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Neurosciences Putting Pieces
â€˘ Jeanes Hospital Leads the Way in Stroke Care â€˘ When a Pain in the Neck Requires Surgery
Neuroscience health matters
euroscience isn’t as much a continuum of care as it is a matrix of specialties. Treatment of neurological conditions calls on the expertise of neurologists, neurosurgeons, pain specialists, physiatrists, and even orthopaedic spine surgeons and primary care practitioners. Having all of those specialists concentrated on one campus helps to create a cohesive team with referral relationships, all singularly focused on each patient’s care. “Creating a neurosciences center on the Jeanes Hospital campus — in equal parts literal and virtual — is another example of how we’re transcending the barriers between specialties,” explained Linda J. Grass, President and CEO at
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Jeanes Hospital. “The result is a patient-focused approach to care that includes all of the pertinent specialties, as well as ancillary services such as diagnostic imaging and rehab.” Coordinated Care Patients with neck or back pain, for example, can get an initial assessment of their condition by a neurosurgeon or an orthopaedic spine specialist. If the condition, such as a herniated disk or a spinal tumor, requires immediate surgery, patients can continue with that physician for expedited treatment. If their problem doesn’t require surgery, at least not initially, patients can be referred to a pain specialist and
“Creating a neurosciences center on the Jeanes Hospital campus — in equal parts literal and virtual — is another example of how we’re transcending the barriers between specialties.” —Linda J. Grass, President and CEO
a physical therapist to manage the condition. “Even if an MRI of your neck shows a bulging disk, we typically recommend trying conservative measures first, such as physical therapy with traction, before resorting to surgery,” said Michael Weaver, MD, Chairman of the Department of Neurosurgery at Temple University School of Medicine. So Dr. Weaver’s interdisciplinary approach can be accommodated with substantial convenience to patients on the Jeanes Hospital campus, the Temple University Hospital campus, or both. Specialized Solutions With the resources at hand, and surgeons from Temple’s faculty as well as private practice, access to the latest surgical techniques is a critical part of the matrix. Minimally invasive cervical spine fusion is a good example. “This kind of surgery, which requires a microscope or an endoscope (a long, thin, flexible lighted tube) to perform, decreases blood loss, post-operative pain, and recovery time for patients,” said Bong-Soo Kim, MD, Director of the Minimally Invasive and Complex Spine Fellowship Program at Temple University School of Medicine. Dr. Kim, who trained under Richard G. Fessler, MD, PhD, a world-renowned minimally invasive neurosurgeon, offers novel, minimally invasive ways of operating on the spine. Pain management is part of the specialty-care matrix, too. Two practices on the Jeanes Hospital campus
Linda J. Grass President and CEO, Jeanes Hospital
specialize in advanced management of chronic pain. They are trained to perform advanced techniques, such as a rhizotomy, in which pain medication is injected into a damaged nerve under X-ray guidance for safety and precision. This procedure anesthetizes a painful spinal joint and provides long-term relief. These pain specialists dovetail their services with neurology, physical therapy, physiatry (also known as physical medicine), and other specialties. Similarly, Jeanes Hospital’s heralded stroke care (see page 4) is all the more valuable to its patients because neurologists are part of a larger neurosciences team. “Patients who are recovering from a stroke, or who need spine surgery, rehab, or pain management, shouldn’t
Michael Weaver, MD Chairman, Department of Neurosurgery, Temple University School of Medicine
have to navigate a confusing maze to get the care they need,” said Grass. “Neurosciences at Jeanes Hospital accommodates these needs and more in an integrated approach that works in every patient’s favor.”
Learn More For more information about neurosciences at Jeanes Hospital, including neurology, neurosurgery, physiatry, pain management, and orthopaedic spine surgery, call 215-728-CARE.
Bong-Soo Kim, MD Director, Minimally Invasive and Complex Spine Fellowship Program,Temple University School of Medicine
Stroke health matters
Jeanes Hospital Leads the Way in Stroke Care
very 40 seconds, someone in the United States has a stroke, according to the American Heart Association. A stroke is a “brain attack” that occurs when a blood vessel that carries oxygen and nutrients to the brain gets blocked by a clot or bursts. The faster you recognize the signs and symptoms of stroke (slurred speech, facial droop, arm or leg weakness, dizziness, and word difficulty), call 911, and get transported by ambulance to a hospital, the more likely you are to recover.
