Dauphin County Medical Society P.O. Box 53 • Robesonia, PA 19551 717-798-9420 • dauphincms.org
2025 DCMS BOARD OF DIRECTORS
Andrew Lutzkanin III, MD President
Everett C. Hills, MD Secretary/Treasurer
Joseph F. Answine, MD Past President
MEMBERS-AT-LARGE
Michael D. Bosak, MD
Robert A. Ettlinger, MD
John Forney, MD
John D. Goldman, MD
Virginia E. Hall, MD, FACOG, FACP
Saketram Komanduri, MD
John C. Mantione, MD
Mukul Parikh, MD
Gwendolyn Poles, DO
Andrew J. Richards, MD, FACS, FASCRS
Jaan Sidorov, MD
Andrew R. Walker, MD
William Wenner, Jr., MD
EDITORIAL BOARD
Gerard Egan, DCMS Executive Director
Joseph F. Answine, MD, Editor in Chief
Robert A. Ettlinger, MD
Gloria Hwang, MD
Puneet Jairath, MD
Mukul L. Parikh, MD
Meghan Robbins
MEDICAL STUDENTS/ RESIDENTS/PENN STATE AMA REPRESENTATIVES
Denise Ocampo, President
Mariya Starostina
WEATHERING The Storm
By ANDREW LUTZKANIN, MD, FAAFP
“If you want to see the sun shine, you have to weather the storm.” – Frank Lane
In my first message to you several months ago I began to outline the three key areas of focus for my presidency:
1. Identifying those needs you all have that the Dauphin County Medical Society can help provide.
2. Looking inward at our own leadership to optimize and streamline going forward.
3. Partnering with other organizations to help carry our mission forward.
I had initially hoped at this point to be diving into #2: re-engaging former board members, looking for new rising stars, jumping into identifying delegates for the PA Med Society House of Delegates. But, alas, life has thrown us all a variety of curve balls.
With a change in administration, we have seen major changes in federal policy. Cuts across the NIH, CDC, and other HHS organizations have cast a great deal of uncertainty for many in medicine, from those on the front lines of public health to those of our colleagues who have devoted their lives to research. And with ongoing uncertainty as to Medicare and Medicaid funding, we all are vulnerable to these winds of change. Here in Pennsylvania the issue of Nurse Practitioner independence has again taken the spotlight with the reintroduction of the NP pilot project, first introduced back in 2020.
And so, in these stormy political times, it is essential that our organization actively partner with other advocacy groups such as our specialty societies, PA Med, the AMA, and other groups with similar missions and
priorities. We here at DCMS have our own voice and deserve to be heard. That voice is amplified when we all come together to fight for our practices, our patients, and our colleagues.
Oh – and lest I forget about item #2: If you have an issue that you think should be addressed at the state level, the deadline for PA Med resolutions is coming up on July 1st. Feel free to reach out to myself or any of the DCMS leadership team whether your resolution is fully written or still in early stages and you need help with writing. And for those considering stepping in to a leadership role, being a DCMS delegate or alternate are great ways to meet others and get going. Look for further communication as we assemble our delegation for the fall.
A MESSAGE FROM THE DCMS EXECUTIVE DIRECTOR, GERARD EGAN
Happy Spring and welcome to a vibrant new season! As the world around us begins to bloom, it’s a wonderful time to reflect on fresh opportunities—both professionally and personally. Whether you’re planning weekend getaways, outdoor hikes, baseball games, or long bike rides (one of my favorite ways to enjoy the warmer weather!), we’d love to hear about your spring and summer adventures. The energy of the season is contagious, and we hope it inspires renewed engagement within our community.
As always, your involvement with DCMS is not only welcomed, but highly encouraged. We’re currently seeking members interested in contributing to leadership and committee activities. Whether you have a little time or a lot to offer, your voice matters. Reach out if you’re interested in learning more—we’d love to help you find a role that fits your interests.
It’s also time to begin preparations for the upcoming House of Delegates. Several important deadlines are fast approaching, including resolution submissions, delegation representation slates for our Society, and confirmations for both online and in-person meeting attendance. Please take a moment to review the materials and information that will need approval. If you have ideas or
issues you feel should be presented or supported, don’t hesitate to contact DCMS leadership. Your contributions are vital to our collective success and advocacy efforts.
We’re also thrilled to share the latest issue of Central PA Medicine magazine, which continues to be an outstanding platform for member voices. In this issue, you’ll find a rich array of timely and thought-provoking articles:
• Summer Medical Dangers, including a focus on foodborne illnesses that often spike during the warmer months.
• A clinical exploration of GLP-1 agonists and their implications for anesthesia, especially relevant with the growing use of these medications.
• A compelling opinion piece on a postoperative pain management case, offering practical insights and considerations.
• A restaurant review of Coda Rouge, a unique dining spot named in tribute to the Redtail jets flown by the Tuskegee Airmen. The owner, Jameson Christopher, proudly honors his grandfather—one of the original airmen—with this inspired establishment.
• An essential article outlining do’s and don’ts if you're being sued for medical malpractice—a must-read for all practicing clinicians.
• Plus, much more!
Remember, the magazine is always seeking new content—from research and opinion pieces to achievements and reflections. This is your platform. Share your voice and enrich our professional community.
Thank you for your ongoing support and commitment to DCMS. We value each of you and look forward to a season filled with growth, collaboration, and connection.
GLP-1 AGONISTS AND ANESTHESIA: AN UNEXPECTED CONSEQUENCE
By JOSEPH F. ANSWINE, MD, FASA
Glucagon-like Peptide 1 (GLP1) agonists have proven to be quite effective for glucose control in type 2 diabetics, and weight loss in the obese.
