-hand with sleep as one of the first things to go by the wayside when holiday busyness sets in. But it’s actually the best time to take advantage of the opportunity to set new traditions and make healthy living a family priority. Graves offered some simple suggestions on how to get moving. “A lot of people are afraid of exercise because they’re intimidated by it or can’t afford equipment or gym memberships. But it doesn’t have to be that complicated to still be effective. Every step you take burns calories, so just take more steps, and you’ll be on your way to better health.” She continued, “I recommend taking 10,000 steps per day. That may sound like a lot, but once you break it down, it’s a very

attainable number, no matter how busy you are or what kind of shape you’re in.” Tips for increasing your steps include: • Make it a family affair. Gift each member of your family with a pedometer and give a reward to whoever logs the most steps each week. • Walk around the perimeter of the gym or field while you’re waiting for your childrens’ sports activities to wrap up. • Walk laps around your house while talking on the phone instead of sitting on the couch. • Instead of switching the channel or fast forwarding through television commercials, get up and walk around the house until they’re over. • If your job or home life involves a lot of sitting, make it a habit to get up and move around every 30 minutes. Fight weight gain Let’s be honest, losing weight during the holidays is a lofty goal. So keep your expectations in check by vowing to simply maintain your weight during this time of year. Here are some helpful ideas to keep your scale in neutral: • Practice the 50/50 rule by filling your plate with 50 percent fruits and vegetables before anything else. • Bring your favorite healthy dish as your contribution to the party so you know that you have a healthy option built in. • Eat a light meal with your favorite lean protein before heading out to curb temptations once you get to the event.

• Spend your time in conversation instead of hovering near the food table; the holidays are ultimately about nurturing relationships with friends and family, not food. • Don’t deprive yourself, it will only result in overindulgence later on. You can eat your favorite foods if you limit them to one or two bites while filling up on the healthier offerings. Travel safely Diabetes is a demanding condition, but even more so when travel is involved. Read on for some helpful tips and reminders to keep in mind during your holiday travels. • If traveling by plane, you’ll need to bring along a letter from your physician listing the supplies that you’ll be carrying with you and why they are essential. • When flying, always keep your testing supplies, low blood sugar treatments and medications with you at all times. Never check these items. • Be aware of time zones and how they affect your medication and meal timing. Always carry a portable snack with you in case you need to eat and food isn’t readily available at that time. • If traveling internationally, bring along a prescription for your diabetes medications in case of emergency. • Wear diabetes identification at all times. • Check your blood sugar often. Changes to your normal routine can affect blood sugar in unexpected ways.

Don’t be Undone by Holiday Desserts Desserts, particularly the especially decadent variety seen during the holidays, can be difficult to turn down. But with this clever creation, you can feel good about having a little treat, because not only is it waistline-friendly, it also includes a serving of healthy, fiber-rich berries.

Angel Food Cake Trifle with Berries 1 angel food cake, cubed 1 quart no-sugar added vanilla or lemon yogurt (or sugar-free pudding) 1 quart fresh strawberries, sliced 1 pint fresh blueberries 1 small container Lite Cool-Whip, thawed Fresh mint leaves for garnish (optional) Layer in a trifle bowl single layers of angel food cake, berries and yogurt (or pudding) and repeat layers until trifle bowl is full or ingredients are used up. Once layers are complete, spread Cool Whip on top with a few fresh mint leaves. Refrigerate until serving. Best if eaten the same day. Servings: 24 Serving size: ½ cup Calories: 100 Carbohydrates: 20 grams (one carb serving)

