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live well PA R T I A L LY O W N E D B Y P H Y S I C I A N S

Making Communities Healthier® F A L L

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Linda Hyman was diagnosed with and treated for breast cancer at Carolina Pines.

More Than a Patient A breast cancer survivor felt she was treated like a friend

Keeping new moms safe and healthy | Women’s health checklist | Understanding menopause


Breast cancer patient receives compassionate care


A NEW PHASE Understanding menopause



A Common Diagnosis Breast cancer awareness is an important part of women’s health

Christy Moody, MSN, RN, Chief Nursing Officer




How healthy habits impact cancer risk


The materials in Live Well are not intended for diagnosing or prescribing. Consult your physician before undertaking any form of medical treatment. For more information, visit our website at cprmc.com or call (843) 339-4563. Copyright © 2019 Carolina Pines Regional Medical Center.

Here at Carolina Pines Regional Medical Center, we believe in bringing awareness to our community about the full spectrum of women’s health. Awareness of breast cancer, the most commonly diagnosed cancer among women, is an important part of that. In the United States, nearly one in eight women will develop breast cancer in her lifetime. South Carolina ranks 13th in the nation for breast cancer deaths Fortunately, breast cancer deaths have been declining nationally since 2000. This decline is thought to be the result of early detection through screenings, increased awareness and improved treatment regimens. Early diagnosis is a key factor in breast cancer survivorship. At Carolina Pines, we promote early detection of breast cancer and screening mammograms, and when there are suspicious findings, our state-of-the-art technology can provide patients with a timely diagnosis so treatment can begin as soon as possible. These factors work together to increase the chances of a good clinical outcome. If you would like more information about breast cancer detection at Carolina Pines, please call us at (843) 339-4790. Kindly,

Christy Moody, MSN, RN Chief Nursing Officer

Welcome Aaron Wynkoop, MD

Specializing in:

Orthopaedic Surgeon Hartsville Orthopaedics and Sports Medicine 700 Medical Park Dr. Hartsville, SC 29550

Ankle pain and injury Knee pain and injury Shoulder pain and injury Knee replacement Shoulder replacement

Medical school: University of Pittsburgh, Pittsburgh, PA Residency: Michigan State University McLaren, Flint, MI Fellowship: Alleghany General Hospital, Pittsburgh, PA

Dr. Wynkoop welcomes new patients. Appointments may be made by calling (843) 383-3742.


Live Well  Fall 2019

PRESSURE ALERT Pink bracelets spread awareness about gestational hypertension after delivery Gestational hypertension is a condition that can occur any time between a woman’s 20th week of pregnancy through five weeks after delivery. It causes high blood pressure and can lead to serious complications. The condition can be overlooked if a woman goes to the Emergency Department for treatment during or after her pregnancy. Kelly Miller, director of Women and Children’s Services at Carolina Pines Regional Medical Center, explains that symptoms of gestational hypertension after delivery—which is also called postpartum preeclampsia or toxemia—include headaches, swelling in the legs, and visual disturbances like spots before the eyes and/or blurred vision. Gestational hypertension is more likely to occur after first-time pregnancies, with twin pregnancies, in women who were overweight before becoming pregnant, in black women and in women over 40. If a woman visits the ED with these symptoms and doesn’t say she was recently pregnant, it is more likely she will be misdiagnosed. To address this, Miller and her labor and delivery nurses Komesha Ashe, RN, and Pam Blackmon, RN, recently started giving every pregnant woman they treat a pink bracelet that states, “I’m a new mom.” They recommend wearing it for 50 days following delivery to serve as a reminder to let healthcare providers know they have recently given birth. Miller and her team also told providers affiliated with Carolina Pines about the program, so they can recognize a patient’s risk even if the patient doesn’t mention the bracelet. “Our providers are starting to see the patients who received the first bracelets through our program,” says Miller. “It’s a small effort, but it’s a good way to raise awareness.”



Are you preparing for a bundle of joy? Register for a Childbirth Preparation Class by calling (843) 339-4563.

