GHS Inside Health Summer 2014

Summer 2014 Getting Knee Recipients Back on Their Feet—Fast!

GHS’ Go-to Specialists for Head & Neck Cancer High-tech Simulator Gives Hands-on Training A Publication of Greenville Health System

“Blue Dye” Research Means Pink for This Mom

MD360® Convenient Care Health Care When You Need It! Walk-in care open 7 days a week

Urgent care • Everyday illness and injuries • On-site lab and X-ray • Physical therapy by Proaxis Therapy All physicians board-certified in Family Medicine or Emergency Medicine Extended hours: Mon.-Fri., 6 a.m.-10 p.m. • Sat., 10 a.m.-6 p.m. • Sun., noon-6 p.m.

Four convenient locations 1025 Verdae Blvd., Ste. B Greenville, SC 29607 (864) 286-7550

1305 S. Suber Rd. Greer, SC 29650 (864) 989-4609

300 Scuffletown Rd. Simpsonville, SC 29681 (864) 329-0029

11402 Anderson Rd., Ste. A Greenville, SC 29611 (864) 631-2799 (in collaboration with Baptist Easley Hospital)

ghs.org 14-21367114

CONTENTS

New Simulator Provides High-tech Training 2 This technology gives doctors realistic surgical “experience”—and it’s found only at GHS.

Uncovering an Answer to Endometriosis 5

2

Kim and Nick Brolin almost had given up hope of becoming parents. Then, GHS researchers found a novel way to resolve one obstacle.

Pain Relief for Knee-ded Replacements 9 It’s common knowledge among people with knee replacements that recovery is painful. At GHS, that story is changing.

Solving a Cancer Tongue Twister 13

5

Many doctors were baffled by Ruth Anne Herron’s unusual symptoms—until, on her first visit with a GHS ENT specialist, she was given the right diagnosis.

Departments Message from the President and CEO 1 Spotlight 2 What’s Right in Health Care 3

9

Clinical Trials 16 Q & A 17 Practice Profile 18 Physician Directory 19

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We welcome your comments, suggestions and ideas. Call (864) 797-7541 or email nparker@ghs.org.

PRESIDENT’S MESSAGE

Together We Serve At Greenville Health System, we celebrated National Healthcare Week recently with the theme “together we serve.” These three words, taken from our Values Statement, aptly sum up how we seek to transform health care through a united mission and singular cooperation for the benefit of the people and communities we serve.

In this issue of Inside Health, you’ll see the ways in which GHS healthcare providers, serving together, have not only enhanced quality of life but also extended life for upstate individuals. Kim Brolin, pictured on our cover, is able to enjoy parenthood because GHS researchers discovered a way to uncover “hidden” endometriosis.

Ray Schroeder experienced a great recovery and start on rehab after knee replacement surgery because of a new pain management process for that procedure in place at GHS (story, page 9). And Ruth Anne Herron is alive today because her tonsil cancer finally was diagnosed and treated by a GHS specialist (story, page 13).

An expanded application of “together we serve” occurs through our role as a one-of-a-kind academic health center model, known as the Clinical University, in which we partner with leading area universities to innovate the delivery of health care and train new healthcare providers (see back cover).

This clinical university model allows multiple universities to utilize GHS clinicians and resources to provide the clinical education of their health profession students. Recent years have

brought marked expansion of such programs at GHS in partnership with the University of South Carolina. These include the certified registered nurse anesthetist (CRNA) satellite program in 2010, the South Carolina College of Pharmacy regional campus in 2011 and USC School of Medicine Greenville in 2012. Even so, with one in every three practicing physicians in the United States anticipated to retire over the next 15 years, we still face an ever-increasing demand for healthcare providers.

For this reason, GHS now is considering how best to help our university partners educate increasing numbers of complementary mid-level providers.

One such initiative is intended to bring nurse practitioner students from the University of South Carolina to train to work in the GHS Behavioral Health Department alongside our psychiatrists.

We are pleased to be working with our university partners in pursuit of groundbreaking strategies to enable the right care at the right time in the right place for our community. Together we serve you.

Michael C. Riordan President and CEO

SPOTLIGHT

New Simulator Provides High-tech Training A new simulation tool is allowing GHS doctors to practice the latest, least invasive method for removing uterine fibroids before bringing the technique to patients.

The simulator, from Symbionix, is a comprehensive tool providing realistic “handson” surgical training. GHS is the only academic institution in the world using a new module that teaches hysteroscopic morcellation (using a small blade inserted through a hysteroscope to remove fibroids in tiny sections).

“This is new technology in operating rooms, and now we can train physicians and residents how to perform it in a safe environment,” said David Forstein, DO, a reproductive endocrinology and infertility specialist with Fertility Center of the Carolinas of Greenville Health System (GHS). Patients benefit from the morcellation technique because it leads to shorter operating times and a decreased risk of complications.

A variety of simulation tools are available in the Greenville HealthCare Simulation Center at GHS, which opened in 2007 and was the first of its kind in the Upstate. The hysteroscopy simulation is performed on the HystSim equipment that assists physicians as they master instruments, manage possible complications and get useful feedback.

Dr. Forstein said this feedback is especially beneficial: “The computer scores how the learner did. There is the opportunity to practice and drill the procedure so that the physician can show competence before going into the operating room.”

