Inside Health Summer 2017

Summer 2017 The Eye Team Takes on Ocular Cancer Palliative Care: Strong Medicine for Serious Illness Patewood: The Joint for Hip and Knee Replacement A Publication of Greenville Health System

Exercise Is Good Medicine

A Change of Epic Proportion in Your Health Care!

Manage Your Own Care with a Few Clicks

Epic, GHS’ electronic medical record and billing system, offers an innovative tool called MyChart that gives you access to your provider at your convenience. With MyChart, you can see key parts of your medical record, communicate with your care team and participate in your care—all online or through your mobile device. In the time it takes to order a movie, you can …

• • • • •

Access your and your family members’ health information View test results and immunizations Request prescription refills from your doctor Schedule and cancel office appointments, including mammograms Pay bills online

Ask for MyChart at your GHS doctor’s office or request an account online at ghs.org/mychart (your secure online portal to your GHS medical record). Sign up for MyChart and start enjoying benefits now!

ghs.org

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CONTENTS

In It for the Long Haul 2 The Supportive Care Team of GHS Children’s Hospital helps pediatric patients through the life of their long-term illness.

Bull’s-eye on Cancer of the Eye 5

2

Targeting ocular tumors takes advanced skills and advanced technology.

Rx for Exercise 10 An exercise a day may keep the doctor away.

Palliative Care: Good Medicine for Those Facing Serious Illness 13

5

This team makes sure the mind and soul, as well as the body, of the patient are being cared for, so he or she can enjoy better quality of life.

Departments Message from the President 1 Spotlight 2 What’s Right in Health Care 3 Q & A 16

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Clinical Trials 17 Practice Profile 19 Provider Directory 20

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

PRESIDENT’S MESSAGE

Size Isn’t Everything At 23 feet long and 3,600 pounds, the manta ray numbers among the titans of the sea. This relative of the stingray has wing-like pectoral fins, and it glides gracefully through the warm waters of its habitat. In spite of its enormous size and power, the manta ray is known to be a gentle, docile creature. It is not defined solely by its size.

Nor are we. While GHS is recognized as the largest healthcare system in the state and a leader in medical research, innovative technology and advanced health care, we are most proud of being a mission-driven organization.

We are answering the call to serve our communities with a higher purpose: heal compassionately, teach innovatively and improve constantly. This mission infuses all that we do, every day, every hour, for every patient.

We provide high-quality, compassionate care to all—no matter their ability to pay or the complexity of their case. We work throughout the Upstate to provide healthcare resources to the underserved.

We invest in new programs and technologies to make more innovative, specialized care available in our communities. We promote wholeperson care, recognizing that spiritual and emotional needs should be addressed as well as physical conditions.

Space does not permit me to share the hundreds of one-on-one moments of compassion that occur every day at facilities and practices throughout our

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large system—the therapist who, on her own time, turns scary radiation masks into superheroes and princesses for her pediatric patients; the social worker who visited a former patient for three years, driving him to the grocery store; the housekeeper who held the hand of a dying patient so he wouldn’t be alone.

You’ll see our mission carried out in the pages of this issue of Inside Health.

On the cover is Parnee Wood-Locke, who has found relief for her leg pain through the groundbreaking Exercise is Medicine program.

And we’ll introduce you to Mary Ruth Garren and Jeremy Knox, whose eyes, threatened by cancer, have been spared, thanks to the teamwork and advanced skills of a community eye surgeon and our own radiation oncologist. Finally, you’ll learn about our palliative care team members and how they help relieve pain and stress for patients with serious or chronic illness—and enhance their quality of life.

With size comes strength, and with good hearts comes compassion. We look forward to meeting your healthcare needs with our extensive resources and, most of all, with the good minds, hands and hearts of our people. Please let us know how we may be of service.

Spence M. Taylor President

SPOTLIGHT

In It for the Long Haul Team assists pediatric patients and families facing chronic illness.

Children’s Hospital of Greenville Health System offers palliative care through the services of the Supportive Care Team, which helps patients whose conditions cause frequent and/or lengthy hospitalizations. The team’s purpose covers a wide range of situations and needs— or, in the words of Cary Stroud, MD, its medical director, to “address the psychosocial needs of children and families with chronic illnesses of uncertain outcome.”

The Supportive Care Team addresses these challenges by combining disciplines and backgrounds. Dr. Stroud served as medical director of the hospital’s BI-LO Charities Children’s Cancer Center for several years before he helped develop this team. Other team members include a nurse practitioner experienced in pediatric hematology/oncology and transplant patients, a clinical psychologist, a nurse coordinator, a chaplain and two child life specialists.

The Supportive Care Team meets each morning to determine which patients need what services that day.

Many families who receive the services of the Supportive Care Team are those with babies in the NICU. Sometimes, before the baby is even born, the team helps families start coping when they receive a diagnosis that will lead to an extended hospitalization or chronic illness. If the baby is not expected to live long, the team works with the parents to outline their desires for the moments immediately after birth and provide memory-making activities for siblings.

Sarah Pierce, CCLS, a child life specialist with the Supportive Care Team, uses a special doll to help Sam Esteban understand how his port works.

For patients with long-term chronic conditions, the circumstances of their hospitalizations may change over the months and years—what unit they are in and which specialists they see, for example—but Supportive Care Team members will be a constant. They are the ones who know the patient and family and can help bring everything together for them.

One goal for growth of the program is to expand bereavement support for families when their child does not survive. Another goal is to add a social worker. Currently, team members cover these functions in addition to their regular duties.