“If people are aware of [gestational hypertension], they usually think it is a problem that only occurs during pregnancy and immediately after delivery.” —KELLY MILLER, DIRECTOR OF WOMEN AND CHILDREN’S SERVICES AT CAROLINA PINES REGIONAL MEDICAL CENTER

Finding out that you’re having a baby can be filled with a range of emotions.

iStock.com: Graffizone

You may wonder what comes next. Have peace of mind that we’re here for you along your journey so you and your baby get the best start possible. To schedule a tour, visit cprmc.com/FirstStep.

cprmc.com  (843) 339-2100



Right time, right place Breast cancer patient receives skilled, compassionate care close to home In February 2018, Linda Hyman went for her usual screening mammogram, and as had happened before, the radiologist requested that she come in for a second scan. “I get called back a lot because I have dense fibers in my breasts,” Linda says. But this time, the second mammogram turned up something more problematic. Linda had a mass in her left breast. ABOVE AND BEYOND Linda, who has been a mortgage banker in Hartsville for 20 years, talked with her primary care physician, Susan Reynolds, MD, about the steps that would be needed to diagnose the mass. Dr. Reynolds personally called Carolina Pines general surgeon Jason Dameron, MD, so Linda could be seen as soon as possible. Dr. Dameron recalls that he discussed options for the biopsy with Linda. “If an abnormality is seen on the mammogram, there are different ways to get a sample of the suspicious tissue,” he says. “We talked about doing a needle biopsy”—in which a needle is inserted into the mass and a sample is drawn—“but Linda thought that even if the mass was benign, she would prefer to have it removed so it wouldn’t show up in subsequent screening mammograms and cause questions every time.” Within a couple days, Linda was scheduled for an excisional breast biopsy, a surgery to remove the mass.


Live Well  Fall 2019

Linda Hyman is doing well after bilateral mastectomy surgery for breast cancer.

Early Detection Is Key 

South Carolina has almost cases of breast cancer each year, which is higher than the national average.

4,000 

Darlington County residents have a


higher risk of being diagnosed with breast cancer than the national average.


The biopsy confirmed that Linda’s tumor was cancer. Dr. Dameron then ordered a battery of tests to check if the cancer had spread. This would determine the best way to treat her. “This was Thursday,” says Linda. “The hospital said we’ll do the tests Friday morning, and get the results back Friday afternoon.” All of Linda’s doctors went to great lengths to make sure the tests were conducted and evaluated quickly. When radiologist Greg Connor, MD, knew he wouldn’t be available to read the scans the same day, he called her to let her know that he arranged for someone else to follow up and give her the results. Linda, somewhat amazed by their attentiveness, thought to herself, “Who does this kind of stuff?” TREATED AS A FRIEND The radiology team followed through and gave the results to Dr. Reynolds on Friday, who promptly called Linda to say that they were negative for additional cancer sites. With that clearance, Dr. Dameron and Linda were able to plan her course of treatment. Linda felt that staying at Carolina Pines was the way to go. Besides getting great care, Linda had established relationships with many of her physicians and nurses. “I talked to everyone I knew that had breast cancer previously, and several had been treated at Carolina Pines,” she recalls. “I just felt comfortable here, and that’s what’s important. I asked Dr. Reynolds and Dr. Connor as friends, ‘Take your doctor hat off—am I doing the right thing? If I need to go to somebody else, don’t do it just because you work for this hospital.’ And they said, ‘Linda, you are doing the right thing and you are going to get good care.’” Linda’s surgery was scheduled for the following week.

CANCER SURGERY AT CAROLINA PINES “Diagnosis and treatment of breast cancer is part of the training for any board-certified surgeon,” says Jason Dameron, MD, a general surgeon at Carolina Pines. This means it is not necessary to go to a large hospital or a cancer center to receive high-quality care for breast cancer. “The care of breast cancer is standardized across the United States,” he continues, “and patients should receive the same continuum of care in any location, but Linda Hyman had the advantage of being treated in a hospital where she was known.” While treatment must be tailored to each woman’s situation, including the size and position of the tumor and the stage to which the cancer has progressed, most breast cancer patients have one of these types of surgery:

B  reast-conserving surgery, also known as a lumpectomy or partial mastectomy, is done with the goal of removing the tumor while maintaining as much of the breast tissue as possible.