The simulator allows doctors and residents to use a real hysteroscope to operate on a model uterine cavity. The surgery is conducted via a monitor when working with patients and, in the simulation, a virtual reality screen can present realistic surgical scenarios.

“There have been lower-tech simulators,” Dr. Forstein noted, “but they don’t give you the same sense of realism.”

The simulator currently supports gynecology and urology, but Dr. Forstein said the benefits of the equipment have led to discussions about expanding the program by adding more modules.

“It could be a resource for the whole region,” he pointed out.

Patients trust doctors to keep up with the latest advances, he added, and access to high-tech simulation tools for the latest surgical techniques is another way he and his fellow GHS doctors can stay at the forefront and provide each patient the optimal treatment.

“GHS is the only academic health center in the world to have this module to train attending physicians and residents to increase skill and enhance patient safety,” Dr. Forstein observed. “This commitment to education helps us teach innovatively, improve constantly, and transform health care for the community we serve.”

Patients benefit from this technique because it leads to shorter operating times and a decreased risk of complications.

W H AT ’ S R I G H T I N H E A LT H C A R E

Here’s a snapshot of what’s going on at GHS as we pursue our mission to heal compassionately, teach innovatively and improve constantly.

2

The number of times GHS’ Hillcrest Memorial Hospital (HMH) has been named a Bariatric Surgery Center of Excellence. HMH has been granted renewal of accreditation by the American Society for Metabolic and Bariatric Surgery Bariatric Surgery Center of Excellence program. Awarded for a term of three years, this recognition demonstrates that HMH provides multi-disciplinary, high-quality, patient-centered care to those undergoing weight-loss surgery.

18

The number of consecutive years that Greenville Memorial Hospital (GMH) has received a Consumer Choice Award.

Sponsored by National Research Corporation (NRC), the award recognizes the nation’s top hospitals that consumers have chosen for providing the highest quality health care. GMH is the only hospital in South Carolina to have won this prestigious honor every year since the award’s inception. It also is one of just six hospitals in the state to be recognized as a 2013/2014 winner.

32,082

The number of people who received free HIV screenings from GHS’ Greenville Memorial Hospital (GMH) in the past six years.

This service, provided through a collaboration of the hospital’s Laboratory Services and Emergency Department under a grant to offer free HIV screenings, has led to GMH’s being recognized with the Outstanding Partner Award from the S.C. Department of Health and Environmental Control as a service provider, community partner and leader in an effort to improve the health of South Carolinians.

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$800,000

435

Sharon have given to establish a scholarship

in the Upstate served by GHS’

fund to help recruit and retain top students

new Veterans Liaison Office

The amount Jerry Youkey, MD, and wife

at the University of South Carolina School of Medicine Greenville. The gift will fully support the education of five physicians over the course of the trust. Dr. Youkey is executive vice president for GHS Medical and Academic Affairs and dean of the

The number of military veterans

through June. This office, which opened earlier this year, works closely with local veterans groups while building partnerships and overseeing the system’s various veteran-focused projects. This initiative allows the system to

medical school. Applicant rates at the medical school have skyrocketed; 2,700+

better collaborate with veterans groups and explore future

students have applied for the 75 positions in

initiatives, including research to

the incoming class.

benefit veterans.

25

The ranking that GHS’ Patewood Hospital received as a hospital with the “cleanest patient rooms”— according to the highest proportion of patients who reported their room and bathroom were “always” clean in a national survey by Hospital Compare.

3

The number of consecutive Certificates of Distinction for Primary Stroke Centers from The Joint Commission that GHS has received. This distinction recognizes centers that make exceptional efforts to foster better outcomes for stroke care. The two-year certification is awarded following a rigorous survey process.

1

Our first priority: taking care of patients and their families.

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Uncovering an Answer to Endometriosis GHS researchers have discovered that even when endometriosis isn’t visible, it still can be present—and that removing “invisible” endometriosis brings pain relief and increased fertility.

By Claire Cross

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I

f you enjoyed invisible ink experiments as a kid, you might remember using baking soda and water to write a message on paper. When the paper dried, it looked like a blank page, but when you painted over it with grape juice— voila!—the hidden message was revealed.

More complex invisible inks have been used in wartime to hide important information. Figuring out how to reveal an adversary’s hidden messages is a triumph and can be critical for defeating the opponent.

Bruce Lessey, MD, PhD, a reproductive endocrinologist at Fertility Center of the Carolinas of Greenville Health System (GHS), has done something similarly triumphant in his research on endometriosis. He has found a way to reveal “invisible” lesions of this disease using methylene blue, a simple blue dye commonly used for diagnostic procedures. The “wins” include pain relief and cured infertility.

Several theories exist to explain the cause of endometriosis, but it’s still not fully understood. It affects five percent of women of reproductive age, and between 40 percent to 70 percent of women with pelvic pain and/or infertility have the disease.

It occurs when endometrium, the tissue lining the inside of the uterus, starts growing outside the uterus, implanting itself on anything in the abdominal cavity—the outside surface of the uterus, ovaries, fallopian tubes, the bowel, bladder or other organs. It can cause excruciating pain, infertility and other problems.

Laparoscopic surgery is the only way to diagnose the disease.

In this minimally invasive procedure, the surgeon examines the inside of the abdomen and pelvis (the lower abdomen) with a viewing instrument inserted through a small incision near the belly button.