Marcia Halpern, MD Medical Director, Stroke Program; and Division Chief, Neurology, Jeanes Hospital
Andrea McCoy, MD Chief Medical Officer, Jeanes Hospital
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What is a Primary Stroke Center? Jeanes Hospital is accredited by The Joint Commission as a Primary Stroke Center. This designation means the hospital has demonstrated its commitment to the highest level of care for its stroke patients. It meets or exceeds performance measures established by the American Stroke Association and the Brain Attack Coalition. Jeanes Hospital also received its third Gold Plus Award from the American Stroke Association, which recognizes the hospital’s success in stroke care. The award shows that Jeanes Hospital has placed extra effort on quality measures and has consistently achieved success in at least five of eight additional measures beyond those required to be a stroke center, explained Andrea McCoy, MD, Jeanes Hospital’s Chief Medical Officer. “Some of these measures include education; evaluating and treating risk factors like high cholesterol; and assuring patients are assessed frequently for changes in their symptoms, such as ability to swallow safely, and are evaluated for appropriate rehabilitation services,” she added. To maintain the Primary Stroke Center accreditation, the stroke team follows a detailed plan for streamlining stroke
treatment. “Patients must be evaluated quickly so that we can determine if they’re a candidate for intervention,” said Marcia Halpern, MD, Medical Director of Jeanes Hospital’s Stroke Program and Division Chief of Neurology. To save precious minutes, blood is drawn in the ambulance. At the hospital, blood work is expedited to the lab for analysis. Brain imaging to confirm the diagnosis and determine the type of stroke and other tests, such as ECG and chest X-ray, are performed within 45 minutes of the order. Within 60 minutes of entering hospital doors, eligible patients receive tPA, a clot-busting drug that can help restore circulation. In comparison, average “door-to-needle time” for tPA is 78 minutes, according to a Circulation study involving more than 1,000 hospitals. “To maintain our accreditation, we have to keep hitting these quality measures,” said Dr. McCoy. After every stroke alert, the stroke team analyzes the results and identifies any opportunities for improvement, measuring themselves against regional and national benchmarks, she explained. “We’ve had some great success stories,” Dr. Halpern said. “Patients who’ve been treated have left the hospital showing no signs they’ve had a stroke.”
Neck Pain health matters
When a Pain in the Neck Requires Surgery
f you’ve never groaned about a pain in your neck before, there’s a good chance you someday will. Neck pain happens to about 85 percent of us during our lifetime. Aging, trauma from an accident or fall, and muscle strain can bring on neck pain. Having a neck pain flare-up doesn’t necessarily warrant a doctor visit if you know why it’s happening, like you started sleeping on a new bed. But if you’re stumped about why your neck hurts, you’ve taken a spill, or you have certain symptoms (neck pain plus weakness or numbness in your arm, trouble walking, or bowel or bladder problems), an orthopaedic surgeon or neurosurgeon should be consulted to make sure it’s nothing serious. Otherwise, there are simple solutions you can try for six to 12 weeks, which help in 90 percent of all cases. “Because neck pain is a common problem, common solutions should be performed first,” said Michael Weaver, MD, a neurosurgeon at Jeanes Hospital and Temple University Hospital, and Chairman of the Department of Neurosurgery at Temple University School of Medicine.
Relief from Your Pain To see any of these physicians at Jeanes Hospital about your neck pain, use our “Find a Doctor” tool at www.jeanes.com.
1. Take a pain reliever. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin, Advil), are the first line of defense for neck pain. “They get at the source of the pain, which is inflammation,” Dr. Weaver said. Take an NSAID as directed and stop doing whatever it was you suspect caused the pain, such as hunching over your computer keyboard. 2. See a physical therapist. A physical therapist can work with you to devise an exercise program that can help strengthen neck muscles, which makes them resistant to everyday wear and tear. “Physical therapy can also help restore blood flow to neck muscles and degenerated disks to help them remodel,” said F. Todd Wetzel, MD, an orthopaedic surgeon at Jeanes Hospital and Temple University Hospital. Surgical Solutions If you still have neck pain after six to 12 weeks, an orthopaedic surgeon or neurosurgeon can determine if surgery is necessary. The latest minimally invasive surgical options for neck pain “use smaller incisions, which means faster recovery time,” explained Bong-Soo Kim, MD, a neurosurgeon who specializes in the technique at Jeanes Hospital and Temple University Hospital. Neck surgery is a last resort, but it is effective. “Ninety to 95 percent of patients see improvement of their pain,” Dr. Weaver said.