M  astectomy is removal of the entire breast and, in some cases, some

adjacent tissues (such as the chest wall muscles). Depending on the position of the tumor, the physician’s recommendation and patient’s desires, one or both breasts can be removed to help prevent the cancer from spreading or returning.

“I talked to everyone I knew that had breast cancer previously, and several had been treated at Carolina Pines.” — LINDA HYMAN cprmc.com  (843) 339-2100


“Providing health Nearly 1 in 8 women will develop breast cancer in her care in a small town lifetime. Black women have a is not just about treating patients. slightly lower rate of getting They are friends, breast cancer neighbors and than white women, but colleagues.” are more likely to die from — JASON DAMERON, MD breast cancer .




SUCCESSFUL SURGERY Linda’s diagnosis was stage 1 invasive ductal adenocarcinoma in her left breast. “She was a candidate for lumpectomy,” Dr. Dameron says, “but that would have required radiation afterwards, which she did not want.” After Dr. Dameron and Linda discussed her case with an oncologist to confirm that radiation or chemotherapy were not needed, they went forward with a bilateral mastectomy, removing the affected breast and the unaffected breast as a preventative measure. Since Linda planned to have breast reconstruction surgery, during the mastectomy, plastic surgeon Joe Griffin, MD, placed tissue expanders in the areas where the breast tissue had been removed so that implants could be placed later, after a short period of healing. While she was in the hospital, Linda received top-notch care from the nursing staff. “My room the morning of surgery was full of nurses that I knew, taking care of me, saying, ‘We’ve got this,’ and cheering me up. It just so happened that I had made mortgage loans for all of them,” she says. “If I had gone anywhere else, I would’ve just been a patient. And I didn’t feel like a patient, I felt like a person. The whole entire time, I felt like a person.” “In general, providing health care in a small town is not just about treating patients,” Dr. Dameron says. “They are friends, neighbors and colleagues. I made sure Linda had my cell number so she could call me at any time.” That kind of care and commitment is what makes Carolina Pines the right place. Linda Hyman and her husband, Kenny

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Expertise in surgery

Carolina Pines offers a full range of surgical services in almost every medical specialty. If you or a loved one needs surgery, you can count on exceptional care from our team of experienced surgeons and caring professionals. To find a surgeon, call (843) 339-2100.


Health Checklist CUT OUT & KEEP

Checkups and screenings are the best way to catch any changes in your health before they become bigger issues. Use these guidelines from the American College of Obstetricians and Gynecologists (ACOG) to stay ahead of the game, and talk with your healthcare provider about what screenings are right for you.

ANNUAL CHECKUP  Well-woman exam This yearly visit includes a physical exam and screenings to check for diseases. Your healthcare provider may review healthy habits with you, like diet and exercise or avoiding tobacco. Ask your provider if you are up to date with your vaccines.  Immunizations G  et the HPV vaccine before age 26. G  et two doses of the shingles vaccine at age 60 or older. W  omen over 65 may need vaccinations to prevent pneumonia, meningitis and blood infections. BONE HEALTH  Bone mineral density test W  omen age 65 or older should have this test at least once in their lifetime. G  et screened earlier if you are at risk for osteoporosis.

iStock.com: asiseeit

BREAST HEALTH  Clinical breast exam E  very 1 to 3 years for women ages 20–39 E  very year starting at age 40  Mammogram E  very year starting at age 40 B  egin earlier if there is a family history of breast cancer. COLORECTAL HEALTH  Colonoscopy E  very 10 years starting at age 50

B  egin earlier if there is a family history of colorectal cancer. DIABETES  Blood glucose test E  very 3 years starting at age 45 B  egin earlier if you are at risk for diabetes. HEART HEALTH  Blood pressure check A  t least every 2 years starting at age 20 G  et screened more often if you have high blood pressure or risk factors for heart disease.  Cholesterol test E  very 4 to 6 years starting at age 20 G  et screened more often if you have high cholesterol, family history of high cholesterol or risk factors for diabetes or heart disease. REPRODUCTIVE AND SEXUAL HEALTH  Cervical cancer screening A  Pap test every 3 years for women ages 21–29 F  or women ages 30–65, a Pap test and HPV test every 5 years or a Pap test only every 3 years W  omen ages 65–70 can stop screening after having three or more normal Pap tests in a row or no abnormal results in 10 years.

