WAVES Spring 2014
Expert Lung Cancer Care at Bayhealth
“I’ve been given a gift!” Susan Simpson
Cardiothoracic Surgeon Paul Fedalen, MD
usan Simpson quit smoking 20 years
lobectomy the surgery requires a six to seven
ago. She eats well, exercises, and sees a
inch incision in the chest, and the patient’s ribs
must be spread or broken so the surgeon can access the lung.
So she was surprised to learn she had lung cancer.
Another type of lobectomy is called a VATS (video-assisted thoracoscopic surgery). In this
“I got the flu. I never get the flu. It was
procedure, the surgeon inserts a camera and
strange,” Simpson recalled. “When I coughed
surgical tools through small incisions to locate
up blood, we went to the emergency room,
and remove the cancer. A VATS lobectomy
and from there, we eventually ended up in the
can offer a shorter recovery period than the
traditional open procedure.
The best approach for her lung tumor was
After a friend had a traditional open lobectomy
a lobectomy, a surgical procedure that
and a long and painful recovery, Simpson
removes part of the lung. In a traditional open
searched for surgical options for treating lung
cancer. She learned that cardiothoracic surgeon
or her chances of long-term survival,” Fedalen
Paul Fedalen, MD, at Bayhealth Cardiovascular
Surgical Associates, offers minimally-invasive robotic lobectomies, which are usually less
“My recovery was almost painless. I was given a
invasive than traditional surgery and may have
prescription for pain medicine, but I didn’t need
a shorter recovery period. Although she lives in
to take any of it,” she said. “I am very lucky.”
Greensboro, Md., Simpson traveled to Dover to meet with Dr. Fedalen.
Dr. Fedalen is part of Bayhealth’s Lung Tumor Conference, a collaboration of physicians and
“As soon as he said he did the robotic surgery, I
nurses. Simpson’s oncologist, Adity Sharma,
knew he was the one,” Simpson said. “He is very
MD, of Bayhealth Hematology/Oncology
experienced and he answered all my questions.”
Associates, is part of the group.
Dr. Fedalen, the only surgeon in Delaware
Surgeons, radiation and medical oncologists,
to offer robotic lobectomies, explained that
pulmonologists (lung physicians), pathologists,
patients must meet certain criteria for this
and others meet regularly to review and
technique. Robotic lobectomies involve four
develop individualized care plans that follow
to five small incisions of about one centimeter
national guidelines. This meeting ensures
each. The surgeon can access the tumor with
that each provider who may care for the
minimal disruption to bones or organs.
patient throughout the process is included in the conversation from the beginning. It is
Patients who receive robotic lobectomies can
sponsored by the Bayhealth Cancer Institute.
generally expect to spend three to four days in the hospital after surgery, compared to five to
Now several months post-surgery, Simpson
seven days with traditional approaches.
sees Dr. Sharma for follow-up care. The focus is on keeping her healthy and making sure her
This recovery is similar to that of the VATS
cancer doesn’t return.
lobectomy. But the real advantage is that the robotic approach provides surgeons with more
“I’ve been given a gift,” said Simpson. “I am
information about the cancer that can help
planning to live life and be grateful for this
determine future treatments.
“We can dissect the lymph nodes and find
To learn more about Bayhealth’s multi-faceted
microscopic disease that we may miss with a
care for lung cancer patients, visit us at
VATS lobectomy. This information can help us
get the patient treatments that will increase his 3
Bayhealth Neurosurgical Services Continue to Grow James Mills, MD
ayhealth continues to expand neurosur-
Comprised of seven private rooms, Bayhealth’s
gical services with the opening of the
Neuro ICU is led by Dr. Mills and includes two
Neurosurgical Intensive Care Unit (Neuro
physician assistants, a neurosurgery nurse navi-
ICU) at Kent General.
gator, a nurse manager, a clinical nurse specialist, 16 staff nurses, and a rehabilitation team
“This was two years in the making, and it is a
with specialized training in the care of neurolog-
dream to open this space to enhance the care of
patients in central and southern Delaware,” said Bayhealth neurosurgeon James Mills, MD.