Endometriosis can look like gray filmy adhesions, or it can resemble red, brown, black, white or clear flecks (called implants) sprinkled on abdominal surfaces. If endometriosis has invaded the peritoneum, which normally is a watertight lining covering the inside of the abdomen, endometrial implants might look more like a nodule. If the disease invades an ovary, it can form blood-filled cysts.

When surgeons see these telltale growths through the laparoscope, they remove them during the same procedure.

But after typical laparoscopic removal of endometriosis lesions, what might look like a pelvis devoid of disease can be deceptive.

No Hidden Agenda What Dr. Lessey and his colleagues discovered after a twoyear research study, published in the December 2013 issue of the Journal of Visualized Experiments, is that even when endometriosis isn’t visible, it still can be present.

The study participants included 45 women with suspected endometriosis, 40 with chronic pelvic pain and five of them without pain.

In each patient, Dr. Lessey inspected and took note of all visible endometriosis lesions. Then, he sprayed the peritoneal surfaces in the abdomen with methylene blue dye, followed by a rinse. After the rinse, some areas of abdominal tissue remained blue for several minutes, until the lymphatic system carried away the dye.

Dr. Lessey examined these biopsied areas where the dye had lingered and found endometriosis was present that, without the dye uptake, couldn’t be seen. He then removed all visible and invisible signs of the disease.

According to Dr. Lessey, the watertight peritoneum becomes leaky and defective in women with endometriosis, allowing endometrial blood and pain-causing substances in the blood—and, in the study, blue dye—access to the nerves underlying it. This break in the peritoneal barrier might explain why women with endometriosis have pain or even why they are infertile.

“When the blue dye stains certain areas of the pelvis, it is sending a message about where the defects are in the peritoneum and thus where subtle or ‘invisible’ endometriosis resides,” explained Dr. Lessey. “The blue dye helps us identify where the endometriosis has spread beyond the boundaries of what’s visible with the eye. It helps us ‘see’ the larger lesion that many doctors may not realize exists.“ Inside Health 6

with severe endometriosis have no pain, while others with just a few growths have pain that’s incapacitating.

Brolin had, however, suffered several miscarriages and came to Dr. Lessey for help with unexplained infertility.

Through laparoscopy, Dr. Lessey discovered Brolin had endometriosis. With the aid of blue dye staining, he also found what he described as a surprising amount of invisible endometriosis, which he removed.

Blue dye reveals “hidden” endometriosis.

“The blue dye really expanded our ability to appreciate just how much endometriosis Kim had,” he noted.

Dyeing for Relief The areas that took up the dye correlated with the areas the study participants said they had been feeling pain. After the procedure, 80 percent of participants reported immediate pain relief.

Dr. Lessey notes that patients with bladder pain called interstitial cystitis (or with irritable bowel syndrome) often have this blue staining on their bladder or rectum, even when there’s no visible endometriosis present.

“By removing the diseased peritoneum and the invisible lesions, we can cure these patients of their symptoms,” said Dr. Lessey.

“By relying on visual inspection alone, we wouldn’t be able to do that.”

In addition, patients are more fertile following this new procedure. Several study participants were able to conceive soon afterward.

“We’re seeing a much higher pregnancy rate after our surgery than has typically been reported in the literature,” Dr. Lessey reported. “Even a very small amount of endometriosis can cause infertility. By removing that bigger area of problematic tissue, we think we’re getting rid of ALL of the disease.”

Not Seeing Is Believing One patient who has benefitted from this new technique is Kim Brolin, age 33, of Piedmont.

Brolin wasn’t experiencing pain and didn’t know she had endometriosis. According to Dr. Lessey, the amount of pain is not always related to the severity of the disease. Some women 7 Inside Health

“I had nearly given up on being a mom,” said Brolin, “but Dr. Lessey wouldn’t let me lose hope.”

Twin Benefits Through medical therapy and in-vitro fertilization (IVF), Brolin became pregnant, and she and husband Nick welcomed fraternal twin girls in 2012. Dr. Lessey is confident that with medical management, Brolin can have more children.

“Dr. Lessey called me the day after the laparoscopic surgery,” recalled Brolin. “He also came to the hospital to see the girls when they were born. He is a godsend. I love him! He’s sympathetic and understands.”

The visible smile on Dr. Lessey’s face when talking about helping his patients needs no deciphering. And there’s no hidden message regarding his determination to keep up the fight against endometriosis; he’s upfront about that, too.

“My hope is that this new procedure will improve detection and elevate diagnostic accuracy for endometriosis at laparoscopy, and that ultimately it will provide a better longterm treatment for this disease,” he said.

For more information about Dr. Lessey and Fertility Center of the Carolinas, visit fertilitycenterofthecarolinas.org. To hear Kim Brolin’s comments, visit ghs.org/kimvideo.

“I had nearly given up on being a mom but Dr. Lessey wouldn’t let me lose hope.

— Kim Brolin Kim Brolin and husband Nick have double the fun with twins Ava (in red) and Stella.

Ray Schroeder is back on track thanks to an enhanced recovery process for knee replacement.

Pain Relief for Knee-ded Replacements At GHS, physicians constantly seek to improve every aspect of a patient’s return to health, from diagnosis to treatment to recovery.

By Lark Reynolds

R

ay Schroeder is practically a new man from the knees down. The 70-year-old, an avid runner, has had total knee replacement surgery performed on both knees at Greenville Health System (GHS).