 Sexually transmitted infections W  omen who are ages 24 and younger and sexually active should be screened for gonorrhea and chlamydia every year; women over age 24 should talk with their healthcare provider about screening frequency. G  et tested for HIV at least once during your lifetime, or at least once a year if you are exposed to HIV risks. P  regnant women should be tested for syphilis, HIV and hepatitis B early in pregnancy. SKIN HEALTH  Skin exam T  ell your healthcare provider if you notice any skin changes or unusual moles. R  egular skin exams may be recommended for people who are at higher risk of skin cancer, such as those who have had skin cancer before or have a family history of skin cancer.


(843) 339-2100 cprmc.com  (843) 339-2100


iStock.com: Tero Vesalainen


Women have a number of options to treat menopause symptoms, including hormone replacement therapy.

A New


Understanding menopause

Women in their early mid 40s should begin preparing for a natural but potentially disruptive development. As a woman enters middle age, levels of the hormone estrogen begin to taper off as her ovaries change. Eventually, the ovaries shut down the monthly release of egg cells, resulting in the end of regular menstrual cycles.

Leroy Robinson, MD, FACOG, is an OB/ GYN at Women’s Care of Hartsville.


Live Well  Fall 2019

GRADUAL TRANSITION The period of transition from fairly regular cycles to their stopping altogether is known as perimenopause. During this phase, many women begin to experience symptoms related to fluctuating hormone levels, including hot flashes, sleep disturbances, irritability, vaginal dryness, memory problems and more.

On average, perimenopause lasts four years, but according to Leroy Robinson, MD, an OB/GYN at Carolina Pines Regional Medical Center, this transitional period is different for every woman. While the severity and frequency of symptoms vary, he also sees women approaching it with different attitudes. “Some people laugh about it and others are very happy to be through with their periods,” he says. “Sometimes a woman’s outlook depends on whether she has a mother, sister or friend who has talked about the symptoms.” When a woman has had no menstrual periods for a year, she is considered to be in menopause. This usually happens around age 49 to 55, but can start as early as age 45.

iStock.com: ALEAIMAGE, littlehenrab, emer1940, LarisaBozhikova, kali9

TREATING SYMPTOMS Often, by the time periods have stopped for a full year, the body has adjusted to symptoms like hot flashes. However, some symptoms may continue to get worse, like loss of libido, vaginal dryness and thinning of the vaginal lining, which might lead to painful intercourse. Dr. Robinson advises women to have a full discussion with their healthcare provider about what treatment can help with symptoms. “I always ask women: ‘What do you want to get out of this?’” he says. “If you just want to alleviate hot flashes or vaginal dryness, there are products that can be used without hormonal side effects or risk.” Women who want to use hormone replacement therapy should learn about its side effects and potential risks, Dr. Robinson continues. Women who have a uterus may be prescribed a combination of progesterone and estrogen, but this slightly increases the risk for breast cancer and cardiovascular problems (heart attack, stroke or blood clots). Women who have had their uterus and/ or ovaries removed might do well with estrogen therapy alone. Some antidepressant medications can alleviate hot flashes, and they are good at alleviating irritability and sleep disturbances. When women ask about natural treatments or supplements, Dr. Robinson reminds them that just because a product is labeled “natural” doesn’t guarantee that it is safe. “Some may choose to use soy or black cohosh to help with hot flashes, but these products might interact with other medications,” he says. “Estrogen-like products [like soy] might alleviate symptoms, but they can also affect the uterine lining or cause breast enlargement or tenderness.” When do the symptoms end? “Menopause is a point,” Dr. Robinson says. “Over time, women’s bodies adjust to the new normal.”


THE NATURAL APPROACH TO MENOPAUSE Many women want to know if complementary health methods can help relieve their menopause symptoms. Below is information about some common remedies. Each woman should work with her healthcare provider to make an informed decision about treating her specific symptoms.