“This unit is special because it focuses on the neurosurgical population,” said Susan Litchford,
Bayhealth’s neurosurgery program began just two
RN, BSN, CNML. “It provides better continuity of
years ago, with the addition of Dr. Mills and his
care for patients who benefit from the expertise,
specialized team, including coordinated care from
competency and coordinated effort of our staff.
experts in departments throughout the hospital.
Patients who stay here also build strong relation-
Before Bayhealth’s program was initiated, pa-
ships with the members of our staff, which also
tients with traumatic brain and spinal cord inju-
contributes to their recovery.” n
ries or other complex neurological conditions had to seek medical treatment out of the community. 4
Meet Bayhealth’s Neurosurgical Services Nurse Navigator and follows up on patients when they return for post-operative office visits. She provides inpatient education and discharge information for all neurosurgical patients. In addition, she assists with the coordination of care for neurosurgical patients by collecting and analyzing data on neurosurgical patients and creating and ensuring standardized care for craniotomy and hemorrhagic stroke patients.
To accelerate patient outcomes after surgery and enhance quality of care, Bayhealth hired Neurosurgical Services Nurse Navigator Olivia Washinski, RN, to coordinate care for patients from pre-op to post surgery to discharge. Washinski assists with pre-surgical classes, gets patients walking in the ICU after surgery, coordinates inpatient physical therapy, transitions patients to either a rehab or home,
“Walking soon after surgery is a big component and key to to a patient’s recovery,” said Washinski. Washinski received her bachelor’s degree in community health from the University of Maryland at College Park and her bachelor’s degree in nursing from the Johns Hopkins School of Nursing. She is certified in Maryland as a forensic nurse examiner and is a member of the Emergency Nurses Association. n
Bayhealth’s STEPS to Healthy Aging Program is a free program for anyone over age 50 living in Bayhealth’s service area. The goal of this program is to inform members of the latest health information for healthy aging, make new health skills a priority and improve lifestyle, diet and attitude for healthy longevity. For more information about the STEPS to Healthy Aging Program, call Bayhealth’s Education Department at (302) 744-7135 or (toll-free) 1-877-453-7107, or visit www.bayhealth.org/steps. 5
“I knew immediately that he wanted to improve my quality of life.”
Gabriel E. Lewullis, MD
oan Cote is well known for the position she
An MRI showed that Cote had meniscal tears
has held for more than two decades at Dover
in her knees – one of the most common knee
Air Force Base. In any given day she can be
injuries. Athletes who play contact sports are at
found welcoming home our military heroes.
risk for meniscal tears. Though, anyone (athlete or non-athlete) at any age can tear a meniscus.
The job is emotionally and physically demanding. So when severe pain in her knees began to slow her
To repair the tears, Dr. Lewullis performed knee
down Cote turned to orthopaedic surgeon Gabe
arthroscopic surgery – a minimally invasive ap-
Lewullis, MD, with Bayhealth Orthopaedic Surgery.
proach. “Everything went exactly as Dr. Lewullis described,” according to Cote.
“My body started to complain,” recalls Cote. “I had pretty sharp pain in my knees, particularly
Now a few months out from surgery, Cote says
when I was walked down stairs.”
she can barely see scars.“For a woman, that’s important. Dr. Lewullis has the surgical skills
Cote was referred to Dr. Lewullis, but she did her
along with the cosmetic skills.”
own research and discovered an impressive college career and clinical background – one that includes
Dr. Lewullis specializes in non-operative and op-
a fellowship in orthopaedic sports medicine.
erative treatment for the knee, shoulder, elbow, hip, and ankle. To schedule an appointment
“The second I met him, I liked him,” says Cote.
with Dr. Lewullis in Dover, Milford or Smyrna,
“I knew immediately that he wanted to improve
call (302) 730-4366. n
my quality of life.” 6
Back in the Swing of Things with a New Hip
ngoing pain in his left hip restricted Todd Sheldon’s golf game. When the strain became too much to tolerate, Sheldon turned to orthopaedic surgeon Trinity Pilkington, MD.