Glp-1 agonists increase insulin release, lower glucagon release, promote satiety, and slow gastric emptying. However, the potential benefits continue to grow. Studies support improved cardiovascular health in diabetics and non-diabetics, renal protective effects in diabetics, improved lipid homeostasis, and neuroprotective effects especially in those with neurodegenerative diseases such as Parkinson’s Disease and Alzheimer’s Disease.
So, we can assume that the GLP-1 agonists will not be going away anytime soon.
However, the chemical gastroparesis that occurs has created concern among anesthesiologists and the anesthesia care team. Many of us have stories of pulmonary aspiration of gastric contents or near-misses in patients taking GLP-1 agonists. The presence of gastric contents occurs even if standard fasting guidelines are followed.
As concern throughout the anesthesia world quickly grew, the American Society of Anesthesiologists (ASA) through their Committee on Practice Parameters (CPP), in 2023, recommended that GLP-1 agonists taken daily should be held for greater
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49.5% of drug-related adverse events due to delayed gastric emptying involved GLP-1 agonists.
than 24 hours, and those taken as weekly injections should be held for at least a week. Elective cases should be held if the recommendations are not followed. If patients are symptomatic (nausea and vomiting and/or bloated feeling) or have a positive gastric ultrasound for retained stomach contents, cancellation should be considered regardless of timing of last medication dose. The guidelines were made without significant data to support the recommendations. Regardless of the lack of data, it put GLP-1 agonist usage on everyone’s perioperative radar.
In an article published this year in the British Journal of Anaesthesia (Glucagon-like peptide-1 receptor agonists and impaired gastric emptying: a pharmacovigilance analysis of the US Food
and Drug Administration adverse event reporting system, Huang, Haoquan et al. BJA, Volume 134, Issue 5, 1486 -1496 (2025).),
49.5% of drug-related adverse events due to delayed gastric emptying involved GLP-1 agonists. The article also found that those at highest risk were females, younger individuals, and those with lower weights. The study also found that the risk decreases with longer use of the medications.
Other data show that the delayed gastric emptying can last for weeks after stopping GLP-1 agonists.
Therefore, questions have arisen as to the benefit of stopping the medications as outlined in the guidelines prior to surgery, especially in those that are utilizing them for glucose control.
In the fall of 2024, based on evolving data, the ASA along with other specialty societies updated their recommendations:
1) Patients in the escalation phase of GLP-1 drugs (early in treatment) are more likely to have delayed stomach emptying, therefore, elective surgery should be deferred and only proceed once the escalation phase has passed and GI side effects have dissipated. 2) Patients who have GI symptoms, including nausea, vomiting, abdominal pain, shortness of breath or constipation, should wait until their symptoms have dissipated before proceeding with elective surgery. 3) Patients should follow a liquid diet for 24 hours before the procedure. 4) Patients with other medical conditions that slow stomach emptying, such as Parkinson’s disease, may further modify the perioperative management plan. Furthermore, the utilization of point-of-care gastric ultrasound should be considered, especially in symptomatic patients.
So much is still unknown, and data production is still in its infancy, so recommendation updates can be expected. Most importantly, surgeons, anesthesiologists and primary care physicians must be carefully watchful for the risk of delayed gastric emptying and perioperative aspiration when our growing number of patients on GLP-1 agonists require surgery.
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MEMORIAL RESOLUTION FOR GWENDOLYN AGNIS POLES-CORKER, DO
Introduced by: Virginia E. Hall, MD, FACOG, FACP, and Chair of the Foundation of the Pennsylvania Medical Society, on behalf of the Foundation of the Pennsylvania Medical Society and the Dauphin County Medical Society
By VIRGINIA E. HALL, MD, FACOG, FACP, AND
THE FOUNDATION OF THE PENNSYLVANIA MEDICAL SOCIETY
On April 8, 2025, the DCMS family lost truly one of its most outstanding members, past DCMS President Dr. Gwendolyn Poles-Corker. I have never met anyone more dedicated to medicine and the care of those less fortunate. She epitomized the doctor-patient relationship. As I moved from specialty leadership to our county medical society, her fire as a member of our board motivated me to be a better advocate for our patients. She will be missed. The resolution below is our way to keep her fire burning.
