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Health

WAVES Spring 2014

Expert Lung Cancer Care at Bayhealth

1


“I’ve been given a gift!” Susan Simpson

Cardiothoracic Surgeon Paul Fedalen, MD

S

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

cardiologist regularly.

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

surgeon’s office.”

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

2


cancer. She learned that cardiothoracic surgeon

or her chances of long-term survival,” Fedalen

Paul Fedalen, MD, at Bayhealth Cardiovascular

explained.

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.

chance.”

“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

www.bayhealth.org n

get the patient treatments that will increase his 3


Bayhealth Neurosurgical Services Continue to Grow James Mills, MD

B

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

ical patients.

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

J

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

O

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

7


Expert Cardiac Care Close to Home

Bayhealth’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


O

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.

three specialties.

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.”

Mannion said.

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-

nion said.

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

10


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-

Mannion said.

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

the sternum.

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.”

11


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.

A

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

12


Bayhealth Wellness Center at Milford High School Hosts “SMAK” Celebration

T

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

the students.

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

14

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

FY 2013

FY 2012

90,142

83,467

2,226

2,236

470,307

482,417

18,078

17,151

293,112

293,136

1,200,083

1,208,200

Operations Performed

13,427

13,508

Average Length of Stay

4.5 days

4.5 days

Unreimbursed Care

$44.5 million

$45.5 million

Total Net Revenue

$482.4 million

$451 million

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

24% Medicaid

15


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


Health Waves - Spring 2014