And while the team’s services are available on an inpatient basis only, team members hope to one day offer an outpatient clinic for children who have chronic conditions but are healthy enough to be cared for at home.

To achieve these goals, team members are dependent on philanthropy. Under the general model for a pediatric palliative care program, a third of the support comes from hospital systems, a third from charges for services and a third from philanthropy.

For more information about the Supportive Care Team, visit ghschildrens.org/supportive-care or call (864) 546-8955. For information on giving, visit ghsgiving.org.

For information on the palliative care program for adults, click here.

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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 live our mission to heal compassionately, teach innovatively and improve constantly.

3,500+

People treated in 2016 by GHS’ trauma center. Greenville Memorial Hospital has been verified as a Level I Adult Trauma Center and Level II Pediatric Trauma Center by the American College of Surgeons. This achievement recognizes dedication to providing optimal care for injured patients.

50,000

In-person interpreter encounters that GHS Language Services facilitates annually; it also is involved in 18,000 phone and video interpretations. In addition to Spanish, the department offers American Sign Language, Arabic, Chinese, French, German, Korean, Russian and Vietnamese, to name a few languages.

100%

Residency placement rate by 51 graduating seniors at the University of South Carolina School of Medicine Greenville during Match Day in March. This success equals the landmark placement rate achieved in 2016.

800

The students anticipated in the next six years who will be trained in Clemson University’s nursing program through a collaboration with GHS. This expansion will more than double the students that the program traditionally has taken and will help meet the need for nurses. Students are expected to begin coursework on Greenville Memorial Medical Campus in fall 2018 after completing their first two years in Clemson. Learn more.

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30 2,500

The number of babies expected to be born at Patewood Memorial Hospital in the first year of deliveries there. Starting in September, women with low-risk pregnancies who are patients of Greenville Ob/Gyn Associates or Piedmont OB/

Minimum SPF your sunscreen should have.

For more summer safety tips, visit ghs.org/30.

GYN will deliver at this convenient Eastside location.

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People who have downloaded PulsePoint, a free smartphone app that alerts off-duty first responders, healthcare professionals and others who know CPR when someone is experiencing cardiac arrest in a nearby public forum. GHS has partnered with Bon Secours St. Francis Health System to offer PulsePoint, which is available for iPhone and Android and can be downloaded from the iTunes Store or Google Play.

Miles walked along the GHS Swamp Rabbit Trail by GHS doctors and community residents in “Walk with a Doc,� an event in April encouraging those in the minority community to become physically active and use the trail.

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

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Bull’s-eye on Cancer of the Eye A more focused treatment is delivering better outcomes for a rare form of cancer.

By Robin Halcomb

The Eye Team (l-r): Dr. Bergstrom places the plaque on the eye; Dr. Greenbaum determines the radiation needed in the pellets; and medical physicist Able Shores ensures safe handling of the radioactive material.

M

ary Ruth Garren of Brevard, N.C., had no history of eye problems. But when a freckle discovered in her left eye in 2013 began to show signs of growth in 2016, the 73-year-old retired information systems assistant became one of the first to undergo a new procedure at Greenville Health System (GHS).

Garren was examined by Chris Bergstrom, MD, OD, with Retina Consultants of Carolina, a Greenville practice partnering with GHS, and Michael Greenbaum, MD, PhD, a radiation oncologist with GHS, and determined to be a candidate for ocular melanoma brachytherapy.

Through brachytherapy, physicians treat ocular (eye) melanomas by placing small, radioactive pellets on or closely adjacent to a tumor. Unlike external beam radiation, the

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procedure makes it possible to treat a smaller area in a shorter time. GHS is the only facility in the Upstate and one of only two in the state offering the procedure.

Dr. Bergstrom performed Garren’s outpatient surgery in October 2016. On the second follow-up visit in March, the tumor had shrunk by about one-third.

“I am so thankful my eye has been saved and for Dr. Bergstrom and the team!” exclaimed Garren. “I was able to get corrective lenses and can go on with volunteer work, playing the piano and doing all I have done in the past.”

Thanks to eye melanoma brachytherapy, Mary Ruth Garren continues to enjoy playing the piano at her local hospital.

Precision Targeting Choroidal nevi, often referred to as eye freckles, are small areas of pigment inside the eye found in roughly one in 10 people. Like skin moles, they have a slight risk of transforming into melanoma. One of every 500 will undergo that progression when tracked over a 10-year period.

For eye freckles that do become malignant, treatment is vital—first, to eliminate the cancer and keep it from spreading to other organs, which happens in approximately half of the cases, and then to save the eye itself.

In the past, treatment of ocular melanoma meant surgical removal of the affected eye. More recently, patients have had the option of keeping their eye by using radiation therapy.

Brachytherapy (brachy = short distance, therapy = treatment)

is a highly focused radiation method that allows treatment of just the part of the eye containing the tumor. Patients keep their affected eye about 90 percent of the time using brachytherapy. (Even if vision is impaired or lost, retaining the eye is less painful and provides a more natural appearance.)

“Treating melanoma requires a high dose of radiation, and that high dose will cause a lot of damage to structures in and around the eye,” explained Dr. Bergstrom. “Brachytherapy localizes the radiation to such a small area that we can minimize the damage.”

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The radiation levels of the pellets are determined by Dr. Greenbaum, then placed in a tiny device called a plaque that is custom fit to the patient and surgically attached adjacent to the tumor by Dr. Bergstrom. This close placement helps focus radiation only on the tumor, thus protecting surrounding tissue.