Sheldon had always been active. He ran a few miles per week and played golf as often as he
could. But arthritis was affecting his quality of life. “I wasn’t able to tie my shoes without pain from the pressure of bone-on-bone,” said Sheldon. Even so, he worried that traditional hip replacement surgery would mean a long, painful recovery. Sheldon considered traveling out of state to have a hip replacement but his physician introduced him to Dr. Pilkington.
Trinity Pilkington, MD The two decided that Sheldon would benefit from the muscle-sparing anterior hip replacement. “I did my due diligence on his background and was impressed by his knowledge and experience,” said Sheldon. First impressions didn’t disappoint. “Dr. Pilkington was very thorough. He didn’t just talk to me, he listened to me.” Just two hours after surgery, Sheldon was able to walk without assistance. The following day, he walked 20 laps around the nurses’ station – the same day he was released from the hospital. Less than a week later, he was back to work and within a few weeks he was playing golf. “From beginning to end, the experience was wonderful,” said Sheldon. “The only regret I have is not having the procedure done sooner. But, I’m happy I held out for Dr. Pilkington to join the Bayhealth Medical Group.” To schedule an appointment with Dr. Pilkington, call (302) 730-4366. n
Expert Cardiac Care Close to Home
Bayhealthâ€™s cardiac surgery team
Paul Fedalen, MD; Daniel Marelli, MD; Gary Szydlowski, MD, chief of Cardiovascular & Thoracic Surgery; and John Mannion, MD, administrative chief of Cardiovascular & Thoracic Surgery. 8
ur community is fortunate to have an
including, but not limited to, the lungs, the lin-
excellent adult cardiac surgery program
ing around the lungs, major arteries and cancer
at Bayhealth. “One of the things I’ve been
anywhere in the chest. Vascular surgery includes
most pleased with is that we have been
clearing the arteries in the neck (for those at
able to provide access to lifesaving care
risk for stroke), creating access for dialysis,
within our region,” said Dr. John Mannion, who
performing bypass surgery on legs and repairing
developed the program at Bayhealth with Dr.
an aneurysm in the abdomen, whether by open
Paul Fedalen 10 years ago.
surgery or the new stenting procedures.
Patients really appreciate the care they have
Cardiac surgery involves any procedure on the
received. This is proven by the wonderful patient
heart, including coronary bypass, valve repair or
satisfaction scores received by our program and
replacement, procedures to correct abnormal
staff. “We continue to work on creating aware-
heart rhythms, and operations on the aorta.
ness of our program,” Mannion said.
Szydlowski, who trained at Jefferson and then went to a large teaching hospital in Pittsburgh,
“Before the establishment of our program in
came to Bayhealth from Lehigh Valley Medical
2004, people who needed heart surgery had to
Center which is described by Mannion as “one
travel to major medical centers such as Johns
of the busier medical centers for heart surgery in
Hopkins in Baltimore, the Hospital of the Uni-
the country and now a leading cardiac center.”
versity of Pennsylvania, or Peninsula Regional
Szydlowski is pleased with the quality and scope
Medical Center in Salisbury. This distance limited
of Bayhealth’s program.
access to heart surgery for residents of Kent and Sussex counties.
“We do 98 percent of what those fields (cardiac, vascular and thoracic) include,” he said.
Some patients have no trouble traveling that far,
“Occasionally, we send patients out to other
but many do. Occasionally, our local patients get
institutions, given that some operations and
lost in follow up or have difficulty returning to
illnesses can be better served at a larger insti-
their primary care provider,” continued Man-
tution. But in spite of the fact that ours is a
nion, who has since moved into an administra-
smaller program, we have excellent results in all
tive role at Bayhealth.