Joseph F. Answine, MD, FASA
WHEREAS, Gwendolyn Agnis Poles-Corker, DO, of Harrisburg, Pennsylvania, born on October 6, 1953 and departed life on April 8, 2025 at the age of 71, leaving behind a great legacy of dedication and service; and
WHEREAS, Dr. Poles, having sickle cell disease and enduring years of personal treatments and hospitalizations never wavered and lived out her life with excellence, grace and grit; and
WHEREAS, Dr. Poles’ academic journey began with graduation from Franklin & Marshall College followed by a Doctor of Osteopathic Medicine from Philadelphia College of Osteopathic Medicine and completion of Internal Medicine Residency at Bryn Mawr Hospital; and
WHEREAS, Dr. Poles was the devoted wife of the late Kenneth Corker. Together they relocated to Harrisburg in 1990 where her Dr. Poles legacy of service took root and flourished; and
WHEREAS, Dr. Poles served as Medical Director of Pinnacle Health System’s Kline Health Center and as a faculty member of its Internal Residency Program. She also held the position of Clinical Assistant Professor of Medicine at both Penn State College of Medicine and Drexel University College of Medicine, earning prestigious honors such as the Dean’s Special Award for Excellence in Clinical Teaching and the Golden Apple Award; and
WHEREAS , Dr. Poles’ leadership and vision reached beyond the exam room. As Medical Director for Pennsylvania’s Office of Medical Assistances in the Department of Public Welfare, she helped to shape state healthcare policy, leading initiatives addressing domestic violence, childhood obesity, and tobacco cessation among pregnant women; and
WHEREAS, Dr. Poles was a 35-year member of the Pennsylvania Medical Society, serving as delegate to the House of Delegates and as a member of the Workforce and Cultural Competency and Medical Diversity task force. In addition, Dr. Poles-Corker also served as Vice President of the Dauphin County Medical Society; and
WHEREAS, Dr. Poles was a dedicated trustee for the Foundation of the Pennsylvania Medical Society. During her service between 2019 and 2023 she served as a champion for the wellness of her physician colleagues and the provision of scholarships for future physicians; and
WHEREAS, Dr. Poles served as a board member of South Central Pennsylvania Sickle Cell Council and was a passionate advocate for patients who has sickle cell disease. Speaking truth to power for patients regarding the stigma sickle cell patients often faced in medical settings, she passionately advocated for the dignity, care and voices of those living with chronic disease; and
WHEREAS, Dr. Poles was deeply devoted to community health education, especially with minority, underserved, and faith-based communities. She was a proud member of the Pennsylvania Osteopathic Association, Christian Community Health fellowship and the Christian Medical and Dental Society. Her commitment to integrating faith and medicine made her a powerful voice in both healthcare and ministry; and
WHEREAS, Dr. Poles found her spiritual home at Zion Assembly Church, Brethren in Christ Church and Christian Fellowship Church of Harrisburg, where her faith fueled her mission of service, healing and advocacy; and
WHEREAS, Dr. Poles-Corker is survived by her brothers, Earl Poles, Philip Poles, and Arlington Morgan; her stepdaughter, Dedre Corker Young; step-granddaughter, Neshiya Harrell-Boynton and a host of nieces and nephews, extended family, godchildren, church family, colleagues, mentees and friends and family whose lives were transformed by her care, counsel and character; therefore, be it
RESOLVED, that the House of Delegates of the Pennsylvania Medical Society observes a moment of silence, recognizing our appreciation for Dr. Gwendolyn Poles-Corker’s many years of service to her community, the medical profession, her Church, and her community; and be it further
RESOLVED, that this memorial resolution be recorded in the minutes of the 2025 House of Delegates and a copy sent to Dr. Gwendolyn Poles-Corker’s family.
SO, YOU ARE BEING SUED!
By JOSEPH F. ANSWINE, MD, FASA
For a physician, a medical malpractice lawsuit is like that monster in your closet. The thing that keeps you up at night. Just starting my career, a wise old doctor asked if I was ever a defendant in a medical malpractice case. I proudly said “no.” His response was quick and eye-opening. “You obviously haven’t practiced long enough.” The point being that it is near inevitable that a busy physician will eventually be sued. Obviously, chances vary by specialty and patient population. However, even a perfect doctor, found only in the world of unicorns and rainbows, will have bad outcomes.
But bad outcomes are not enough to generate a lawsuit. There must be the preponderance of the evidence consistent with a deviation from the “standard of care.” True, sort of.
I have been an expert witness for the defense in a few dozen medical malpractice cases. Why only the defense? Because if it gets to me, I feel that there is reasonable doubt that negligence occurred. If negligence was obvious, a monetary settlement would have been requested and a check sent. If there is doubt, in my opinion, the doctor, mid-level, and hospital are innocent.
As opposed to a scientific search for truth where a hypothesis is made and a study is performed leading to an outcome which determines the validity of the hypothesis, a lawyer has a bad outcome and creates a story to explain that outcome. The plaintiff’s attorney will hire a member of your peers
to provide expert testimony describing your deviation from the “standard of care.” Many of these opinions have been some of the best pieces of medical fiction I have ever read, which is another reason I am not a plaintiff’s expert.
Here is what I recommend to do and not to do if sued.
If a bad outcome occurs, talk to the patient, or if there is a death, the family. A lack of communication has lead many patients and families to seek legal counsel. State that you are sorry as any human being would be for that bad outcome, but avoid describing anyone’s actions as a mistake.
Stay out of the chart unless your presence within the chart or the note you plan to write will improve the patient’s care and/ or outcome. If you do write a note, within the note itself, state that it is after-the-fact with the current time and date and why the note must be written so there is no possibility that it can be construed that the intent of the note was to deceive the reader. Remember that within an EMR, every login and page viewed are recorded. The urge is to rummage through the records and try to explain your actions further. I don’t think doing it ever helps the provider, facility or the patient.
After a lawsuit has been filed against you, ask your lawyer to provide you with the records rather than you going into the EMR or hardcopy chart and pulling the data yourself.
Once you receive the records, review them to refresh your memory since two years or so may have elapsed since the event occurred.
Do your best not to talk about the case with colleagues unless at the request or in the presence of your lawyer. Assume every face-to-face conversation, phone call, email, or text is discoverable. I have seen pages of phone texts with pretty damning statements which I assume the writer thought would never be read by anyone other than the intended recipient.
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There will be a list of complaints directed at you as a defendant. Your integrity, at least in your opinion, will be under attack. Nobody wants to hear or read that they are bad at what they do. Stress, and a strain on your wellness, will inevitably occur. Seek counseling as needed to assure your wellbeing. This process will take years so it is not a short-term experience.
search for a misstep or a sign of weakness to attack. I know this sounds terrible, and I am not saying they are terrible people, but they have a job to do.
The attorney asking the questions may initially attempt to have you place blame on other defendants such as other physicians, nurses or the hospital, purposely “giving
Avoid getting angry because that is when answers are based on emotion and not on fact. Remember, you were not negligent, so a clear, truthful answer will best portray your innocence of negligence. State facts, not opinions.