Michael Weaver, MD Chairman, Department of Neurosurgery, Temple University School of Medicine
F. Todd Wetzel, MD Orthopaedic Surgeon, Jeanes Hospital and Temple University Hospital
Bong-Soo Kim, MD Neurosurgeon, Jeanes Hospital and Temple University Hospital
Vascular Disease health matters
Leg Pain May Signal
Peripheral Artery Disease
ou’re probably familiar with coronary artery disease. This condition occurs when arteries in the heart become clogged with waxy plaque buildup. But when arteries outside the chest, including those in the neck and brain, abdomen, arms, and legs, become narrower or blocked from plaque buildup, this vascular disease takes a different name—peripheral artery disease, or PAD for short. PAD affects roughly eight million Americans, most commonly in the legs and pelvis. “One of the early symptoms is leg pain that you don’t notice unless you’re walking or running,” said Eric Choi, MD, Chief of Vascular Surgery at Temple University Hospital, and Associate Professor of Surgery at Temple University School of Medicine. “Patients often ignore this sign, thinking it’s muscle cramps or arthritis.” Over time, the arterial blockage can worsen, and the leg and foot pain can become constant, even when you’re just sitting. It can also progress to nonhealing sores on the foot and toes due to lack of blood flow. If left untreated, PAD can cause ulcers or gangrene, requiring a leg amputation. Moreover, “PAD is a warning sign for any vascular problem. So if you have
Eric Choi, MD Chief of Vascular Surgery, Temple University Hospital
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PAD, you have to worry about the heart as well,” said Frank Schmieder, MD, Division Chief of Vascular Surgery at Jeanes Hospital. “If you have PAD, your risk for stroke and heart attack is four to five times greater than the average person’s.” Be Proactive If you think you may have PAD, see your doctor to reduce the risk for further damage. “Your internist can do a full examination and order an arterial duplex, an ultrasound test that can detect arterial blockages in your legs,” Dr. Choi said. In most cases, lifestyle changes, such as regular exercise, smoking cessation, and controlling your blood pressure, cholesterol, and diabetes, can prevent PAD from worsening. In severe situations, surgery to open or replace a damaged artery may be necessary.
Could You Have PAD? To see a physician at Jeanes Hospital about PAD or vascular surgery, use our “Find a Doctor” tool at www.jeanes.com or call 215-728-CARE.
Frank Schmieder, MD, Division Chief of Vascular Surgery, Jeanes Hospital
SUI affects up to
A Patient’s Story health matters
Stress Urinary Incontinence
f you frequently leak a small amount of urine after coughing, laughing, or sneezing, or when physically exerting yourself, you’re far from alone. The condition, known as stress urinary incontinence (SUI), affects up to 35 percent of women. “SUI is a huge qualityof-life issue,” said Carol A. Glowacki, MD, Division Director of Female Pelvic Medicine and Reconstructive Surgery at Jeanes and Temple University Hospitals. Tina Skuzinsky knows firsthand how annoying and potentially embarrassing SUI can be. “Anytime I’d sneeze or lift something or laugh too hard, I wasn’t able to hold it,” said the 67-year-old medical office receptionist. Tina experienced SUI for years, managing the condition by constantly wearing mini pads. In April 2013, however, Tina underwent a sling procedure at Jeanes Hospital to correct the problem. During the 30-minute operation, Dr. Glowacki implanted a small ribbon of surgical mesh around the neck of Tina’s bladder. The support the sling provides can cure SUI in 80 to 90 percent of cases. “With stress incontinence, the goal is at least 50 percent improvement, but a large number of patients are dry,” Dr. Glowacki said. Tina counts herself among them. “Now, I don’t leak at all. It’s wonderful,” she said. Get Relief If you think you may have SUI, which is associated with childbirth and more common after menopause, see your doctor, preferably a gynecologist or urogynecologist. If you’re diagnosed with SUI, a sling is just one option. Your doctor may also suggest: • Pelvic floor exercises. Learning and doing exercises to contract the
Stop Your Suffering To schedule an appointment with a gynecologist or a urologist at Jeanes Hospital, call 215-728-CARE.
muscles of the pelvic floor can reduce and prevent leakage by strengthening the muscles that surround the urinary tract. Pelvic floor exercises help 60 percent of women with stress incontinence. The exercises have other benefits as well, such as improved sexual function. • Botox. The FDA recently approved Botox for adults with overactive bladder, which can cause incontinence. Botox injections can help the bladder relax, increasing its ability to store urine. • Fluid management. Avoiding drinking large amounts at a time can help reduce SUI episodes. • Medication. There’s one medication
approved for use in the United States that works well for some patients, though the side effects may outweigh the benefits, Dr. Glowacki said.
Carol A. Glowacki, MD Division Director, Female Pelvic Medicine and Reconstructive Surgery, Jeanes and Temple University Hospitals
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Jeanes Hospital, the only Quaker-founded acute care hospital in the United States, is part of Temple Health. The hospital provides communities in Northeast Philadelphia, Montgomery County, and Bucks County with advanced medical, surgical, and emergency services. Health Matters is published quarterly by Jeanes Hospital to provide its community with health, wellness, and safety information; however, it does not replace the advice of your physicians. You should always consult your physician regarding any medical concerns and before making any changes in your lifestyle, physical activities, or treatment plan. If you would like to be removed from our mailing list, call Jeanes Hospital at 215-728-3313 and request removal from Health Matters distribution. Jeanes Hospital does not exclude participation in, and no one is denied the benefits of, delivery of quality medical care on the basis of race, religious creed, sex, sexual orientation, gender identity, disability, age, ancestry, color, national origin, physical ability, or source of payment.
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Published on Sep 24, 2013