Dr. Gary Szydlowski, Bayhealth’s new chief of
As our volumes grow, we expect to have even
cardiovascular and thoracic surgery, defined the
better results. ” Mannion added, “It is of no
three kinds of surgery performed at Bayhealth:
value to have heart surgery at a non-academic center if the results are not good. Results at Bay-
Thoracic surgery involves anything in the chest
health really are quite excellent. We have been 9
mentioned as one of the top 100 hospitals in
ered here because the new ideas and services that
the entire nation for our clinical results on mor-
we develop jointly are also easily transferable. “For
tality — the percentage of patients who survive.
example, we have developed a minimally invasive approach to treating thoracic and abdominal aneu-
That’s a very good success rate. We’ve achieved
rysms so a patient does not need a large incision;
that in two straight years. Previous to that, we
rather, the condition can be effectively cured with
had a five-star rating for valve surgery. So, over
a minimally invasive approach.
the course of 10 years, our patients, fortunately, (not meaning to brag) have had access to very
“Patients are usually in the hospital for just two
superior outcomes when it comes to the most
or three days. Dr. Daniel Marelli is the surgeon
important reporting statistic — patient benefit
doing these minimally invasive vascular repairs,”
from surgery. We are very pleased with that.”
Another advantage of a good local program with advances in cardiology, Mannion said, is
“I am so happy with the connection with Penn!
that “many patients having a heart attack have
It provides us the latest information on best
to go to the closest hospital and be treated with
practices. We have a weekly meeting with
stents and dilation.
Penn’s surgeons via the Internet, with constant discussion of approaches and outcomes.
It’s always safest to have stent and angioplasty programs in a hospital that has heart surgery
For me, it feels almost like I’m really a part of
available so that heart surgery and other treat-
Penn’s faculty. It’s close to actually being there.
ments can go hand in hand. “The progress in technology has made operating ”Another unique aspect of our program, Man-
in remote areas from academic medical centers
nion said, is that Bayhealth has a formal af-
much safer. It has made it possible for advances
filiation with the Hospital of the University of
to be distributed faster at a local level,” Man-
Pennsylvania, “so when we do have a compli-
cated situation, or have a person in need of new technology we do not have available, we have
“Another aspect of our program that’s unique
quick access to the University of Pennsylvania
is our thoracic surgeon who does robotic lobec-
Health System, which ranks among the best in
tomy (removing a section of the lung). That sur-
the world for cardiac surgery.
geon is Dr. Paul Fedalen who went into private practice for a few years, expanding into thoracic
Six or seven programs in the Philadelphia area have
and vascular surgery, before rejoining the group
cardiac affiliations with the University of Pennsylva-
in Dover about two years ago. This is a great ex-
nia. That connection has improved the care deliv-
ample of how Bayhealth services such as cardiac
and oncology partner to provide expert care for
Another procedure being done in limited, highly
patients in our region.
specialized centers is the use of a heart-lung machine called ECMO (Extracorporeal Membrane
“There are very few surgeons in Philadelphia
Oxygenation) to treat pneumonia. This proce-
and I don’t think any others in Delaware who
dure uses a machine to take over the work of
are able use a robot with such good results and
the lungs and sometimes the heart. “ECMO can
such tiny incisions.” Mannion also had high
be done here in an emergency,” Szydlowski said.
praise for Szydlowski, who joined the group last
“We are looking into expanding the program.”
fall. “Dr. Szydlowski has vast experience and we anticipate some new programs may be able to
He continued, “We are committed to keeping
be developed at Bayhealth using techniques he
pace with more advanced techniques to see
has already established at Lehigh Valley.” Szyd-
how they fit into this hospital and community;
lowski said the group is beginning to investigate
all within the setting of government regulations
robotic heart surgery.
and requirements.” Approximately 200 heart surgeries a year are performed at Bayhealth,
“We’re evaluating this option and obtaining ap-
propriate training. This robotic procedure would be on highly selected and limited cases. They
“Our greatest satisfaction comes from know-
are also investigating a new aortic valve replace-
ing that the people in Delaware have access to
ment procedure, without the need for opening
expert care, and that we have been able to save
lives by providing a good quality, local program close to home,” explains Mannion.