A significant period of time will go by, but eventually you will be deposed. During the deposition, in the presence of your lawyer and the lawyers of other defendants, one of the plaintiff’s attorneys will ask you questions about the case. It will be hours of questioning, starting with your background then to a journey into just about every nook and cranny of the records focusing on your involvement as well as the involvement of other defendants. Your attorney will want to do practice depositions as you did before your oral board examination. It’s incredibly helpful. Insist on it if not offered.
Your deposition is a legal record and it could be your only chance to state your case prior to a decision being made. Most cases never make it to a court room. Either they are dropped or a settlement is made. So take it very seriously.
There will be frequent interruptions, objections, and other legal discussions which could confuse you. Do not hesitate to ask to have the question repeated or clarified. Plus, it gives you time to breathe and think.
Regardless of the small talk, the person asking the questions is not your friend. You stand between that lawyer and a paycheck. The plaintiff’s attorneys are spending money to proceed with this case and few if any are there out of pure altruism. Their website boasts about the money obtained from malpractice cases. There is a constant
you hope” that his/her wrath will not be directed toward you. Your time will come, sadly. So, stay in your lane. For example, if an anesthesiologist is asked about the surgeon’s care, the anesthesiologist should say, “I am a defendant, not an expert in this case. And, I am an anesthesiologist not a surgeon, therefore, I choose not to render an opinion about the surgeon’s care.” If the attorney references an opinion about you rendered by another defendant, you can defend your actions but do not buy into the “he said, she said” that plaintiff’s counsel hopes will occur which, I promise you, will be used against both of you. My experience has shown that throwing another defendant under the bus to hopefully improve your chances of being found innocent or being removed from the case will backfire. It just makes you look guilty.
Take your time and ponder the question asked. It is not a speed test. Avoid getting angry because that is when answers are based on emotion and not on fact. Remember, you were not negligent, so a clear, truthful answer will best portray your innocence of negligence. State facts, not opinions. Again, you are not a paid expert, so your opinion is not of value to you or the case.
Avoid falling into the trap as to what is “standard of care.” There are many definitions of “standard of care.” Plaintiff’s lawyers love to discuss what is the “standard of care.” One reasonable definition would be “the level at which an ordinary, prudent
professional with the same training and experience in good standing in a same or similar community would practice under the same or similar circumstances.” However, a layperson such as a juror may assume that it is a level or type of care that if deviated from in any way, would be considered unacceptable. Rather, state that what you did was a common and acceptable way to practice based on the patient and situation.
Avoid quoting literature as a “gospel” for your practice. Rather, state that you use many texts, applications (apps), experiences and papers to guide your practice, and your practice changes based on a change in the preponderance of the current evidence. If you describe a single text, app or paper as your guide, then anything within that piece of literature that supports the opinions of the plaintiffs will be used against you. If you make it to court, congratulations. The odds are in your favor. Your deposition, the depositions of others, and the report from your expert appropriately supported your innocence. Prior to your appearance, review all the depositions, expert reports from both sides, and the records as you did for your deposition in order to be maximally prepared. Wear your best suit to show respect for the process. Speak calmly and direct your responses to the jury. Again, state facts, not opinions. Your expert will state opinions.
Most importantly, be kind and respectful to everyone including the plaintiff’s attorneys. They don’t expect it, so it takes them off their game. Plus, it will keep you focused, and your answers factual and exactly as you want them to be conveyed in the record or to the jury.
Being sued is tough to endure, but you are used to tough situations. You are a physician.
Reprinted from Anesthesiology News, March 2025
NEVER EAT AN OYSTER IN A MONTH WITHOUT AN “R”
JIM G. AND THE OUTER BANKS
By J. ERIC GREENSMITH, MD, PhD
“Eric, it’s Bill – Bill L. – Jim G’s wife just called me and she’s beside herself. She’s at some tiny hospital in rural North Carolina and Jim is desperately ill. She doesn’t know if he should be moved to another facility or if he’s too sick to move. I need you to get down there and look over the situation.”
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“I’ll get right on it,” was my answer. What else can you say? Not just because Bill’s my boss and I’d never heard him sound worried in all the time I knew him, but because Jim G was a colleague from the Navy. He was senior to me, both in years and rank, and he had been a kind face and a helping hand when I was starting at Navy – my first job after residency – and that means a lot. He had stayed on for a few years after I started – working both the OR and the ICU at the Naval Hospital and then, during the year when I was off at my Critical Care Fellowship, he left to join a private practice anesthesia group in Maryland. Now Jim was in trouble. His wife was alone and worried. In the extended fraternity of physicians and brother military officers, there really is no other answer other than, “I’ll be there.”
This premise was to be tested further that night. The reason I was so awake at 3:00 a.m. was – I had just gone to bed. I had been out “moonlighting” at the trauma hospital in Norfolk from 7 p.m. to 2 a.m. and I had just gotten home. I hadn’t slept for 22 hours prior. I was in no shape to drive to rural North Carolina so I called my best friend, Kim A, a pulmonary/critical care physician from Navy, and quickly explained the lay of the land. There wasn’t a second’s hesitation before he said, “Let’s go!”
I picked Kim up at 3:30 and we drove off into the darkness to find our comrade who had fallen on hard times. The sun was just coming up over the Outer Banks of North Carolina as we pulled into the parking lot of the Albemarle Hospital. It was a small, modern, three-story structure. We walked in the front door, past the dark and empty reception desk and straight up to the Intensive Care Unit. Sue, Jim’s wife, met us outside the ICU and filled us in on Jim’s situation. The G family had driven from Maryland for a July family vacation at the Outer Banks. At a dinner party the night before, Jim had eaten some raw oysters. Later in the evening Jim had abdominal pains and his wife had taken him to the “Urgent Care” facility at the place where the bridge from the mainland comes onto the barrier islands.