“I’ve been a runner all my life and have even run a marathon,” Schroeder said. “My knees were just bone on bone.”

Before his first knee surgery, Schroeder was warned by jogging buddies about the pain involved in the recovery.

The surgeon who performed Schroeder’s two surgeries is Brian Burnikel, MD, an orthopaedic surgeon with GHS’ Steadman Hawkins Clinic of the Carolinas who specializes in hip and knee replacement. He knows that horror stories about pain following total knee replacement often have caused patients to delay having the surgery.

“They hear all these stories about how bad the pain is,” said Dr. Burnikel. “So over the years, we’ve been working to make that better—not only improve the pain but also try to minimize the side effects from the pain control and improve their rehabilitation.”

Relieving Side Effects In late 2012, between Schroeder’s surgeries, GHS began using a new method of pain management for total knee surgeries that involves a recently developed, long-acting local anesthetic called Exparel. By injecting Exparel into the knee near the completion of surgery, doctors often can eliminate the need for stronger narcotics such as Demerol, OxyContin and morphine that traditionally have been used to minimize patients’ post-operative pain. GHS was the second institution in the U.S. to begin using Exparel for total joint surgeries.

“Narcotics are great for pain control; the problem was that you would get patients sedated so they couldn’t do their therapy,” Dr. Burnikel explained. “You also would get nausea and vomiting in about 75 percent of patients. So the combination of those two factors was increasing their length of stay because they weren’t able to get moving until several hours after surgery.”

Another element of pain management that frequently has been used in total knee replacements is a femoral nerve catheter in the front of the thigh.

Brian Burnikel, MD, is pioneering new, safe pain management for knee replacements.

“It pumps in local anesthetic to the nerves in the front of the thigh,” Dr. Burnikel said. “And that was really great for pain control, but it shut off all of the muscles in the front of the leg, so it really slowed patients down as far as doing their rehab.”

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The use of Exparel replaces the need for the femoral nerve catheter, too. Dr. Burnikel described the means by which the new drug works:

“I felt pumped up about going in for the second knee—not that I want to keep doing this,” Schroeder joked.

Expanding Exparel’s Use “It’s a local anesthetic that has a sustained release. It releases over about 72 hours, so the patients never really get into a lot of pain.”

Exparel is one component of the multi-modal pain management program in use for total knee replacements at GHS. Other components include Tylenol and an anti-inflammatory called Toradol, both administered intravenously. According to Dr. Burnikel, some patients need very little extra pain medication beyond those two drugs when Exparel has been used.

Back to Business That was the case for Schroeder, who noticed a big difference between the recoveries for his two knee surgeries. During his first surgery in March 2011, Schroeder remembers how the drugs “gave me five or six hours that I was totally out, so I didn’t get out of the bed or do anything. And then, I felt the effect of the drug for up to two full days afterward.”

“When we started using Exparel,” said Dr. Burnikel, “we knew right away that it was better than what we were doing.”

His department has conducted a retrospective review of the drug used in this population, and the findings are promising.

“It’s made a tremendous difference in patients’ pain control, and it’s also decreased the side effects significantly,” Dr. Burnikel reported. “We’ve found that patients walk farther in the hospital; we’ve had statistically significant decrease in their length of stay; and at three weeks, we’ve actually shown a statistically significant improvement in their range of motion.

So it’s showing us that it’s helped their pain control, and it’s also helped their progress even three weeks down the road.”

The dosage used at GHS is a safe dosage, with no signs of any complications associated with the injection in approximately 1,000 total knee replacement surgeries.

Schroeder, CEO of Interim HealthCare, tried to ease back into the running of his business in the days following his surgery but found it difficult.

Dr. Burnikel said there is much potential for expanding the use of Exparel, not only to other joint replacement surgeries but also for the benefit of different populations.

“I’m trying to get on the phone and do things, and I’m thinking, gosh, my clarity isn’t there,” Schroeder said. “It was a couple of days of almost like being in the twilight zone.”

“We’re developing a study now looking at Exparel’s use in elderly patients with hip fractures,” Dr. Burnikel said. “That’s a group of patients where we get a lot of side effects from the use of narcotics. We get over-sedation, constipation and confusion. That would be a population for which it may be very beneficial.”

He noticed a marked difference after his second surgery, performed October 2013, in which the multi-modal pain management system was used.

“Within two to three hours after the surgery, I was awake, feeling clear and ready to take my first walk,” Schroeder emphasized. “So it put me well ahead of where I was on the first one.”

Schroeder said Dr. Burnikel explained the new pain management system before his surgery and gave him the choice of trying it or opting to stay with the pain management method that had been used during his first surgery.

He discussed Exparel and the multi-modal pain management technique with physical therapists who work for his company, and they informed him that they were hearing great stories about the new drug.

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He continued, “In addition, we’re currently conducting a study of Exparel use for total shoulder replacements, with plans to study its use in total hip replacements. Those joint replacements tend not to be quite as painful, so the pain control hasn’t been as big of an issue as it has been with total knees. Still, if you can make patients a little more comfortable, it will be worth it.”

Meanwhile, Schroeder enjoys walking and even runs frequently these days. “I often walk or run to think through business matters and to make decisions for my life,” he commented. “I’m thankful to be walking well again.”

For more information, visit steadmanhawkinscc.com/knee.

To hear Ray Schroeder’s comments, visit ghs.org/rayvideo.