‘Fast Tracking’ Advanced Care The GHS brachytherapy program began with discussions in March 2016—and with a sizable commitment on the part of GHS administrators and team members that included Alan Leahey, MD, chief of Ophthalmology at GHS, it was up and running within three months.

“Brachytherapy is a very effective cure for this cancer, which is the most important thing,” said Dr. Greenbaum. “It also gives us the option of keeping the eye in place rather than removing it. And in roughly 50 percent of patients, the vision in the affected eye is preserved.”

Vision loss depends on the size of the tumor and how close the tumor is to the parts of the eye essential for sight. Recent advances in eye brachytherapy can increase the chance of keeping vision for some patients. Dr. Greenbaum and his GHS colleagues use the most advanced ocular brachytherapy method available to maximize the chance of preserving vision without compromising on a cure.

Eye melanoma typically (though not exclusively) develops around age 60, and most patients are Caucasian. The causes of the disease are unknown—unlike skin melanoma, it is unrelated to sun exposure. Further, eye melanoma gives no symptoms and is not preventable.

Break-in Breakthrough Jeremy Knox, a 38-year-old resident of Spartanburg, had his eyes examined to get replacement glasses after his backup pair was stolen while on vacation in July 2016.

That examination found a tumor in his right eye, and Knox was referred to Dr. Bergstrom late in July. The surgeries were successfully completed in August 2016, and he now follows up with Dr. Bergstrom every three months.

“Working with Dr. Bergstrom and Dr. Greenbaum to set up this program has been a worthwhile endeavor,” said Dr. Leahey. “We’ve treated patients from across the state. And with our interdisciplinary team approach, patients can see all of their physicians conveniently.”

Both Garren and Knox have seen little change in their vision since their procedures, but they have been advised that the treatment likely will cause some loss of central vision in the coming years. The risk was worth it for both of them. “This is a far better outcome than losing my eye,” Garren asserted.

As with glaucoma, early detection is critical to good outcomes for ocular melanoma. “It is important,” Dr. Leahey noted, “for all adults to get a dilated eye exam every two years, even if the eyes are healthy, or every six months to a year for someone with other ocular diseases.”

Having the procedure available at GHS was important to both patients. “All of my family is in the Greenville-Spartanburg area,” Knox commented. “So having it done at GHS meant we didn’t have to disrupt our family life by being away for an extended time.”

He added, “Ocular melanoma is a silent, life-threatening disease you need to catch early to keep your sight—and your life.”

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To make an appointment for an eye checkup at the GHS Eye Institute, call (864) 522-3900. Dr. Bergstrom takes patients via physician referral and can be reached at (864) 233-5722.

This model shows a plaque template placed on the eye and two plaques. In each eye plaque are slots where radioactive seeds are custom-loaded for each patient to create an ideal treatment area of concentrated dose.

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EIMG is a 12-week program that gives patients the skills and encouragement needed to make exercise part of a daily routine, which can help control many chronic conditions.

Rx for Exercise An innovative program to help patients improve their health is just what the doctor ordered.

By Robin Halcomb

T

he U.S. population is more overweight and out of shape than ever. And the problem is more than skin deep: We know that obesity and/or lack of regular exercise contributes to heart disease, type 2 diabetes, hypertension, stroke, some forms of cancer, joint pain, dementia and a host of other health issues.

To tackle this growing problem, Greenville Health System (GHS) and the University of South Carolina (USC) School of Medicine Greenville have launched an innovative new program. Exercise is Medicine Greenville® (EIMG) is part of the national Exercise is Medicine® movement co-launched in 2007 by the American Medical Association and the American College of Sports Medicine. In addition to vital signs such as heart rate and blood pressure, EIMG evaluates a patient’s exercise activity based on the U.S. Physical Activity Guidelines of 150 minutes of moderate-intensity exercise per week.

According to the Centers for Disease Control and Prevention, 52 percent of U.S. adults (18 and older) do not meet the

150-minute guideline. In Greenville County, S.C. Department of Health and Environmental Control 2013 statistics show that 35 percent of adults are overweight and 31 percent are obese.

“Most chronic diseases can be prevented through lifestyle,” said Jennifer Trilk, PhD, FACSM, EIMG program director and assistant professor with USC School of Medicine Greenville.

“Unfortunately, most people think exercise is about weight loss, but it’s much more. The literature shows exercise can help control blood sugars, blood pressure and lipid profiles in a short time frame without a change in body weight. EIMG gives patients nearly immediate health benefits to hang onto while reaching for long-term goals like weight loss.”

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Through EIMG, Dr. Trilk and her team sought a way for healthcare systems to understand the need, value, importance and power of exercise as both prevention of and treatment for obesity and other chronic diseases.

For two program participants, EIMG was a game changer.

At 76, retired lab technician Parnee Wood-Locke has seen decreases in her blood pressure and A1c level, but the lessening of leg pain is the result that stands out.

“We wanted to create a classroom-to-community model,” Dr. Trilk described, “to teach in the medical school and to support in the health system to serve our community.

Given the epidemic of disease related to lifestyle, we know it is imperative to train future doctors to understand the relationship of lifestyle and health.”

“I always had pain in one leg, but since EIMG, I have no pain,” she remarked. “Now, I can socialize again and walk to my Bible class without holding people up.”

A Different Prescription EIMG is a 12-week program that gives patients the skills and encouragement needed to make exercise part of a daily routine.