Called TAVR, for “transcatheter aortic valve replacement,” the procedure can be done through
“We are pleased, and even more excited, about
a catheter in the groin or a small incision in the
developments that are taking place now and will
left side of the chest, Szydlowski said.
continue to take place in the future!” n
He stressed, “The FDA has approved the procedure and the device; however, it is only being done in a limited number of centers. We’re investigating the possibility of doing TAVR here. There are certain requirements that have to be met first, so we are beginning to evaluate this program.”
Training the Next Generation of Physicians Stephen Manifold, MD
Bayhealth and Penn Medicine Create Orthopaedic Physician Residency Program
Brad Kirkes, MBA, MHA, OTR/L, CHT, FACHE
cal Services, Brad Kirkes, MBA, MHA, OTR/L, CHT, FACHE, produces the curriculum and collaborates with other orthopaedic attending physicians at Penn to make sure the curriculum meets Penn standards.
s part of Bayhealth’s orthopaedic affil-
Under the supervision of an attending physi-
iation with Penn Medicine, Bayhealth
cian, the residents examine patients, make a
initiated a residency program that
diagnosis, decide which tests to order, develop
brings Penn orthopaedic surgeons to
a treatment plan, work in the operating room,
our hospitals to experience working as
and participate in follow-up care.
community physicians. “This program introduces residents to this
Residents receive practical knowledge not nec-
community and potentially can help with
essarily learned in the classroom or academic
recruiting new surgeons,” said Dr. Manifold.
hospital setting, such as value-based purchas-
“We will need more specialized surgeons as the
ing, legal and business aspects of running a
baby boomers start getting older and needing
practice, pros and cons of being a private prac-
surgery. At academic centers you might not see
tice or employed physician, physician contract-
the common, straightforward patient problems
ing, and compensation.
that we see here. You would only see very complex cases that are referred in for that level
Stephen Manifold, MD, serves as medical
of care. Here, you get training in community
director of the program and together with
surgeries – hip fractures, rotator cuff injuries,
Bayhealth Vice President, Ancillary and Clini-
shoulder ailments, arthritic conditions.” n
Bayhealth Wellness Center at Milford High School Hosts “SMAK” Celebration
o thank the SMAK (Students for a Million
“You have proved that change is possible and
Acts of Kindness) Ambassadors throughout
that genius occurs at any age,” Chafin praised
the Milford School District, as well as local
fire departments and the Milford Police Department, the Bayhealth Wellness Center
“It started with you – you have the potential to
recently hosted a celebration that included special
set the world on fire and make it grow brighter
guest Senator Tom Carper and Director of the
than the sun,” said Sen. Carper.
Delaware Division of Public Health Karyl Thomas Rattay, MD, MS.
Since October 15, students have documented more than 700,000 acts of kindness. If they
Su Chafin, Counselor and SMAK Advisor at
reach a million acts of kindness by the end of the
the Bayhealth Wellness Center at Milford High
school year, Chafin has promised to shave her
School, welcomed students and special guests
head, and other staff members plan to participate
and explained the concept of “SMAK.”
in fun activities as well.
The program started as a student project to
As part of the project, students participate daily
prevent bullying during National Bullying Preven-
in individual or group acts of kindness and record
tion Month in October and turned into a cul-
them through the Milford School District website.
ture-changing crusade throughout the district. Stu-
Individual acts of kindness can be as simple as
dents and staff members in the district, through
holding the door open for someone with a smile.