“I often walk or run to think through business matters and to make decisions for my life. I’m thankful to be walking well again.” — Ray Schroeder

Solving a Cancer Tongue Twister Head and neck cancers, which are on the rise, often present challenges in diagnosis and treatment.

To meet the challenge, GHS specialists are drawing upon both their expertise and a team approach.

By Leigh DeLozier

“

s there any possibility this could be cancer?” That’s not a question anyone wants to ask a physician, but Ruth Anne Herron of Anderson, S.C., reached that point in early 2012. She had noticed over a period of several weeks that her saliva was thicker than normal and the back of her tongue was elevated.

“It wasn’t sore, but it was uncomfortable,” she recalled. “I felt a little swelling, and it just seemed strange.”

Visits to several physicians, attempts to resolve the issue with multiple medications and even a soft tissue CT scan of Herron’s neck didn’t make a difference or reveal any answers.

When Herron went for her routine dental checkup, her dentist didn’t like what she saw but wasn’t sure of the cause.

Ruth Anne Herron is thankful that her tonsil cancer was finally diagnosed and treated.

By the time Herron returned to her dentist six months later, the problem had worsened, but she still had no answers. “The pressure was uncomfortable,” Herron said. “The pain reached up to my ear and into my neck muscles. I couldn’t even lie on my right side.”

The dentist referred her to an oral surgeon, who in turn referred Herron to an otolaryngologist, or ENT (ear, nose and throat specialist). Rob Brown, MD, of Greenville Ear, Nose & Throat, part of Greenville Health System (GHS), saw Herron the next week.

a five-year survival rate of 50 to 60 percent. According to some studies, patients with HPV cancer have upward of an 80 percent five-year survival rate.”

“My first appointment with Dr. Brown was September 27, 2012,” Herron said. “He thought it was squamous cell carcinoma but needed to verify it. I had an MRI the next day.”

A biopsy a week later confirmed that Herron had tonsil cancer.

“Dr. Brown gave me two treatment choices,” she recounted. “I could have chemotherapy and radiation and maybe take care of things, or I could have surgery and radiation and definitely get rid of it.”

On October 25, 2012—less than one month after first meeting Dr. Brown—Herron had surgery to remove both tonsils and some lymph nodes. She followed the surgery with 30 radiation treatments at GHS that concluded in January 2013.

On the Rise Herron’s tonsil cancer is one of the increasing numbers of head and neck cancers (HNC) that physicians treat.

“It’s now number six in prevalence,” noted Paul Davis, MD, also of GHS’ Greenville Ear, Nose & Throat.

According to Dr. Davis, one of the state’s few ENT specialists with fellowship training in head and neck oncology, research shows that the human papillomavirus (HPV) normally associated with cervical cancer risk now is contributing to head and neck cancers.

“Smoking and alcohol used to be the primary causes of throat and oral cancer,” said Dr. Brown. “Those numbers seem to be decreasing, but we’ve seen a dramatic increase in cases caused by HPV. “The HPV virus is rampant in our population,” he continued.

“Up to 75 percent of people would be positive for it if tested.”

Having HPV doesn’t always lead to cancer. But for the patients who are diagnosed, the good news is that they usually have a much better outcome than HNC patients whose cancer is caused by other factors.

“Patients with HPV-related cancers tend to do better,” commented Dr. Davis. “HNC patients traditionally expected

Rob Brown, MD, (left) and Paul Davis, MD, are two of the few ENT physicians in the Upstate with special expertise.

It Takes a Team Physicians at Greenville Ear, Nose & Throat focus on a multidisciplinary approach to treat all of their patients, whatever type of cancer they have. A team of GHS surgeons, medical oncologists, radiation oncologists, speech therapists, nutritionists and social workers come together on behalf of each patient.

Some patients, such as Herron, also work with rehabilitation specialists or have acupressure treatments as part of their care to help the nerves and surrounding areas recover.

“Many people other than physicians help our patients,” Dr. Brown explained. “Speech pathologists can help patients with their swallowing during and after treatment. Nutritionists help them find things to eat that appeal to them without making treatment side effects worse. It’s what we call ‘multidisciplinary care,’ and Ms. Herron was a ‘poster child’ for how the process of working together as a team should go.”

“We see the patients and discuss treatment options together,” Dr. Brown added. “We determine the solution we think is best and present it to the patient and family. It saves valuable time for the patients and us because they don’t have to keep being referred to other specialists for opinions. What used to be a month-long process of deciding what’s best for the patient can be condensed into two or three days since we can do it all at once.”

“The key to multidisciplinary care is thinking about things differently and changing how we take care of folks,” said Dr. Davis. “We do our best to do the right thing for people.”

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That approach sometimes includes highly specialized care such as microvascular (or free flap) reconstruction. The physicians at Greenville Ear, Nose & Throat are some of the few in the Upstate with the expertise to complete these procedures, which means doctors from surrounding areas trust them to care for their patients.

“A skin graft on top of tissue or muscle usually can grow in and survive,” Dr. Davis explained. “But a lot of head and neck cancers tend to be pretty complex because of the areas involved. We can’t always use just a skin graft to make the repair. We need bone, bigger tissues, even blood vessels from other areas to complete the procedure.”

earned a Bachelor of Perseverance degree. It was a fitting award, considering how she continued to seek help before reaching their practice.