This little Urgent Care facility is just the place to go if you have poison ivy or a fishhook caught in your toe or a bladder infection when you are ostensibly having fun on vacation. This is not a hospital, not an intensive care unit, not even a place where you can stay overnight. When the intake nurse took Jim’s blood pressure it was very low – so low she re-checked it immediately. Despite the fact that Jim was talking and had walked into the Urgent Care facility (albeit with a shaky gait), the systolic pressure was around 50 – less than half of normal. The Urgent Care physician inserted an intravenous line and proceeded to give Jim over 7 quarts of intravenous fluids – yes, almost two gallons of IV fluids – and now the systolic blood pressure was topping out at 70 – still critically low by any criteria.
An ambulance was summoned and Jim was transported over the causeway to the mainland and up the highway to the very first hospital they encountered. Albemarle Hospital is a small, quaint facility that is subject to the extremes of patient census that plague any vacation community – tens of thousands throng to the Outer Banks in the summer, but very few live in the area year-round – especially back in the early 1990s.
There were just two patients in the ICU. An elderly white-haired gentleman was sitting up in a bedside chair eating his breakfast and reading his newspaper. Except for the EKG wires attached to his chest, he could have been any retiree eating a leisurely morning meal.
Around the corner was Jim’s room. As we approached the door, a disheveled man in a rumpled, long white coat came out of the room. His hair was standing up at the back of his head and I blinked when I saw the bristles of a toothbrush sticking out of the left breast pocket of his long white coat – where one would normally find a pen. His white coat was embroidered “Dr. Rxxxxxxx, Nephrology.”
We stopped him, introduced ourselves and asked about our friend. He blinked at us, then seemed to snap to resolution and said,
“In here!” We stepped through the doorway and almost tripped over a folding cot that was set up next to the patient’s bed. Now it all came together. This guy, this rumpled nephrologist with the toothbrush in his lab coat, went from bumbling hick-town doctor to hero in my mind. There was no intensive care specialist in this hospital. This guy stepped up. He had just spent the night in Jim’s room, checking on him, monitoring him and cat-napping on the cot in between. I saw the guy with new eyes and a newfound admiration. He may or may not be conversant on the latest sepsis medical literature, but he had stepped into the breach and he put the patient’s care ahead of his comfort.
Right away our eyes were drawn up to Jim. He sat bolt-upright in his hospital bed. He wore a 100% non-rebreather face mask to give him high oxygen levels. His face was beet red. He breathed hard and deep and fast, like the sound a runner makes as he rounds the last curve of the track during the 440-yard dash. “Choo, choo, choo, choo, choo......” The effort to breath was palpable. Jim glanced at us – I think he recognized us – and went right back to breathing – purposeful breathing. The kind of breathing where you don’t do or think of anything else but breathe, breathe, breathe, breathe. The breathing that you must do to stay alive – life is that tenuous........ Only Jim’s young age and superb physical condition had enabled him to make it this far. He had a severe metabolic acidosis and he was breathing hard and fast to blow off carbon dioxide to balance the acids in his blood stream.
Jim was septic. Sepsis is the name given to the change in the body’s physiology when it responds to a life-threatening danger. In Jim’s case, he was infected with an organism that is common along the Atlantic seaboard. Vibrio vulnificus is a comma-shaped bacterium that is closely related to the bacteria that causes Cholera. Vibrio cholera is a common organism that can suddenly change from docile to deadly for reasons that are ambiguous. The result is a gastrointestinal incubator for millions of new cholera organisms, each making a
Jim was septic. Sepsis is the name given to the change in the body’s physiology when it responds to a lifethreatening danger. In Jim’s case, he was infected with an organism that is common along the Atlantic seaboard.
toxin that paralyzes the body’s attempt to mount an immune response. After millions of new organisms are spawned, they are released in an explosive watery diarrhea that dehydrates the host and guarantees new victims if any food or water source becomes contaminated. Vibrio cholera rivals Tuberculosis and AIDS as a worldwide cause of death.
In Jim’s case, the culprit wasn’t Vibrio cholera, but its cousin, the ubiquitous Vibrio vulnificus. This organism is found mixed among the flotsam and jetsam that washes up upon the beach. The organism is almost always present in beach sand, but warm water temperature enhances the growth such that titers are higher in the summer months. Mollusks such as clams and oysters gain their food source by siphoning in gallons of seawater and straining it for any edible materials. As they siphon in bacteria with the seawater, they act to concentrate that bacteria to a dangerous level. While the Vibrio do not seem to harm the shellfish, they can be lethal to a person who eats an oyster loaded with concentrated Vibrio. Thus arises the common admonition, “Never eat an oyster in a month without an R.” Since the bloom of Vibrio peaks in the summer, months between April and September (i.e. May, June, July and August – all months without an R) are not considered optimal for raw oyster consumption.