B  lack cohosh: The roots of this North American herb are used in

dietary supplements. Studies show inconsistent results in relieving menopause symptoms, but women with liver conditions should avoid this, as liver damage has been reported (although it was not clear if the black cohosh caused the damage).

H  ypnotherapy or mindfulness meditation: These methods use the mind to help a person cope with a variety of problems. Both have good safety records, and preliminary studies show they might be beneficial for menopause.

P  hytoestrogens: These estrogen-like compounds are derived from plant sources like soy, flaxseed, legumes and whole grains. Some studies showed relief of hot flashes, but not at a rate higher than a placebo.

V  itamin E supplements: A few studies have shown that vitamin E

might have a limited effect on menopause symptoms (for example, eliminating one hot flash daily). At high doses it might interfere with blood thinners like warfarin (Coumadin) or cause excessive bleeding (even in the brain).

Keep your symptoms in check To make an appointment with Dr. Robinson to talk about menopause symptoms or other women’s health issues, call (843) 339-9222.

cprmc.com  (843) 339-2100


AGram of Prevention Answers to your questions about mammograms

WHAT HAPPENS IF A LUMP IS FOUND? It’s important to note there are two types of mammograms: screening and diagnostic. Screening mammograms take X-ray pictures of each breast from two different angles to search for signs of breast cancer in women who are not experiencing breast symptoms or problems. If a lump or suspicious findings are seen, your doctor will probably order a diagnostic mammogram, which may take extra images of the breast. From there, your doctor would most likely perform a biopsy.

A mammogram is an X-ray of the breast that radiologists use to detect early signs of breast cancer. There are more than 245,000 new cases of breast cancer reported annually in the United States, making it one of the most common types of cancer in women. Routine mammograms are the best way to find breast cancer early. Carolina Pines Radiologist Gregory Connor, MD, answers common questions about this important screening. WHO NEEDS A MAMMOGRAM? Anyone with pain or lumps in a breast, and all women over age 40, according to the American College of Obstetricians and Gynecologists (ACOG) guidelines. WHEN SHOULD I GET A MAMMOGRAM? If you are experiencing pain or lumps, then right away. You should schedule yearly screenings starting at age 40, according to ACOG guidelines.

IN THEIR WORDS “I enjoy being able to calm patients and reassure them during their exam.” — Lorie Hunt (left), mammographer at Carolina Pines for one year, radiographer for 10 years “What I like most about my job is the bonds I have formed with my patients over the years.” — Jennifer Cooke (right), mammographer at Carolina Pines for 19 years

HOW LONG DOES A MAMMOGRAM TAKE? The procedure itself takes 5 to 10 minutes. DOES IT HURT? There is mild discomfort when the breast is compressed. This is needed to spread out tissues to detect cancer.


To schedule a mammogram or other screening, please call

SHOULD I BE CONCERNED ABOUT RADIATION FROM A MAMMOGRAM? No. The dosage of radiation from a single mammogram is very small.

(843) 339-4500.

Gregory Connor, MD, is a radiologist at Carolina Pines Regional Medical Center.


Live Well  Fall 2019

WHAT ELSE CAN A MAMMOGRAM DETECT? In addition to cancer, mammograms can detect abscesses, cysts and benign tumors. WHAT MEDICAL AND TECHNOLOGICAL ADVANCES HAVE OCCURRED WITH MAMMOGRAMS? Advances continue all the time in breast health. Women’s awareness about signs and symptoms of early breast cancer and what to check for during breast self-exams are only the beginning. Digital mammograms offer much more detailed information than the previous analog images. This increase in detail has allowed for much earlier detection of small, contained breast cancers and could reduce the need for aggressive surgery and treatment in most cases. Breast biopsy advancement, known as a stereotactic biopsy, has allowed patients to save most of the breast tissue without major deformity after surgery and is now considered to be an outpatient procedure with very little down time for the patient. Even with all these advancements, early detection through preventative techniques such as screenings and wellness exams is still the key to saving women’s lives from breast cancer.

iStock.com: Denes Farkas





Kimberly Alton, RD, CSSD, LD, is director of Food and Nutrition Services at Carolina Pines.