“I kept saying, ‘It’s still there, folks. What is it and what are we going to do?’ ” she emphasized. “I’m very, very grateful to have found people who could help me and who stood beside me through this journey.”

She concluded, “It sounds crazy, but even before I had the surgery I felt as if I were going to get well. Just finding physicians who listened

Dr. Davis continued, “We’re doing reconstructive surgery in a different way today. It’s more complex but means the patient usually has better function after surgery than he or she did before.”

and who knew what to do made me think I was

Patients such as Herron are enjoying the results of those new techniques and the support that goes with them.

For more information about the ENT services offered by GHS, visit ghsgreenvilleent.org. For other concerns about cancer, visit ghs.org/sooner. To hear Ruth Anne Herron’s comments, visit ghs.org/ruthvideo.

On her last day of treatment, the staff at the GHS Cancer Institute gave Herron a certificate announcing that she’d

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on the road to recovery.”

CLINICAL TRIALS

Participants Needed

Hundreds of clinical trials are conducted throughout Greenville Health System on a variety of drug therapies, surgical devices and other treatments in all areas of medicine.

Persons With Any Cancer ITOR (the Institute for Translational Oncology Research) conducts Phase I cancer clinical trials to give patients access to the most advanced treatments available. Could you benefit from one of its research protocols? Studies range from those for newly diagnosed metastatic pancreatic cancer to those for patients who have exhausted conventional therapies. Call Lisa at (864) 455-3735 or Jill at (864) 455-3737.

Women at High Risk for Breast Cancer If you are pre-menopausal, less than 50 years old and are at a higher risk for breast cancer because you were previously diagnosed with early stage breast cancer or benign breast disease or have a strong family history of breast cancer, you may be eligible to participate in this study looking at prevention of breast cancer. The purpose of this study is to see if vitamin D can decrease breast density, which may be associated with an increased risk for future breast cancer. Call Kate at (864) 455-2860.

Women With Early-stage Breast Cancer This trial studies the efficacy of acupuncture for joint symptoms related to aromatase inhibitors in women with early-stage breast cancer. If you are a post-menopausal woman

currently taking aromatase inhibitors for treatment of early-stage breast cancer and you are experiencing joint pain or stiffness, you may be eligible for this trial. You also must be willing to come to Greenville for acupuncture appointments for 12 weeks. Call Kate at (864) 455-2860.

Relatives of People With Type 1 Diabetes This study is searching for ways to prevent and quickly medically intervene in those newly diagnosed with diabetes.

Researchers are seeking to test family members of people with type 1 diabetes to determine if they show signs of developing the disease. Parents, brothers, sisters and children of those who have type 1 diabetes (ages 1-45), and cousins, nieces, nephews, aunts, uncles and grandchildren (ages 1-20) can be tested for their risk of developing type 1 diabetes free of charge. Benefits of participation include finding out your family members’ risk level for developing diabetes, possibly receiving an early diagnosis of diabetes that would allow for early treatment and contributing to the fight against type 1 diabetes.

Adult patients or their relatives may call Shirley at (864) 455-3261. Relatives of pediatric patients may call Jennifer at (864) 454-5591.

Children With Type 2 Diabetes If you are 10 to 17 years of age and have type 2 diabetes, you may be eligible for this study, the purpose of which is to evaluate the effectiveness of the oral suspension medication Welchol for decreasing HbA1c levels. In addition to receiving the study drug, participants are counseled on ways to improve eating and exercise habits. Call Jennifer at (864) 454-5591.

Children and Teens With Autism This study is designed to evaluate genetic markers as a way to find out how efficient and safe two FDAapproved medications are in treating irritability in children with autistic disorder. It consists of nine study visits over a period of 12 weeks. Participation in the study is limited to children between 6 and 17 years of age. Call Jennifer at (864) 454-5591.

To learn more about research at GHS, please visit ghs.org/research.

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Q & A

When Cancer Is All in the Family

If cancer “runs in your family,” this Q&A will help you to determine whether you should consider genetic counseling for hereditary cancer.

Q. Why would families want genetic testing?

A. Genetic counseling and testing can provide powerful information that can break the cycle of hereditary cancer.

Carriers for hereditary cancer can start cancer screening earlier, have it performed more frequently, take medications to lower cancer risk or have preventive surgery. If a carrier already has cancer, this information could change the treatment plan or allow the patient to enroll in a clinical trial designed just for carriers.

Q. Should I have genetic testing to find out if the cancers in my family are hereditary?

A. A genetic counselor can help you determine if genetic testing is right for you. Talk to your doctor about a referral to genetic counseling if you or a close family member has had any one of the following: • Breast, colon or uterine cancer diagnosed under age 50 • Ovarian cancer or male breast cancer diagnosed at any age • 10 or more colon polyps

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• Three close family members in the same bloodline with – The same type of cancer – OR breast and/or ovarian cancer – OR colon and/or uterine cancer • Two or more separate cancers in one person • Ashkenazi Jewish ancestry and a family history of breast or ovarian cancer

Q. Is genetic testing for hereditary cancer covered by insurance?

A. We work only with laboratories that verify insurance coverage before tests are run. This way, you can make a decision about whether to test without the worry of an unexpected bill. Some insurance plans, such as Medicare, will cover hereditary cancer testing only once, so it is important to order the correct test the first time.

Genetic counselors will help patients determine if they meet their health insurance criteria for test coverage and will address any other insurance concerns they may have.