Knowledge is Power Elliott P. Joslin, MD, the founder of modern diabetes care and of the world-renowned Joslin Diabetes Center at Harvard Medical School in Boston, was an unfailing proponent of education and knowledge as the primary tool for managing diabetes. It is in this spirit that Diabetes Self Management Education (DSME) is the cornerstone of care at the Joslin Diabetes Center Affiliate at Floyd Memorial, the only American Diabetes Association-recognized education program in Southern Indiana and the only Joslin Center affiliate in the Kentuckiana area. Education opportunities are offered at a variety of convenient times and locations, including mornings, afternoons, evenings, full days, Saturdays and even at off-site locations. They include: • Balance and Control-a program designed for individuals looking to • One-on-One Exercise Counseling get their diabetes under control, new to diabetes or new to insulin. • One-on-One Medical Nutrition Therapy • Diabetes Refresher-for patients who have been through the Balance • Balancing Life with Diabetes Support Group-a monthly support and Control course and are ready to set new goals to help them stay group led by diabetes educators, offering discussion on diabetesin control of their condition. related topics as well as group support. • Pre-Diabetes Class-for patients who have pre-diabetes or those who • Making Strides Exercise Club-starting in January, 2013, certified are overweight and age 45 or older. Designed to help determine what diabetes educators will lead a twice-monthly free exercise class at changes are needed to avoid developing type 2 diabetes, and to the Joslin Diabetes Center Affiliate on the second and fourth set goals for living healthier. Thursday of the month at 10 am. • Real World >9% A1c-designed to help patients with dangerously high blood sugar averages gain better control of their condition. • Gestational Diabetes Education-offered on an individual basis to For more information on programs and help expectant mothers with gestational diabetes manage their offerings at the Floyd Memorial Joslin condition during pregnancy. Diabetes Center Affiliate, call (812) 949-5700 or visit www.floydmemorial.com/joslin. • Diabetes Management Technology Education-offered for patients interested in using insulin pumps and/or continuous glucose monitoring systems.

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NOVEMBER/DECEMBER 2012 Calendar of Events

To register, call 1-800-4-SOURCE (1-800-476-8723), or visit www.floydmemorial.com, unless another number is listed.

*

• A ll events are free and meet in Floyd Memorial’s Paris Health Education Center unless otherwise stated. Screenings Sponsored by:

Stroke & Aneurysm Vascular Screenings Every Tuesday & Thursday by appointment Stroke & Aneurysm Vascular Screenings are offered by the Floyd Memorial Heart & Vascular Center. They include non-invasive screening for Abdominal Aortic Aneurysm, Peripheral Artery Disease and Carotid Artery Disease. The cost is $49 for all three. To make an appointment, call 1-800-4-SOURCE.

Lung Cancer Screenings CT scanning of the lungs is a simple, quick radiological test that is capable of detecting lung cancer at a very early stage, when treatment can be most successful. If you are a current or past smoker age 50 or older, or have been exposed to heavy second-hand smoke, this screening could save your life. Physician referral not required. Cost is $150, which includes a results consultation immediately after your scan with a physician radiologist. To register call, (812) 949-5570. Diabetes Fair and Foot Screenings Saturday, November 10, 8 - 10:30 am Paris Health Education Center Participants will receive a free blood sugar and hemoglobin A1C screening as well as a comprehensive foot screening and educational resources. Registration required.

Free Take 2 for Heart and Stroke Screenings Thursday, December 6 & January 3 by appointment. One-on-one screening with a cardiac nurse, full lipid cholesterol panel, blood pressure, blood sugar, blood sugar A1C and body mass index. Because it will take at least six months for the results of lifestyle changes to show up in future screenings, participants who receive abnormal results must wait at least six months before scheduling another screening. Those with normal results can be screened on an annual basis. Registration required.

Health Screenings at the New Albany YMCA Monday, November 12, 5 - 7 pm In honor of Diabetes Awareness month, Floyd Memorial will be offering free blood sugar and hemoglobin A1C screenings.

Free Blood Pressure Screenings 1:30 - 3 pm every other Friday in the main lobby. December 7, 21, January 4 & 18.

Health Screenings at the New Albany YMCA Tuesday, January 8, 9 - 11 am Start the year healthy! Join us at the New Albany YMCA to receive a tri-fecta of free health screenings. Hospital staff will be on site to offer blood pressure, blood sugar and body composition screenings for the community and YMCA members.

Free Osteoporosis Screenings The pDXA screening is a scan of the bone density of the heel. The screenings take place in the Women’s Imaging Center and are offered by appointment only. To register call, (812) 949-5570.

Massage, a Smart Holiday Gift

Gift certificates for massage are a wonderful holiday gift. Floyd Memorial Rehabilitation Services offers Swedish, deep tissue, injury and pregnancy massage by certified therapists. Their skilled hands can help relieve stress, manage pain and provide a luxurious treat. Massage can provide an emotional balance that is just as valuable as the numerous physical benefits.

Free Colon Cancer Screening Kits Through December 31, 2012 Floyd Memorial Cancer Center of Indiana Free occult blood colon cancer screening kits are available for pickup at the Floyd Memorial Cancer Center of Indiana front desk through December 31, 2012.