Kim and I knew a fair amount about Vibrio – especially vulnificus. Just the week prior to Jim’s mishap, we had cared for a retired Navy Captain in our ICU. He was elderly (over 70) and somewhat immunocompromised due to a prior leukemia (which seemed to have been treated successfully). He had a minor scratch on his leg that he received while frolicking with his grandchildren in the breakers off Virginia Beach. A few days after this minor scratch he became suddenly
and violently ill. He had a high fever, intractable diarrhea and very low blood pressure. He came to our medical center and was triaged up to our ICU where even powerful medications like norepinephrine seemed incapable of maintaining his blood pressure in the normal range. The antibiotics which are generally effective in most cases of sepsis were impotent. Hour by hour it seemed more likely that we were going to lose this old sailor. Then, the Infectious Disease specialist cultured the patient’s left ankle, drawing fluid from the hot, swollen, red joint. The fluid was swimming with red, comma-shaped bacteria. VIBRIO! A hasty change in antibiotics was made, to a tetracycline – a drug rarely used in ICU practice; more likely to be used to treat your teen-aged daughter’s acne or as therapy for some randy young sailor’s shore-leave indiscretion. Even though this was the right antibiotic, it was too late to reverse this old guy’s course by itself. It didn’t look as though we’d have enough time for the drug to work before our patient succumbed to the infection. In a desperate move to save the Captain’s life, he was taken to the operating room and his left leg was amputated below the knee, taking off the septic ankle joint and with it the nidus of the Vibrio. I wasn’t in the OR but I was told that within minutes after the leg was cut off, the blood pressure stabilized, and the patient was off all blood pressure support medications by the time the dressings were applied.
Armed with our recent encounter with Vibrio and knowing that Jim had eaten raw oysters just 36 hours earlier, we went over the antibiotics with his doctor. Jim was on the standard “big gun” agents used for sepsis in the ICU. Unfortunately, Vibrio is impervious to most of these medications. We told the nephrologist about Vibrio and its vulnerability to the antibiotic doxycycline and within 15 minutes Jim had his first dose.
Jim improved within hours. In a few days he left the hospital, but not unscathed. The prolonged period of low blood pressure had severely compromised his kidneys and he required hemodialysis for a period of six months when he got back home. But he did get home, he did recover and he is hale and hearty today. I am quite certain he will never again “...eat an oyster in a month without an ‘R’.”
CASE REPORT: POST-OPERATIVE PAIN: WHAT IS THE CAUSE?
By JOSEPH F. ANSWINE, MD, FASA
55-year-old female with right-sided buttock/side pain following open abdominal surgery (bilateral oophorectomy, appendectomy, lysis of adhesions)
FROM THE PATIENT’S HPI:
The patient reports she had right-sided pain in Oct. 2023 while working. She was using a sander while sanding floors and felt the pain then. She was doing this work for several days. She turned quickly and hard from the waist and she started to have sharp pain, located very low on the right side in the buttock region, about 4.5 inches from the tailbone on the right side. She denies any shooting pain down her leg. She initially thought it was a bladder or kidney infection and was seen in urgent care. She was also seen by the primary care physician.
In March 2024, the patient underwent exploratory laparotomy via vertical incision, removal of ovaries, remaining tube, cyst, appendix, and bowel resection. She was told the appendix and bowel resection were performed due to adhesions.
The patient reports she now has pain with bending and turning that is very painful, all across the lower part of her back and across the tailbone. The pain is not as bad on the left, but it does cross the whole lower back. She was seen by a urologist and was told she might have sciatic problems.
OPINION BASED ON THE DATA:
The pain or a similar pain was present prior to the surgical procedure. In fact, it was the cause of the workup which lead to the exploratory laparotomy. The event which lead to the appearance of the pain leads one to believe it is of spine or musculoskeletal origin. The dermatomes involved are lower lumbar (L-5) and sacral, and the location is consistent with the findings of an MRI demonstrating narrowing at those levels. That being said, another etiology must be considered, and that is pain secondary to the surgical procedure itself. Below is a description of a possible etiology if that were true:
The pain described is not commonly associated with the incision or the intraabdominal manipulation. However, nerve injury is not an uncommon occurrence during gynecological surgery due to duration, patient positioning (lithotomy as well as positioning for robotic surgery) as well as retraction of tissues to allow for access to the site of the pathology within the pelvis.
Unless the peripheral nerve is transected (cut in half), stretch or compression are the most common causes of nerve injury; therefore, recovery is possible and probable. It can be assumed that the symptoms, whether pain, weakness or numbness, will resolve in time. The time it takes, however, could be weeks to months. Until that time, medications such as gabapentin, NSAIDs, acetaminophen and anti-depressants can be used to lessen the symptoms. Muscle injury by itself or in combination with nerve injury is also possible. This too will resolve in time. Far less likely would be an intra-abdominal process related to the surgery or the disease process for which the surgery was indicated.
Common nerves involved are the femoral nerve leading to weakness of hip flexion and adduction and knee extension, ilioinguinal and iliohypogastric nerves leading to burning pain in the perineal area and thigh, genitofemoral nerve leading to pain in the perineum and femoral triangle, lateral cutaneous nerve leading to pain and numbness over the posterio-lateral thigh, obturator nerve leading to numbness of the anterior thigh and weakness of the hip adductors, common perineal nerve leading to numbness below the knee and foot drop, pudendal nerve leading to gluteal and perineal pain, and sciatic nerve leading to pain in the buttocks which can radiate down the posterior thigh and into the calf. It is difficult to determine who will develop such nerve and musculoskeletal injury, and symptoms can occur even with the best positioning and padding.
Whatever the origin, workup should include a physical examination looking for the exact site of the pain and any associated numbness and weakness, and the specific locations of all the abnormalities. Also, further radiologic imaging of the involved area may be able to identify nerve, muscle, soft tissue or bone abnormalities (see recommendation below). Nerve conduction studies as well as a neurology consultation may be indicated if the etiology is still unknown.
OVERALL ANALYSIS:
Based on the patient’s symptoms, presentation, time of presentation, and radiological findings, the likely etiology is
nerve root compression at the L4-L5 and L5-S1 levels. Compression injury of the sciatic nerve during surgery is a less likely cause of the pain.