“Making exercise a habit is the challenge,” noted Peter Tilkemeier, MD, MMM, chair of the GHS Department of Medicine. “Patients say ‘I’ll take a pill so I don’t have to change my lifestyle.’ Changing lifestyle is a much harder pill to swallow.”

Anecdotal reports from participating doctors indicate patients love the program, and the doctors are seeing significant improvements in blood pressure and A1c numbers (the measure of diabetic blood sugar levels over a three-month period).

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Amanda Coyle, a stay-at-home mom, always had exercised, but a back injury put that activity on hold and resulted in weight gain. Earlier weight-loss efforts by the 35-year-old were ineffective, but with EIMG, she noticed inches coming off.

“After EIMG, I feel better, have more energy and confidence in exercise, and am off blood pressure medication,” she marveled. “Now I run, do squats, cardio and Zumba, and can keep up with my kids!”

Billy Serrao, wellness specialist at GHS Family YMCA, enjoys seeing participants overcome obstacles and meet goals.

“People are afraid to push themselves and think they are not capable,” he commented. “But if we don’t push ourselves, we won’t see the results. EIMG is a kick start for participants to continue their journey.”

It Takes a Community EIMG is a partnership among GHS, the USC School of Medicine Greenville, YMCA of Greenville and the American College of Sports Medicine. EIMG was the first entity in 43 countries to develop Exercise is Medicine into a functioning clinical exercise program from an awareness campaign.

“This level of investment by the health system in community wellness is exceptionally refreshing,” said Dr. Tilkemeier “Exciting opportunities develop when health systems partner with communities.”

EIMG is available at the GHS Life Center®, Caine Halter Family YMCA Downtown, Eastside Family YMCA in Taylors, GHS Family YMCA in Simpsonville and George I. Theisen Family YMCA in Travelers Rest.

The cost is $199, which may be deferred by YMCA scholarships for eligible persons.

“We are grateful to have the opportunity to work with our partners to establish physical activity intervention as a new standard in health care,” said Scot Baddley, president of YMCA in Greenville. “And we are committed to making this program available regardless of ability to pay.”

Since the program launched in August 2016 with four GHS practices, more than 70 patients have been referred into the program. Expansion to other GHS practices is planned this year.

The Art of Medicine Meets the Science of Technology Taking part in Exercise is Medicine reflects GHS’ commitment to staying on the forefront of medicine. EIMG information is built into each patient’s electronic health record (EHR). As part of a regular checkup, clinicians are prompted to ask how much exercise the patient gets each week. An indication of less than 150 minutes triggers an offer of counseling and health education. Patients at risk or already with chronic conditions may be referred into the program.

Mary Jane Rogers, BSN, RN, manager of EHR Informatics at GHS, talks about the digital side of the program. “We first developed a workflow for providers to enter Exercise Vital Sign to calculate which patients have a score less than 150 minutes/week,” Rogers reported. “Risk factors built into the program evaluate patients on a scale of Level 1 to Level 4, giving doctors clinical decision support. A patient-readiness ladder, which measures commitment and the ability to participate, also is used to determine eligibility.”

Exclusive to GHS is a patented and copyrighted EIMG toolkit.

The Exercise Vital Sign and referral order in the patient’s EHR facilitate a provider’s order to the YMCA or Life Center for exercise therapy sessions with an EIM professional that are tailored to the patient’s diagnosis and health needs.

“What we wanted was to package the workflow so that anyone would be able to help patients with exercise no matter what EHR they are in, what gym they are referred to or what doctor’s office they visit,” explained Rogers.

‘Take Two Walks and Call Me in the Morning’ It’s remarkable to consider the possibility that prescriptions for exercise may become as common as medical advice to take aspirin or ibuprofen.

“We view Exercise is Medicine as a cornerstone of preventive medicine and chronic disease management,” said Adrian Hutber, PhD, vice president for Exercise is Medicine, the national program. “The combined efforts of our partnership will enable us to provide better outcomes, reduce healthcare costs and enhance the quality of life for all.”

No one is more convinced that Exercise is Medicine than those who have participated in this effort.

“I tell everybody I know,” Parnee Wood-Locke declared, “they should do this program.”

If you believe exercise would be good medicine for you, see your healthcare provider for a checkup before beginning an exercise program and for help in developing a plan. If you don’t have a healthcare provider, call 1-844-GHS-DOCS (447-3627) or visit ghs.org/mydoctor.

You also may consider using the help of a certified personal trainer at the GHS Life Center. Visit ghs.org/lifecenter for more information.

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Palliative Care: Good Medicine for Those Facing Serious Illness GHS’ nationally recognized program is just what the doctor ordered.

By Lee Savage

“We are the advocate for patients and their families. We are communicators to their providers, relaying how they feel and what they want. Sometimes, seriously ill patients don’t have the courage or strength to do that.”

—Leslie Porell, LMSW

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K

en Dyar had no idea what to expect when he was referred to the Division of Palliative Care of Greenville Health System (GHS) last November after being diagnosed with esophageal cancer.

“I didn’t know what it was and wasn’t sure what ‘palliative’ meant,” said the 55-year-old construction worker. “But it’s been wonderful.”

the help with pain management and the mental aspect of cancer.

With no esophagus and on a feeding tube, Dyar has not had a solid meal in over a year, and the mental stress has been problematic. “But they helped me mentally as well as physically and spiritually,” he affirmed. “I was just blessed, truly.”

Bringing the ‘Whole’ to Holistic Care Palliative care is specialized medical care for people with serious illnesses, providing patients with relief from symptoms, pain and stress. It uses a team approach that includes doctors, nurses, social workers, chaplains and others who provide an extra layer of support for patients and families.