Prevention Is in Your Hands


A Carolina Pines dietitian can help you plan a diet. Call (843) 339-4530.

Research shows healthy habits impact cancer risk By Kimberly Alton, RD, CSSD, LD

iStock.com: 4kodiak, anilakkus, barol16, Canadapanda, Vladimir Obradovic

If you do an internet search, you will find countless claims about methods to prevent, destroy or miraculously cure cancer. Before you go wrapping yourself in duct tape or making a smoothie from the weeds in your yard, let’s take a step back and look at what the scientific evidence has to say.

1. EXCESS WEIGHT MATTERS. Both the American Institute of Cancer Research and the American Cancer Society recommend achieving and maintaining a healthy weight. While we may think that excess body fat is just hanging out, it actually is working destructively on the inside and can spur cancer cell growth. Excess weight is linked with increased risk of several types of cancer, including breast, colon, pancreas and kidney cancers. Even moderate weight loss of 7% to 10% can reduce your cancer risk. 2. PHYSICAL ACTIVITY HELPS. Physical activity helps with weight loss, and it can help control hormone levels that are linked to increased cancer risk. You need 150 minutes of moderate intensity activity or 75 minutes of vigorous activity each week. Ideally, this should be spread out throughout your week. 3. SITTING IS RISKY. Emerging research shows a link between long periods of sitting and an increased risk for cancer development. Find ways to move more in your day. If you spend a lot of time in front of the TV, get on a treadmill or stationary bike while watching. If your job requires a lot of computer time, set a timer and stand up for the last 10 minutes of each hour, take a walk on your lunch break or walk to visit a coworker instead of sending an email. Remember, simple changes add up, and you’re worth it.

FIGHT CANCER WITH FOOD A diet rich in plant-based foods has been linked to lower cancer risk. Does that mean you become a vegetarian? Not unless you want to. Having a more plant-based approach to eating means that you focus ¾ of your plate on plant foods – fruits, vegetables and whole grains. The remaining fourth of your plate can house your meats or other proteins. Here are some ideas on what to stock in your pantry and freezer for a more plant-based diet: • A variety of beans (black, pinto, chickpeas, lentils) • Brown rice and whole-wheat pasta • A variety of grains (couscous, quinoa, bulgur, faro, barley) • Frozen vegetables and fruits Limit how often you eat fast food and highly processed packaged foods. These foods are typically high in fats, starches and sugars, which can contribute to excess weight gain.

Start Now

Today is a great day to start getting healthy. Here are three things you can do now: 1. Eat one more vegetable or fruit serving than you did yesterday. 2. Switch white bread for whole-grain bread at one meal. 3. Park just a bit further away when you go to the store.

cprmc.com  (843) 339-2100



1304 W. Bobo Newsom Hwy. Hartsville, SC 29550

(843) 339-2100

Find us online! carolinapinesrmc carolina.pines Carolina Pines cprmc.com



Please be our guest each month! Each class meets in the Education Classroom directly next to the cafeteria. Senior Scene Senior citizens always get the best of the good life with this free program. First Thursday of the month 10–11 a.m. Living Well with Diabetes Beneficial and educational support group for people living with diabetes. Second Thursday of the month 6 p.m.




Live Well  Fall 2019

Ostomy Support Group Our Inpatient Wound Care Nurse Karen Butler, BSN, RN, WCC, OMS, is certified as an ostomy management specialist and leads our support group for ostomy patients and their caregivers. Fourth Tuesday of the month 7–8 p.m. Contact Karen Butler, (843) 339-4259 or karen.butler@cprmc.com

Lunch and Learn* Enjoy an informative talk with a different physician each month over lunch. Third Thursday of the month 12–1 p.m. Childbirth Preparation Class* Free for expectant mothers and their labor partner. First Saturday of the month 9 a.m.–4 p.m. *Please RSVP for Lunch and Learn and Childbirth Preparation Class at (843) 339-4563.

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Live Well Fall 2019  

Live Well Fall 2019