Also, consider the gift of an office chair massage for your employees this holiday season. It’s a convenient, cost-effective gift, and your staff will love it! Benefits include: • Reduced stress and anxiety • Increased performance • Improved general well being and morale • Eased muscle soreness • Increased flexibility and range of motion

Call Floyd Memorial Rehabilitation Services at (812) 948-7416 for more information.

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HEALTH EDUCATION Kidney Disease Treatment Options Classes Wednesday, November 21, December 19 & January 16, 10 am - Noon Learn about the types of treatment for kidney disease including hemodialysis (home and in-center), peritoneal dialysis for home, and kidney transplantation. Call (502) 452-2047 ext. 13 for more information. Free Bone & Joint Pain Seminar Tuesday, November 27, 6 - 7 pm Floyd Memorial Medical Group-Salem 1101 Jim Day Road, Suite 107A Thursday, December 6, 6 - 7 pm Paris Health Education Center Learn about advanced treatments that may offer dramatic relief of your knee or hip pain. An orthopedic surgeon and nurse will discuss medications, exercise and joint replacement surgery. Registration required. Stroke Clinic Southern Indiana Rehab Hospital offers a free stroke clinic for anyone who has experienced a stroke. The survivor is screened by a variety of professionals including therapists, case managers, nurses and physicians who can review their ongoing recovery and make recommendations as needed. Contact: (812) 941-6120 or (812) 941-6154.

SUPPORT GROUPs All support groups meet in Floyd Memorial’s Paris Health Education Center unless otherwise stated.

Alzheimer’s Support Group Third Thursday of each month 2 - 3:30 pm & 6 - 7:30 pm Contact: Sadie Powell, (812) 948-1311

CareGiver Support Group First & third Thursday of each month, 6:45 - 8 pm Floyd Memorial Cancer Center of Indiana Contact: Helen, (812) 945-4000 ext. 6231

Amputees in Motion Support Group Fourth Wednesday of each month, 7 pm Contact: Brittany Bley, (502) 724-4490 Meets at Southern Indiana Rehab Hospital

La Leche League of Southern Indiana Third Monday of each month, 6:30 - 8 pm Breastfeeding support and information Contact: Lisa at (812) 941-1960

Balancing Life with Diabetes Support Group Tuesday, November 20, 10 - 11 am Topic: Dealing with the Holidays Tuesday, December 18, 10 - 11 am Topic: Exercise During the Winter Tuesday, January 15, 10 - 11 am Topic: Setting S.M.A.R.T. Goals for 2013 Meets at Floyd Memorial Joslin Diabetes Center Affiliate - 2019 State Street, New Albany To register, call 1-800-4-SOURCE.

Mended Hearts Support Group Fourth Monday of each month, 6 pm Contact: Jackie Lattis at (502) 819-2085 for meeting location.

Brain Injury Support Group Third Thursday of each month, 7 pm Meets at Southern Indiana Rehab Hospital Contact: Beverly Setree (502) 819-2542 Breast Cancer Support Group Second Thursday of every other month, 7 pm Please note: February’s meeting will be held February 21. Contact: Pat Kasse, (812) 948-1215 Cancer Support Group First & third Thursday of each month, 6:45 - 8 pm Floyd Memorial Cancer Center of Indiana Contact: Helen, (812) 945-4000 ext. 6231

Multiple Sclerosis Support Group Fourth Monday of each month, 6 pm Contact: Michael Quinn at (502) 797-5878 Parkinson’s Support Group First Tuesday of each month, 6:30 - 7:30 pm Contact: Richard Mattox (812) 256-5424 Stroke Support Group Second Tuesday of each month, 1 pm Meets at Southern Indiana Rehab Hospital Contact: Deb Strickler, CTRS (812) 941-6153 Together for Breast Cancer Survival Men’s Caregiver Support Group Fourth Tuesday of each month, 6:30 pm Floyd Memorial Cancer Center of Indiana Contact: Doug Drake (812) 945-4393 www.cosurvivors.org