The GHS Division of Palliative Care works with a range of seriously ill adults, including those who have been diagnosed with cancer, heart failure, COPD, emphysema, kidney or liver disease, and dementia, according to Parampal Bhullar, MD, medical director of the division. Palliative care doctors and nurses don’t take over treatment but bolster and support the treatment plan in place.

Since the division was founded in 2014, the staff has more than tripled as demand for the service grows. “Our consultations have gone through the roof this year,” Dr. Bhullar noted. “We are seeing many patients, but for every patient we see, there are others we could help. We want to let people know we are here to help.”

Unlike hospice or terminal care, which is designed for patients who are expected to live six months or less, palliative care is available for serious illness at any stage in the treatment process. Some patients may be in later stages and near the end of life, while others may be improving steadily or have an uncertain prognosis.

Dyar travels 100 miles round trip to and from Seneca for each appointment, but the effort is more than worth it. He values

Before GHS Department of Medicine established this new division, a Palliative Medicine service was provided through the Division of Geriatrics, where Dr. Bhullar formerly worked.

The Palliative Care division has an inpatient consultation service, an outpatient clinic one-and-a-half-days each week for patients with cancer and another half-day every other week for patients with advanced lung disease, heart disease and other conditions. Dyar receives services via the outpatient cancer clinic.

Stephanie Richardson, BSN, MA, RN, Palliative Care nurse coordinator at Greenville Memorial Hospital (GMH), said doctors increasingly suggest palliative care for patients with serious illness, and some patients or family members ask for it.

With many doctors and specialists involved, the medical picture can be confusing. “We talk to everybody involved to make sure the patient and family are getting a clear understanding,” Richardson commented. “We put the pieces of the puzzle together so that the family knows what the big picture is and assist with complex medical decision-making.”

The palliative care process typically begins with an intake nurse, who talks to patients and families to assess needs and desires. Then, a specially trained social worker or chaplain may be called in to assist with emotional, spiritual and sometimes physical support.

“We (social workers and chaplains) do work with pain management through guided imagery, breathing and cognitive therapy,” explained Leslie Porell, LMSW, a social worker in the division. “When we talk about total pain, that means that patients often are in emotional as well as great physical pain.”

The idea is to offer holistic care that assesses and treats the whole person wherever the pain originates—as well as family members who are an important part of the process.

Courtesy of Michigan Medicine

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The Palliative Care team meets regularly to determine how best to meet the needs of each individual patient.

“We are the advocate for patients and their families,” Porell pointed out. “We are communicators to their providers, relaying how they feel and what they want. Sometimes, seriously ill patients don’t have the courage or strength to do that.”

Richardson has seen patients open up to their social worker or chaplain in ways they don’t for their physician—even about medical issues. “It’s a team-oriented approach,” she observed.

If needed, Palliative Care staff members can coordinate participation in support groups, bereavement groups or other resources.

The Sooner, the Better Studies have found that palliative care increases patient and family satisfaction with their healthcare experience while also lowering costs and often reducing the length of hospital stays.

Dr. Bhullar, Richardson and Porell hope more healthcare providers, patients and families learn about the division, so they can request help earlier. The sooner symptoms can be managed and the sooner patients have an advocate and access to psychosocial resources, the better their condition will progress.

“We are constantly educating,” Porell said. “A lot of people think we are hospice, and we are not. If we are consulted earlier, we can help people make the most of their life. If at some point hospice becomes necessary, we have those relationships.”

Dr. Bhullar said great strides have been made, and the team is now focusing on expanding outpatient palliative care. “How 15 Inside Health

can we provide early palliative care and not just later-stage care?” he asked. “How can we help patients in the community before they get to the hospital? That’s the next step.”

For Dyar, palliative care has been a lifeline. The Palliative Care staff helped him gain weight after dipping from 200 to 103 pounds. If an upcoming scan reveals good news about his cancer, Dyar will have a new esophagus created—which will require the weight gain.

“They are nursing me physically and mentally back to health,” he remarked. “They look at me as an individual and know me.

They have been wonderful.”

For Dr. Bhullar, it is fulfilling to see patients like Dyar get the additional support they need and take control of their healthcare decisions. “It’s very rewarding,” he reflected. “Even small changes can make a world of difference for patients, and it’s been amazing to witness.”

We are sad to report that since the writing of this article, Ken Dyar passed away of causes unrelated to his cancer.

For more information about palliative care at Greenville Memorial Hospital, call (864) 455-3287; for services at Oconee Memorial Hospital, call (864) 885-7129.

Q & A

Joint Resolution

GHS is moving most of its joint replacement procedures to Patewood Memorial Hospital.

Why is The Joint Center at GHS consolidating most of its joint replacement procedures at Patewood Memorial Hospital (PMH)?

We want what’s best for our patients: In recent years, studies have shown that specialty surgery centers with high volumes have better patient outcomes, have higher patient satisfaction and provide care at lower costs. PMH specializes in these procedures.

What benefits does PMH offer as the site for these procedures?

As a short-stay surgical hospital, PMH is an ideal location for shoulder, hip and knee replacements. The nursing, physical therapy, operating room and ancillary staff have not only the knowledge and skills but also a unique passion to care for patients receiving total joint replacement.

It’s worth noting that PMH was ranked #19 in the nation and #1 in the state in orthopaedics by U.S. News & World Report. In addition, Patewood receives high patient satisfaction scores. And The Joint Center is certified by The Joint Commission for disease-specific care in hip, knee and shoulder replacement.