Q. How do I schedule an appointment for genetic counseling?

A. Talk to your doctor about your family history of cancer. Your doctor can refer you to genetic counselors at GHS Cancer Institute for an evaluation. For more information, call (864) 455-5836.

The Cancer Genetics Program is part of GHS Cancer Institute. The Cancer Institute offers the latest advances in cancer diagnostics, personalized treatment and research.

Carla Jorgensen, MD, is director of the Cancer Genetics Program.

PRACTICE PROFILE

Teaming Up Is Good Medicine at Family Medicine–Mountain View After completing their residencies at Greenville Health System in 1979, Tom Ballard, MD, and Graham Lawrence, MD, joined another young doctor to establish Mountain View Family Practice (now Family Medicine–Mountain View). William Byars, MD, a third comrade from medical school and residency, came on board a few years later after his military tour of duty.

Today, the practice has expanded to include two more physicians and a physician assistant. Drs. Ballard, Byars and Lawrence continue to care for families in the Greer area in the same location.

With its rich 35-year heritage, Family Medicine–Mountain View (FMMV) operates under two guiding principles: to provide excellent health care rooted in a commitment to timeless compassionate care and to pursue innovative approaches that enhance care.

FMMV physicians understand the value of an entire family being under the care of the same provider and of children remaining in the same practice after they reach adulthood.

“In-depth knowledge of our patients and continuity of care are immeasurable,“ observed Dr. Lawrence. “Obviously, our families feel very comfortable with their care, or we wouldn’t have our generations of patients.”

One innovation that FMMV has implemented is the Team Care approach, in which a medical assistant helps the provider throughout the office visit. That way, providers can focus on the patient, not the computer. The medical assistant also provides “pre-care” before the provider enters by taking the patient’s history and updating the electronic medical record— and then “post-care” at the end of the visit by reviewing the treatment plan and prescriptions and answering questions.

Another benefit of Team Care is more open acute illness slots, so providers are better able to see regular patients when they are ill.

“We agree with Dr. Peter Anderson, the founder of Team Care,” said Dr. Lawrence, “that the best physician for ill patients is their ‘familiar physician.’ ”

FMMV providers practice Team Care: (clockwise from left) Thomas V. Ballard, MD; K. Graham Lawrence Jr., MD; Adrienne Labotka, MD; Marla G. Johnson, PA; William D. Byars, MD; J. Hunter Leigh, DO.

“At Family Medicine–Mountain View, our goal is to deliver, kind, compassionate, professional health care to our patients. We are privileged to have been entrusted with the care of so many patients in Greer for so many years.”­­ — Graham Lawrence, MD Family Medicine–Mountain View 406 Memorial Drive Ext. Greer, SC 29651 (864) 877-9066 ghs.org/fmmv Hours: Monday-Friday 8 a.m.-5 p.m.

For more information on other GHS family medicine practices, see the directory on page 19.

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GHS PRIMARY CARE PRACTICES Having a personal physician with whom you can establish a lifelong relationship is as important as getting your screenings. If you need assistance finding one, here is a list of Greenville Health System primary care physicians who will help keep you healthy and loving life! To find out more about these physicians, go to ghs.org/primarycare. For a complete list of primary and specialty physicians, go to ghs.org.

FAMILY MEDICINE

PEDIATRICS

Advanced Family Medicine 210 S. Broad St., Clinton, 29325 833-0973

Cypress Internal Medicine–Simpsonville 1409 W. Georgia Rd., Ste. D Simpsonville, 29680 454-6540

Center for Family Medicine 877 W. Faris Rd., Ste. A, 29605 455-7800

GHS Pediatrics & Internal Medicine 1809 Wade Hampton Blvd., 29609 522-5000

Family Medicine–Mountain View 406 Memorial Dr. Ext., Greer, 29651 877-9066

Heritage Pediatrics & Internal Medicine– Simpsonville 727 S.E. Main St., Ste. 320, Simpsonville, 29681 454-6440

Greenville Family Medicine 2-A Cleveland Ct., 29607 271-7761 Greer Family Medicine 1107 W. Poinsett St., Greer, 29650 879-8886 Keystone Family Medicine 1409 W. Georgia Rd., Ste. B Simpsonville, 29680 454-5000 Laurens Family Medicine 106 Parkview Dr., Laurens, 29360 984-0571 9100 Hwy. 14, Gray Court, 29645 876-4888 Palmetto Medical Associates 210 Freeman Farm Rd., Duncan, 29334 968-5123 Riverside Family Medicine–Eastside 215 Halton Rd., 29607 454-2700 Riverside Family Medicine–Maxwell Pointe 3909 S. Hwy. 14, 29615 522-1320 Travelers Rest Family Medicine 9 McElhaney Rd., Travelers Rest, 29690 834-3192 INTERNAL MEDICINE Cross Creek Internal Medicine 50 Cross Park Ct., 29605 797-7035 Cypress Internal Medicine–Greer 325 Medical Pkwy., Ste. 200, Greer, 29650 797-9550 Cypress Internal Medicine–Maxwell Pointe 3907 S. Hwy. 14, 29615 522-1300 Cypress Internal Medicine–Patewood 200 Patewood Dr., Ste. B460, 29615 454-2226