OFFERED BY

FLOYD MEMORIAL Cancer Center of Indiana Look Good…Feel Better Monday, November 26, December 17 & January 28, 6 pm Floyd Memorial Cancer Center of Indiana This American Cancer Society class provides volunteer cosmetologists who teach make-up techniques and ways to disguise hair loss to women who are battling cancer. Registration deadline is Thursday, November 22, December 13 and January 24. To register, call (502) 560-6035. ‘Be the Match’ Bone Marrow Donor Registry Drive Thursday, February 7, 3-7 pm Floyd Memorial Cancer Center of Indiana Be the match. Save a life. Thousands of patients with blood cancers such as leukemia or lymphoma depend on the National Bone Marrow Donor Registry to find a match to save their life. The Floyd Memorial Cancer Center of Indiana will host a community registry drive to sign up community members interested in joining the registry. People between 18-44 years of age who meet health guidelines and are willing to donate their bone marrow if a genetic match is found are encouraged to participate. Joining the registry is quick and painless-it only takes a simple cheek swab to potentially save a life. No appointment necessary. For more information on the Be the Match Registry, visit www.marrow.org.

OFFERED BY

Joslin Diabetes Center

The Floyd Memorial Joslin Diabetes Center Affiliate offers on-going education classes so patients can keep their condition in check. Call (812) 949-5700 for information.

Balance and Control Program designed for individuals looking to get their diabetes under control, new to diabetes or new to insulin. Covered by most insurance plans. To register, call (812) 949-5700. Diabetes Refresher Course Program helps patients set goals for healthy management of their diabetes. Highlights include: what’s new in diabetes; understanding the numbers; counting carbohydrates; latest treatment options; evaluating old goals and setting new ones. Covered by most insurance plans. To register, call (812) 949-5700.

SPECIAL WINTER NOTICE: If Floyd County schools are closed due to bad weather, all classes and support groups will be canceled. If bad weather occurs late in the day, call 1-800-4-SOURCE (1-800-476-8723) or (812) 944-7701 to find out if the class will be held.

Joslin Making Strides Club Beginning January 2013 Second & Fourth Thursday of each month, January 10 & 24, 10 - 11 am Get moving for better health with the help of a Joslin Center educator and a group of people facing the same challenges as you. A certified diabetes educator will be present to lead the group in low-impact exercise activities. Good candidates include those that need guidance and/or structure in doing low-impact activity. Participants are asked to bring their own glucometer to check blood sugar before and after activity. For more information on this free club, call (812) 949-5515. Pre-Diabetes Class If you have pre-diabetes, or are overweight and 45 or older, you are at high risk of developing type-2 diabetes. Class is designed to help determine what changes are needed, and set goals for living healthier. Class is self-pay and costs $25. To register, call (812) 949-5700.

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Floyd memorial Birthing center

OFFERED BY

All Birthing Center classes are held in the Floyd Memorial Paris Health Education Center.

Cesarean Section Class C-section classes are scheduled on an individual basis by appointment. Goals of the class are to learn options available to you with a cesarean birth, to reduce fears and anxieties by obtaining knowledge about the procedure and to take an active role in creating a satisfying birth experience. The cost is $15. Registration required. Sibling Class Saturday, November 17, 10:30 am - Noon This free class is for soon-to-be new brothers and sisters, ages 3 to 11, and their parents. Children will be shown how to diaper and hold a baby (doll), and tour the Birthing Center where they get to listen to the baby’s heartbeat. Registration required. Prenatal Class Thursday, January 3 to February 21, 7 - 9 pm For the expectant mom and dad or other support person. This free class is a six-week session and should be taken at the beginning or middle of pregnancy. Taught by several of our highly skilled obstetrical nurses. Registration required. Prepared Childbirth Class Saturday, January 19 & 26, 8:30 am - 12:30 pm (2-part series) Cost - $30 per couple. These classes discuss the physical preparation and education needed for a successful delivery. The classes involve relaxation techniques using a variety of methods, as well as tips for pregnancy fitness including physical therapy. Take during the middle of pregnancy. Registration required. OFFERED BY

Weight Management Center

Beat that Holiday Temptation The holidays are the most difficult time to lose weight, or even maintain your current weight. The experts at the Floyd Memorial Weight Management Center can help you stay on track. Weekly Health Management Resources (HMR) classes offer support and accountability which can make all the difference during holiday celebration months. There’s even an at-home packaged meal option for your convenience. The HMR program has proven to deliver results. Call (812) 949-7151 to get started. HMR Informational Seminars If you want to lose anywhere from 10 to 200 pounds, HMR can help. Free informational seminars are available on Mondays and Wednesdays through December, and Mondays and Thursdays beginning in January 2013. Call (812) 949-7151 to schedule. The program offers several diet options including a medically supervised plan, a moderate diet option and an at-home program. 11


November-December 2012 HealthScope