How does The Joint Center help patients have a highly satisfactory experience?

One of our most helpful strategies is Comprehensive Joint Day, a oneday session during which the patient undergoes all pre-operative screenings and blood work; meets with the hospitalist, anesthesiologist, nurse case manager and others on the medical team; and receives education about what will happen the day of surgery, during their hospital stay and after discharge. Medical issues to watch for after surgery are addressed as well.

We emphasize patient-centered care, which includes providing patients with extensive education about their procedure to minimize anxiety and fear of the unexpected.

multimodal pain management program to enhance recovery. These are just a few elements that help our patients experience excellent outcomes.

Is PMH the only GHS location where joint replacement procedures take place?

No. We will continue offering joint replacement procedures at The NewLife Center for Joint Health at Oconee Memorial Hospital and also at Laurens County Memorial Hospital. Both of these facilities have excellent outcomes in joint replacement.

Patients who require hip replacement for a fracture typically will have their procedure at Greenville Memorial Medical Campus.

Infection prevention begins before surgery with patient screening for resistant organisms and by providing education on a skin-cleansing program to use beforehand.

Our Blood Conservation Program decreases the need for blood transfusions, and we opt for a

Brian G. Burnikel, MD, an orthopaedic surgeon who specializes in hip and knee replacement, is the division chief of the Adult Reconstruction Service and medical director for The Joint Center at GHS.

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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.

Cancer Survivors for Registry GHS Cancer Institute’s Cancer Survivor Registry is a database of demographics, contact information, and tumor and treatment information. Survivors can receive helpful information about moving forward. Contact Matt, (864) 455-5119 or molinger2@ghs.org.

Survivors of Breast Cancer as Advisors The Breast Cancer Patient Engagement Studio is looking for women who have experienced breast cancer or their family members to help review projects designed to provide better care for patients. Patient opinions are needed!

Participation involves meeting as an advisor (not a research participant) with a group of similar patients, researchers and clinicians to review projects as they are proposed. If interested, a patient application is available at hsc.ghs.org/ pes/application. You also may call (864) 455-8894 or email the Studio at PEStudio@ghs.org. If selected, you will receive compensation for taking part on the patient advisory board.

Survivors of Cancer with Insomnia Sleep disturbance, particularly insomnia, is a common problem for survivors of cancer. This study is open to patients who have completed all scheduled surgery, chemotherapy and/or radiation

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therapy for cancer within the last 2-60 months and have some type of sleep disturbance. Because there is no ideal standard of care for effectively treating sleep problems in survivors of cancer, the purpose of this study is to compare the effectiveness of three different treatments for improving sleep problems and determine which is best. The three treatments are yoga, survivorship health education and cognitive behavioral therapy. Call Claudette, (864) 522-4263 or cphinney@ghs.org.

Survivors of Lung Cancer Having Anxiety The purpose of the Reducing Lung Cancer Survivors’ Anxiety (RELAX) research study is to compare the effects of device-guided breathing on anxiety and shortness of breath in survivors of lung cancer. This study is open to survivors of early-stage lung cancer who have completed treatment and are experiencing anxiety. The study will involve using a breathing device daily for 12 weeks and filling out patient questionnaires. Call Claudette, (864) 522-4263 or cphinney@ghs.org.

Survivors of Lung Cancer A lung cancer support group has been formed through the collaboration between GHS and Lung Cancer Alliance (LCA). The support group meets the third Tuesday

of every month, 11:30 a.m.-12:30 p.m.

This group meets to connect, have open discussion and provide resource opportunities. Focus groups take place within the support group facilitated by an LCA facilitator annually for two years. The focus groups allow participant feedback as well as evaluate the effectiveness of the group. Contact Matt, (864) 455-5119 or molinger2@ghs.org.

Survivors of Head and Neck Cancer with Dry Mouth after Radiation The purpose of the study is to see if acupuncture can decrease excessively dry mouth that can be caused by radiation treatment. The study is open to patients who had radiation treatment to both sides of their head and neck at least 12 months ago and still have extremely dry mouth. The study requires saliva collection and patient questionnaires; some patients will be given twice weekly acupuncture for four to eight weeks. The acupuncturist office is located in Greenville. Contact Jennifer, (864) 455-2860 or JCaldwell@ghs.org.

Young Adults with Type 2 Diabetes The purpose of this study is to evaluate the effects of dapagliflozin on children diagnosed with type 2 diabetes who are taking metformin. Throughout this study, participants will be tested to see if the combined effects of the study

CLINICAL TRIALS

drug and metformin can reduce average blood sugar levels. Participants in this 52-week trial will receive study drugs at no cost. Contact Lisa, (864) 454-5168 or llooper@ghs.org. Â

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, determining eligibility for an ongoing interventional trial, 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 Lisa at (864) 454-5168.

Teens and Adults with Eosinophilic Esophagitis (EoE) Currently, there is no approved medication for the treatment of EoE. The purpose of this study is to test the effectiveness of an oral budesonide medication as a treatment for teens and young adults who have EoE. Participants in this 16-week study will be evaluated for reduced symptoms of EoE and will receive study medication at no cost.

Contact Amy, ayes@ghs.org or (864) 454-5591.