Carolina Pediatrics of Greenville 200 Patewood Dr., Ste. A120, 29615 454-2670

Heritage Pediatrics & Internal Medicine–Wren (in collaboration with Baptist Easley) 1115 Wren School Rd., Piedmont, 29673 859-0740 Internal Medicine Associates of Greenville 1025 Verdae Blvd., Ste. A, 29607 242-4683 OB/GYN Carolina Women’s Center 102 Medical Park Ct., Clinton, 29325 938-0087 Greenville Midwifery Care 35 Medical Ridge Dr., Greenville, 29605 455-1600 Greenville Ob/Gyn Associates 2 Memorial Medical Dr., 29605 295-4210 1025 Verdae Blvd., Ste. F, 29607 286-7500 727 S.E. Main St., Ste. 120, Simpsonville, 29681 454-6500

The Children’s Clinic 890 S. Pleasantburg Dr., 29607 271-1450 727 S.E. Main St., Ste. 100, Simpsonville, 29681 454-6520 325 Medical Pkwy., Ste. 150, Greer, 29650 797-9300 Christie Pediatric Group 9 Mills Ave., 29605 242-4840 3911 S. Hwy. 14, 29615 522-1340 1409 W. Georgia Rd., Ste. A Simpsonville, 29680 454-5062 Heritage Pediatrics & Internal Medicine– Simpsonville 727 S.E. Main St., Ste. 320, Simpsonville, 29681 454-6440 Heritage Pediatrics & Internal Medicine–Wren (in collaboration with Baptist Easley) 1115 Wren School Rd., Piedmont, 29673 859-0740 Pediatric Associates–Easley 800 N. A St., Easley, 29640 855-0001 Pediatric Associates–Greer 318 Memorial Dr. , Greer, 29650 879-3883

Greer OB/GYN 325 Medical Pkwy., Ste. 100, Greer, 29650 797-9200

Pediatric Associates–Powdersville 207 Three Bridges Rd., 29611 220-1110

Gynecology Specialists 890 W. Faris Rd., Ste. 510, 29605 101 Halton Village Circle, 29607 455-1600

Pediatric Associates–Spartanburg 1686 Skylyn Dr., Ste. 201, Spartanburg, 29307 500 Squires Pte., Duncan, 29334 582-8135

Piedmont OB/GYN 890 W. Faris Rd., Ste. 330, 29605 455-1270 3917 S. Hwy. 14, 29615 522-1360 Premier Women’s Care 209 Three Bridges Rd., 29611 220-4209

URGENT CARE MD360® Urgent Care 1025 Verdae Blvd., Ste. B, 29607 286-7550 300 Scuffletown Rd., Simpsonville, 29681 329-0029 1305 S. Suber Rd., Greer, 29650 989-4609 11402 Anderson Rd., Ste. A, 29611 631-2799 (in collaboration with Baptist Easley Hospital)

The practices listed here are part of Partners In Health Inc. and affiliated with Greenville Health System.

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Inside Health is published by Greenville Health System as a community service. This information is for educational purposes solely—it should not take the place of medical advice or diagnoses made by healthcare professionals.

Greenville Health System is known for its comprehensive services and world-class physicians, in addition to being an academic health center and conducting leading-edge research.

However, our compassion and strength come from our people—12,000 dedicated professionals, your neighbors, who work together to care for you and your family.

Editor-in-chief Jerry R. Youkey, MD Executive VP, Medical and Academic Affairs, Greenville Health System Founding Dean, USC School of Medicine Greenville Art Direction GHS Creative Services Contributing Photographer George Reynolds Contributing Writer Leigh Savage For more information, contact Nancy Parker, Editor, Marketing Communications Greenville Health System 701 Grove Road Greenville, SC 29605-5601 (864) 797-7541 nparker@ghs.org

© 2014 Greenville Health System 14-21372914 6/14

701 Grove Road • Greenville, SC 29605-5601

NONPROFIT ORG. U.S. POSTAGE PAID GREENVILLE SC PERMIT NO. 842

GHS Vision Transform health care for the benefit of the people and communities we serve.

GHS Mission Heal compassionately. Teach Innovatively.

Improve constantly.

GHS Values Together we serve with integrity, respect, trust and openness.

GHS Named an Academic Health Center Greenville Health System (GHS) became an academic health center last fall as it joined with academic partners Clemson University, Furman University and the University of South Carolina to announce a unique “clinical university model” focused on applied education and research that will improve healthcare delivery.

GHS’ health system-centric model is the first of its kind in the nation. Only about two percent of healthcare systems in the U.S. are academic health centers. According to the Association of Academic Health Centers, a “center” typically is a university with a medical school and at least one other health profession school that owns or is affiliated with one or more teaching hospitals or health systems.

GHS, however, is the first academic health center in which a healthcare system and multiple universities are partnering together.

Unlike most hospitals, academic health centers are teaching hospitals that provide a range of care from routine to highly complex; develop new technologies and treatments; provide patients first-in-region access to clinical trials; conduct research; and educate new healthcare providers.

GHS President and CEO Michael Riordan said, “We believe that the clinical university model is a game changer that will improve patient care, not only at GHS, but also across the state and even at a national level.”

Students from USC School of Medicine Greenville mark completion of their EMS training during a disaster drill in October. Requiring firstyear students to become EMS certified is unique among medical school curricula. This experience immerses them in patient care, offers insight into patients’ lives, and provides practice in interdisciplinary and interagency collaboration.