If the pain is related to the spine pathology, it will only resolve with orthopedic intervention including physical therapy, antiinflammatory medications either systemic or by regional placement such as via an epidural injection, or finally surgical correction.
If it were due to surgical manipulation, which I think is far less likely, one could wait to see if there is slow resolution; however, it could take weeks.
The pain regardless of etiology should not be life-long as long as either it is left to resolve over time, or if this doesn’t occur, orthopedic surgical intervention is instituted. I feel that even if a “watch and wait” plan is initially undertaken, orthopedic surgical consultation should be a next step. I would allow them to make recommendations for any further studies or consults.
Pain medications as described in the 5th paragraph could be continued or added as well as physical therapy as outlined by the orthopedic consult.
Also, regardless of the etiology, undergoing the surgical procedure was likely necessary due to the findings of the gynecological workup, so I do not feel that the surgical intervention was unnecessary.
REFERENCES:
Kuponiyi et al. Injuries associated with Gynecological Surgery. The Obstetrician and Gynecologist. 2014; 16:29-36.
Flynn et al. Sensory Nerve Injury after Uterosacral Ligament Suspension. Am J Obstet Gynecol. 2006; Dec; 195 (6): 1869-1872.
TWO DOCTORS NAMED WILLIAM JONES HELPED LEAD HARRISBURG’S BLACK COMMUNITY IN THE OLD 8TH WARD
By JOE MCCLURE, PENNLIVE.COM/THE PATRIOT-NEWS
Two Harrisburg men shared a name, William Jones. They both served as doctors. And both lived in the same part of town, the largely Black and immigrant Old 8th Ward. It was wiped out more than a century ago to expand the Capitol Complex.
One was a jack of all trades who was a major figure in the Underground Railroad. The other was a pioneering Black doctor who promoted the City Beautiful movement among African Americans.
Today, a monument at Fourth and Walnut streets commemorates the Old 8th Ward. It depicts four figures tied to the neighborhood — William Howard Day, T. Morris Chester, Frances Ellen Watkins Harper and Jacob T. Compton — and lists the names of 100 others who lived in or had connections to it.
The name William Jones is listed on the monument. Twice.
Dr. William H. Jones was a prominent Black doctor in Harrisburg who promoted the City Beautiful movement among African Americans in the early 20th century. harrisburghistorical.org
DR. WILLIAM M. JONES
Newspaper accounts about Dr. William M. Jones say he was born around 1791 in Luzerne County. But local historian George F. Nagle notes in “The Year of Jubilee: Men of God” that in censuses after the Civil War, Jones listed his birthplace as Maryland.
He arrived in Harrisburg around 1823 and worked for a druggist for a number of years. Although he didn’t have formal education, his knowledge of herbal remedies and folk medicine earned him the nickname of “Doctor,” even among white residents, Nagle writes.
Jones treated patients in surrounding counties such as Cumberland, Lebanon and York.
He also worked in a foundry as a molder and was an early member of Wesley Union AME Zion Church, which was located in the Old 8th Ward at the time.
But Jones’ most notable work was as a leader of the Underground Railroad in Harrisburg.
In fact, he used another one of his jobs, as a rag merchant, to transport freedom seekers from Harrisburg to places farther north.
“For many years Mr. Jones was one of the most efficient men connected with the ‘Underground Railroad’ in this locality,” an 1887 Harrisburg Telegraph article said. “He had acquired a thorough knowledge of the routes leading northward, and was always prepared to furnish competent guides. His large covered wagon, drawn by two horses and driven by himself in the capacity of rag merchant, was frequently to be met on the road leading towards Wilkes-Barre or Pottsville.”
He hid freedom seekers in his home and testified in fugitive slave cases.
In one case, two years before the Civil War began, Harrisburg resident Daniel Dangerfield was accused in April 1859 of escaping from enslavement in Virginia in 1854. He was arrested in Harrisburg and taken to Philadelphia for a hearing.
Jones’ testimony in support of Dangerfield — that the alleged fugitive had helped him dig the cellar of his house in 1853, the year before he was supposed to have escaped — played a significant part in Dangerfield’s exoneration, Nagle writes. Afterward, abolitionists arranged for Dangerfield to move to Canada.
A historical marker at Aldie Mill Historic Park in Aldie, Virginia, about the case calls Jones “the chief conductor of the Underground Railroad in Harrisburg.”
Jones died Aug. 1, 1881.
“As a citizen, he had the respect of all good men,” the Telegraph said, “and lived an upright life.”
DR. WILLIAM H. JONES
Six years after Jones’ death, Dr. William H. Jones came to Harrisburg.
Born in Snow Hill, Maryland, in 1860, this Jones received a medical degree from Howard University and did postgraduate work at New York Polyclinic Institute.
A Republican with an independent streak, Jones became involved in politics early on. Joining the 1891 coroner’s race, he was the first Black Republican to run for a countywide office in Dauphin County. He lost, which he and scoffing Democrats attributed to white Republicans refusing to vote for a Black man.
In 1902, the school board selected Jones to fill a vacancy. When he opposed the Republican Party’s endorsed candidates, his chances of seeking a full term sank, and he decided not to run in 1904.
“Dr. Jones was knifed by the Machine …,” the Harrisburg Star-Independent said.
Meanwhile, Jones was promoting the City Beautiful movement in the Old 8th Ward. The early 1900s campaign achieved vast improvements in sanitation and parks, among other things.