People with Interstitial Cystitis/ Bladder Pain Syndrome (IC/BPS) This study is evaluating the safety and effectiveness of a new medication for the treatment of IC/BPS. IC/BPS is a disease (not an infection) that causes bladder pain, the feeling of always wanting to urinate, and frequent urination day and night. The reason why IC/BPS occurs is unknown. AQX-1125 is an experimental new drug therapy that may help to reduce the bladder pain and symptoms associated with IC/BPS. AQX-1125 is under investigation and is not approved by the U.S. Food and Drug Administration (FDA) for use outside of research studies like this one. Please contact Leesa, (864) 797-7306 or RBradley@ghs.org.

To learn more, visit ghs.org/research.

Inside Health 18

PRACTICE PROFILE

Skylyn Medical Associates “Treating the patient first,” said Shannon Webb, MD, “is the foundational principle of Skylyn Medical Associates. It’s what we do every day. Everything else takes a back seat.”

Skylyn Medical Associates is a family medicine practice offering comprehensive care for every age—from infants to seniors. When you or a family member is ill or injured, knowledgeable Skylyn providers will assess, diagnose and treat the problem, not just the symptoms. And through annual exams and other prevention measures, the staff will help you achieve and maintain optimal health.

Since joining this Greenville Health System (GHS) practice in 2016, Dr. Webb has been impressed with all of the GHS family physicians he has met. “We all understand that we’re here for the patient’s benefit,” he commented, “and to provide high-quality care.”

Dr. Webb has just welcomed Lien Nguyen, MD, to the practice. “She brings a fresh perspective,” he noted, “having just finished GHS’ residency program.”

Dr. Webb continued, “Our nurse practitioner, Denise Weinberg, has special training in geriatrics. And our physician assistant, Christel Schweizer, came to primary care with 14 years of experience in several specialty areas.”

For these providers, the best part of their jobs is getting to know and care for multiple generations within the same family.

Providers Lien M. Nguyen, MD Shannon C. Webb, MD, FAAFP Christel A. Schweizer, PA-C A. Denise Weinberg, AGNP-BC

Skylyn Medical Associates 1776 Skylyn Drive • Spartanburg, SC 29307 (864) 577-9970 • (864) 522-0905 Fax

Office Hours: Monday-Friday, 8 a.m.-5 p.m. ghs.org/skylyn

Skylyn Medical Associates has undergone an office facelift, so the facility has been made even nicer for the optimum patient experience. Even so, at this practice, it always comes back to patient care.

“We want to provide the same excellent, compassionate, evidence-based care to every patient,” emphasized Dr. Webb.

19 Inside Health

This practice is recognized by the National Committee for Quality Assurance (NCQA) as a Patient-Centered Medical Home. Practices that receive this recognition support the delivery of high-quality care and are built on evidence-based, nationally recognized clinical standards of care. Learn more about what this means for you and your family at ghs.org/pcmh.

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 GHS primary care practices or call GHS Physician Finder at 1-844-GHS-DOCS (447-3627). To find out more about these practices, go to ghs.org/mydoctor. For a complete list of primary and specialty physicians, go to ghs.org.

CLEMSON Clemson-Seneca Pediatrics 208 Frontage Rd., Ste. 1, 29631 654-6034 CLINTON Advanced Family Medicine* 210 S. Broad St., 29325 833-0973 Carolina Women’s Center 102 Medical Park Ct., 29325 938-0087 GHS Internal Medicine–Laurens 22725 Hwy. 76 E., Ste. A, 29325 833-4545 DUNCAN Palmetto Medical Associates* 500 Squires Pte., Ste. B, 29334 968-5123 Pediatric Associates–Spartanburg* 500 Squires Pte., Ste. A, 29334 582-8135

Children’s Hospital After-hours Care (Urgent Care) 890 S. Pleasantburg Dr., 29607 271-3681 Christie Pediatric Group* 9 Mills Ave., 29605 242-4840 3911 S. Hwy. 14, 29615 522-1340

Riverside Family Medicine–Maxwell Pointe* 3909 S. Hwy. 14, 29615 522-1320

Cypress Internal Medicine–Patewood* 200 Patewood Dr., Ste. B460, 29615 454-2226

GREER

GHS Internal Medicine–Maxwell Pointe* 3907 S. Hwy. 14, 29615 522-1300 GHS Pediatrics & Internal Medicine– Wade Hampton* 1809 Wade Hampton Blvd., Ste. 120, 29609 522-5000

EASLEY Pediatric Associates–Easley* 800 N. A St., 29640 855-0001

Greenville Midwifery Care & Birth Center 35 Medical Ridge Dr., 29605 797-7350

GRAY COURT

Greenville Ob/Gyn Associates 2 Memorial Medical Dr., 29605 295-4210 1025 Verdae Blvd., Ste. F, 29607 286-7500

GREENVILLE Carolina Pediatrics of Greenville* 200 Patewood Dr., Ste. A120, 29615 454-2670 Center for Family Medicine* 877 W. Faris Rd., Ste. A, 29605 455-7800 The Children’s Clinic* 890 S. Pleasantburg Dr., 29607 271-1450 415 Duncan Chapel Rd., 29617 522-2600

Riverside Family Medicine–Eastside* 215 Halton Rd., 29607 454-2700

Cross Creek Internal Medicine* 50 Cross Park Ct., 29605 797-7035

Greenville Family Medicine* 2-A Cleveland Ct., 29607 271-7761

Laurens Family Medicine* 9100 Hwy. 14, 29645 876-4888

Piedmont OB/GYN 890 W. Faris Rd., Ste. 330, 29605 455-1270 3917 S. Hwy. 14, 29615 522-1360