Bayhealth’s Wellness Center at Milford High
Each school club has a SMAK Ambassador who
School, launched the program to promote kind-
helps drive kindness projects, such as food drives
ness among students, staff and the community.
and sending kind notes to others. Through the year, students will receive awards for reaching milestones on the way to the one million mark. n 13
of Surgeons (ACS). Dr. Alexander was named the chapter president while Dr. Rather was selected as the 2014 Delaware Young Surgeon. The ACS is a scientific and educational association of surgeons that was founded in 1913 with a goal to improve the quality of care for surgical patients and to set high standards for surgical education and practice.
Bayhealth Surgeons Honored by the American College of Surgeons Edward Alexander, MD, and Assar A. Rather, MD, both general surgeons at Bayhealth Surgical Associates, Dover, were recently honored by the Delaware Chapter of the American College
As president, Dr. Alexander will proudly serve 200 general surgeons and surgical specialty surgeons throughout the state. He will concentrate his energies on raising the standards of surgical practice and improving the care of all surgical patients. In his new role as 2014 Delaware Young Surgeon, Dr. Rather will provide a voice for young Fellows of the ACS on a national level. He will promote programs and initiatives that will benefit young surgeons, in all types of practices, through the country.
Welcome New Physicians
Need a physician?
Department of Obstetrics/Gynecology
Department of Surgery (General)
Department of Pediatrics (Neonatology)
John Deaver, MD
Louis E. Costa, DO
Julia Ryan, MD
Fredericka S. Heller, MD Walter Kobasa Jr., MD Michael Meyer, DO Department of Medicine (Infectious Deases) Ngozi Mezu, MD
Department of Diagnostic Imaging Leon M. Novak, MD Department of Surgery (Ophthalmology) Karen Rudo, MD
1-866-BayDOCS Shazia Bhat, MD Haritha Vellanki, MD
Department of Pediatrics Anuradha Naram, MD Department of Medicine (Endocrinology) Tadele Desalew, MD
Bayhealth Performance For the fiscal years ending 6/30/2013 and 6/30/2012
Average Length of Stay
Total Net Revenue
ED Visits Births Outpatient Visits
Patients Admitted Diagnostic Imaging Procedures Laboratory Tests
Payor Mix - Bayhealth Fiscal Year 2013 Our primary service area has seen rapid population growth in the last few years, with continuing growth of 5% per year. Medicare and Medicaid patients comprise the majority of our patient population at 67%. These patients are typically higher utilizers of healthcare services in the community. 4% Champus
Bayhealth Payor Mix
1% Compensation 7% Managed Care
3% Private Pay 43% Medicare
3% Commercial 15% Blue Cross
Generous Gifts Received by Bayhealth Foundation
A naming celebration took place on April 28, 2014, at Bayhealth Kent General, honoring the late Gregory S. Kramedas. Bayhealth acknowledged a generous gift from Avelina Kramedas with a plaque outside the multi-disciplinary conference room in the Bayhealth Cancer Center, Kent General. Family, friends, and caregivers gathered at the Cancer Center to celebrate the life of Gregory
A new plaque outside trauma room A1 in the emergency department at Bayhealth Kent General acknowledges a generous gift from John and Linda Paradee. The Paradees’ gift supports the important services that the Bayhealth trauma program provides to Kent and Sussex Counties.
Kramedas and recognize the patient-centered care that takes place in this space. This conference room is the home of the MultiDisciplinary Cancer Conference where surgeons, oncologists, pulmonologists (lung physicians), radiologists and others meet regularly to review and develop individual care plans that follow national guidelines.
When a trauma alert is called, it sets into motion a complex series of activities and professionals who work together with a shared goal- to save a life. How quickly a trauma victim receives care can make a significant difference in patient outcomes. Personnel and equipment must be ready to take action to achieve a positive outcome for the patient.
The Bayhealth Foundation receives, manages and disburses all contributions, including cash donations, securities, real estate, gifts-in-kind, or bequests, to improve Bayhealth’s services. To find out how you can help support Bayhealth, please contact the Foundation office at (302) 744-7015 or bayhealthfoundation.org. 16