These were important to Jones, especially as a doctor. As far back as 1891 in a letter to the Telegraph, Jones was calling for a “summer resort” to be established near the city “where children … who are unable to visit foreign places, can indulge in innocent games, breathe fresh air, romp and play, read and talk, at a moderate expense; where respectable people can be granted immunity from disorderly characters; with good drinking water, and pavilions with lunch counters — all at a reasonable charge.”
In January 1902, days before voters would decide on whether to approve a bond issue to fund the improvements, Jones led a meeting at Wesley Union AME Zion Church in which City Beautiful leaders such as J. Horace McFarland made the case for the bond.
Continued on next page
These photos from the Harrisburg Telegraph show a fountain and entrance to the 12th Street Playground in Harrisburg that were dedicated in Dr. William H. Jones’ memory in November 1915, 10 years after his death. The fountain and entrance are no longer standing at the playground, which is known as Sunshine Park. PennLive file
“While representation was poor and many voices of the African American community were left out of the (City Beautiful) decision-making process,” Kyle Shively and Emmy Varner write on Messiah University’s new Harrisburg Historical website, “prominent leaders like Jones led the community to support the movement.”
The bond issue passed, and Shively and Varner wrote that the 1st Precinct of the Old 8th Ward had the highest percentage of voters who cast ballots in favor of it: 96%.
Also in 1902, the Dauphin County Medical Society unanimously elected Jones as president, making him the first Black person to lead the organization.
Jones’ life was cut short at age 44. In 1905, he slipped and fell on the icy state Capitol steps. Pneumonia set in, and he died two weeks later on Jan. 19.
The Capitol, which occasioned his death, would expand, and in less than a decade, his neighborhood, the Old 8th Ward, would
begin to disappear.
In the years after Jones’ death, Black residents honored him. A gold medal named for him was awarded to African American high school students for academic achievements.
And a fountain and an entrance to the 12th Street Playground at Forster Street, also known as Sunshine Park or Clarence C. Morrison Park, were dedicated in November 1915. Today, neither remains.
“His fidelity to and interest in his profession, his clean personal life; his active interest in civic affairs and his concern for the human race,” the Harrisburg Academy of Medicine, of which Jones was a founder, said in a resolution marking his death, “were his qualities worthy of emulation by us all.”
The Old 8th Ward is gone, but those who lived there are remembered.
One name. Two men. And a multitude of contributions to Harrisburg’s life and health.
A monument commemorating the Old 8th Ward was unveiled in 2020 at Fourth and Walnut streets in Harrisburg. The monument features four figures who lived in or had ties to the neighborhood: T. Morris Chester, Jacob T. Compton, William Howard Day and Frances Ellen Watkins Harper. (Dan Gleiter, PennLive, 2020)
A view of Short Street in the Old 8th Ward in Harrisburg in the early 1900s. The Old 8th Ward was a predominantly Black and immigrant Harrisburg neighborhood that was wiped out more than a century ago to expand the state Capitol Complex. (Pennsylvania State Archives)
OLD 8TH WARD PLAY
If you’re interested in the Old 8th Ward, you can see a play that’s tied to the neighborhood, as well as the historic Lincoln Cemetery in Susquehanna Township.
Sankofa African American Theatre Company and Gamut Theatre Group are presenting the play “Voices of the Eighth, Part III: Hallowed Ground.”
The work, written and directed by local playwright Sharia Benn, is being performed Fridays, Saturdays and Sundays through March 2 at Gamut Theatre, 15 N. Fourth St., Harrisburg.
For information, go to gamuttheatre.org/vote. Originally published February 13, 2025 and reprinted with permission from the editor of pennlive.com.
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Food will always be one of the singular ingredients to bring family and friends together; a restful break from our work and other distractions. Elevated dining doesn't have to only be enjoyed at dinnertime. For an amazing breakfast or brunch in a relaxing atmosphere, try Coda Rouge in uptown Harrisburg, newly opened this past summer.
Located a few blocks west of the Farm Show Building, it was named for the Redtail jets flown by the Tuskegee Airmen in WWII, one of whom was the grandfather of owner Jameson Christopher. Formerly home to a private social club, the attractive renovated building features a small dining area with colorful art and soft jazz/blues. A private cigar lounge and upstairs bar are currently available for pop-up dinners and private parties, with plans for dinner seating over the next year.
Working under Wolfgang Puck in California for many years, Chef Sachiko Baez uses an intercontinental approach to her meal prep. Three large Spicy Empanadas were stuffed with eggs, chorizo, caramelized onions and potato, served with a chili aioli. The SBLTO had grilled salmon, B/L/T, crispy shallots and a lemon herb remoulade on thick Texas toast. A lofty Morning Burger featured Angus beef topped with eggs, Vermont cheddar, grilled onions, roasted tomato and bacon with garlic aioli. The house specialty, a Japanese-inspired Omu*Rice Omelet, combined umami-laden NY Strip and soy sauce with sweet English peas and tomato jam.
Save room for desserts from Sweet Tooth Bakery (created by
CODA ROUGE
Jameson’s mom, Pastry Chef Lisa Christopher) ... or make it your meal if you prefer sweet over savory brunch fare. Warm plates arrive with two pieces of puffy French toast stuffed with blueberry cheesecake or caramel apple pie filling. Coffee cakes were topped with pumpkin spice cream cheese or cinnamon streusel. The Triple Berry Bar blended black/blue/strawberries, banana and agave nectar in a flaky quinoa crust. Open each morning except for Wednesdays, Coda Rouge is a memorable dining experience on mornings when rushing to the office is the furthest thing on your mind.
CODA ROUGE
12013 N. 6th Street, Harrisburg, PA 717-226-3884 thecontinentalhbg.com
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