Gynecology Specialists 890 W. Faris Rd., Ste. 510, 29605 101 Halton Village Circle, 29607 455-1600 (for both) Internal Medicine Associates of Greenville 1025 Verdae Blvd., Ste. A, 29607 242-4683 MD360® (Urgent Care) 1025 Verdae Blvd., Ste. B, 29607 286-7550

The Children’s Clinic* 325 Medical Pkwy., Ste. 150, 29650 797-9300 Cypress Internal Medicine–Greer* 325 Medical Pkwy., Ste. 200, 29650 797-9550 Family Medicine–Mountain View* 426 Memorial Dr. Ext., 29651 877-9066 Greer Family Medicine* 1107 W. Poinsett St., 29650 879-8886 Greer OB/GYN 325 Medical Pkwy., Ste. 100, 29650 797-9200 MD360® (Urgent Care) 1305 S. Suber Rd., 29650 989-4609 Pediatric Associates–Greer* 318 Memorial Dr., 29650 879-3883 LAURENS Laurens Family Medicine* 106 Parkview Dr., 29360 984-0571

Inside Health 20

GHS PRIMARY CARE PRACTICES

PIEDMONT/POWDERSVILLE Heritage Pediatrics & Internal Medicine– Wren* 1115 Wren School Rd., 29673 859-0740 MD360® (Urgent Care) 11402 Anderson Rd., Ste. A, 29611 631-2799 (in collaboration with Baptist Easley) Pediatric Associates–Powdersville* 207 Three Bridges Rd., 29611 220-1110 Premier Women’s Care 209 Three Bridges Rd., 29611 220-4209 SENECA Blue Ridge Women’s Center 103 Carter Park Dr., 29678 482-2360 10110 Clemson Blvd., 29678 985-1799 Clemson-Seneca Pediatrics 109 Omni Dr., Ste. B, 29672 888-4222 Mountain Lakes Community Care (Urgent Care) 100 Omni Dr., Ste. B, 29672 885-7425 Mountain Lakes Family Medicine 10110 Clemson Blvd., 29672 482-3148

Dr. Timothy Sanders Family Medicine 100 Omni Dr., Ste. A, 29672 885-7520 Seneca Medical Associates 11082 N. Radio Station Rd., 29672 882-2314 Upstate Family Medicine 12016 N. Radio Station Rd., 29678 882-6141 SIMPSONVILLE GHS Family & Internal Medicine– Simpsonville 727 S.E. Main St., Ste. 300, 29681 522-1170 Greenville Ob/Gyn Associates 727 S.E. Main St., Ste. 120, 29681 454-6500 Heritage Pediatrics & Internal Medicine– Simpsonville* 727 S.E. Main St., Ste. 320, 29681 454-6440 Hillcrest Family Practice* 717 S.E. Main St., 29681 522-5400 Keystone Family Medicine* 1409 W. Georgia Rd., Ste. B, 29680 454-5000 MD360® (Urgent Care) 300 Scuffletown Rd., 29681 329-0029 Pediatric Associates–Simpsonville 1409 W. Georgia Rd., Ste. A, 29680 454-5062

*The National Committee for Quality Assurance (NCQA) Recognition Programs assess whether clinicians and practices support the delivery of high-quality care and are built on evidence-based, nationally recognized clinical standards of care. †Most insurances accepted, including S.C. Medicaid program and Medicaid Managed Care.

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

21 Inside Health

SPARTANBURG Children’s Hospital Spartanburg Night Clinic*† 201 E. Broad St., Suite 210, 29306 804-6998 GHS Internal Medicine–Boiling Springs 2400 Boiling Springs Rd., 29316 599-0731 MD360® (Urgent Care) 2400 Boiling Springs Rd., 29316 599-0731 Pediatric Associates–Spartanburg* 249 N. Grove Medical Park Drive Ste. 100, 29303 582-8135 Skylyn Medical Associates 1776 Skylyn Dr., 29307 577-9970 Spartanburg Pediatric Health Center*† 201 E. Broad St., Ste. 210, 29306 707-2135 TRAVELERS REST Travelers Rest Family Medicine* 9 McElhaney Rd., 29690 834-3192

The Care You Need, The Way You Want It Click

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—15,000 dedicated professionals, your neighbors, who work together to care for you and your family.

For online care for common conditions: ghs.org/SmartExam

Walk

Editor-in-chief Jerry R. Youkey, MD Executive VP, Medical and Academic Affairs, Chief Medical Officer, Greenville Health System Founding Dean, USC School of Medicine Greenville USC Associate Provost for Health Sciences Greenville

For convenient after-hours care: ghs.org/MD360

Call

Art Direction GHS Creative Services Contributing Photographer George Reynolds 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

To find a new healthcare provider: 1-844-GHS-DOCS (447-4627)

ghs.org

© 2017 Greenville Health System 17-0467 7/17

A New Partnership for Your Good Health Greenville Health System (GHS) and Palmetto Health are coming together to create a new, not-for-profit, locally governed health company to shape and lead the future of health care for all South Carolinians. Through this affiliation, the new company will improve the patient experience, clinical quality and access to care and address rising healthcare costs.

The two systems intend for the new health company to be a model for how private, not-for-profit health systems can effectively bring value to the communities served.

This affiliation will have the scale, scope and resources required to address the serious health issues—including obesity, diabetes, stroke and other diseases—that plague South Carolinians. This partnership will give both entities a unique opportunity to make positive changes over time. We will work together to reach more patients, make South Carolina healthier, attract new team members, spur economic development, offer new and broader services to our patients and help make health care more affordable and accessible.

For more information or to submit a question, please visit SCBetterTogether.org.

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.