Backin the Saddle

36 Pages·2015·2.21 MB·English

break throughs
LIVING WELL ON THE WESTSIDE | SPRING 2015
Back Saddle
in the
STAR JOCKEY GARY STEVENS
RESUMES HIS CAREER AFTER KNEE
REPLACEMENT SURGERY
letter
breakthroughs
from the Chief Executive LIVING WELL ON THE WESTSIDE
SPRING 2015
I’m delighted to announce
that Providence Saint John’s
Health Center has been named
a Healthgrades® America’s 50
Best Hospitals™ for nine years
in a row—2007 to 2015. SAINT JOHN’S HEALTH CENTER
EDITORIAL STAFF
America’s 50 Best Hospitals are the
Chief Executive
top 1% of hospitals in the nation for
Marcel Loh
providing overall clinical excellence
across a broad spectrum of conditions Director of Marketing
& Communications
and procedures consistently for a
Connie Matthews Barilla
minimum of seven consecutive years.
Saint John’s is the only hospital in
California to earn this distinction for
nine consecutive years and only one of
11 hospitals nationwide to do so.
Marcel Loh
This designation has real meaning
Chief Executive for our patients. It conveys that we are
58 11th Street,
dedicated to quality and excellence Hermosa Beach, CA 90254
Tel [phone] Fax [phone]
and have put the people, protocols and technology in place to achieve the highest moontidemedia.com
standards of hospital care day in and day out. It also means that we pay attention VP, Branded Media
to details and value the small things, such as a welcoming smile from the volunteer Emily S. Baker
at the front desk, the quality of our food and the education programs we provide
Creative Director
the community. Angela Akers
In this issue of Breakthroughs, you can read about the people who make Saint
Editor
John’s what it is today. The cover story on acclaimed jockey Gary Stevens and
Shari Roan
his treatment by one of our top-ranked orthopedic surgeons is testimony to our
commitment to innovation. You can also read, in the stories on radiation oncology Copy Editor
Laura Watts
and the Doctors of Saint John’s medical group, about how having good doctor-
patient relationships translates to good care. And the story on our hospital’s “clean Graphic Designer
team” shows how we value teamwork. Michelle Villas
We hope you enjoy this issue, and we stand by to meet your health care needs.
Contributors
Victoria Clayton, Sandi Draper,
With utmost respect, Beth Howard
Marcel
Photographers
Scott Gilbert, Michael Neveux,
Lauren Pressey, Remy Haynes
Managing Partners
Charles C. Koones
Todd Klawin
2 breakthroughs SPRING 2015
contents
departments
2 | Letter from the Chief Executive
12 | On the Horizon
30 | Happenings
34 | Shout Outs
in good health
4 | Help With Watching
Your Weight
6 | A Pregnancy Warning
7 | Preventing Eye Infections
8 | Robotic Surgery for Joints
9 | Healthful Recipe
10 | Banish Spring Sneezing
features profiles
14 | Moving the Finish Line 26 | The Doctors of Saint John’s
Jockey Gary Stevens resumes his A growing group of physicians
career with a new knee. draws rave reviews.
20 | Relationships Matter 28 | Neat and Clean
Radiation treatments for cancer Eddie Paez and his team keep
are eased by an attentive Saint John’s sparkling.
health care team.

23 | A New Model for Thyroid Care
Rates of thyroid cancer are rising, but ON THE COVER
Saint John’s doctors are fighting back. Jockey Gary Stevens prepares
for a race only months after
knee replacement surgery.
Photographed by Zoe Metz
SPRING 2015 breakthroughs 3
in good health
Want to Lose Weight?
Two-thirds of Americans are overweight The class, called “Mindful Living: A
or obese. That’s why it makes sense to Healthy Way to a Healthy Weight,” is open
join with others to share ideas and sup- to anyone age 18 and older, no matter what
port in the quest to shed some pounds their weight loss or management goals are.
and improve your health. A new, 12-week Class topics will include goal-setting,
weight management class—centered on the monitoring progress, sharing and celebrat-
principle that sharing and caring leads to ing successes, meditation, exercise, relation-
success—is available at Providence Saint ships and other subjects. The class is held at
John’s Health Center. Providence Saint John’s Health Center.
For more information on enrollment and the class fee, call 310-829-8077.
Hospital Again Earns High Marks by Healthgrades®
Orthopedic Services (2015)
Healthgrades, a national company that • Five-Star Recipient for Total
Knee Replacement (2011 to 2015)
provides information about physicians,
• Five-Star Recipient for Total Hip
hospitals and health care providers, issued
Replacement (2012 to 2015)
numerous recognitions to Providence Saint • Five-Star Recipient for
Back Surgery (2015)
John’s Health Center in its most recent hos-
• Five-Star Recipient for
pital rankings report. Saint John’s has been
Spinal Fusion Surgery (2015)
ranked as one of America’s 50 Best Hospi-
tals™ for nine years (2007 to 2015). Five GASTROINTESTINAL CARE
• Gastrointestinal Care
stars means the hospital’s clinical outcomes
Excellence Award™ (2015)
are statistically better than expected.
• Top 5% in the Nation for
Overall GI Services (2015)
• Top 5% in the Nation for
AMERICA’S 100 BEST BY SPECIALTY
Interventional Procedures (2009 to 2015)
GI Medical Treatment (2015)
• America’s 100 Best Hospitals for
• Five-Star Recipient for Treatment
• Top 10% in the Nation for GI Medical
Cardiac Care™ (2012 to 2015)
of Heart Attack (2003 to 2015)
Treatment (2014 to 2015)
• America’s 100 Best Hospitals for Joint
• Five-Star Recipient for Treatment
• Five-Star Recipient for Esophageal/
Replacement™ (2012 to 2015)
of Heart Failure (2015)
Stomach Surgeries (2014 to 2015)
• America’s 100 Best Hospitals for
• Five-Star Recipient for Treatment
Gastrointestinal Care™ (2015)
ORTHOPEDIC CARE of GI Bleed (2014 to 2015)
• Orthopedic Surgery
CARDIAC CARE
Excellence Award™ (2015)
• Cardiac Care Excellence Award™
CRITICAL CARE
• Joint Replacement Excellence Award™
(2010 to 2015)
• Five-Star Recipient for Treatment
(2012 to 2015)
• Top 10% in the Nation for Overall
of Sepsis (2004 to 2015)
• Top 5% in the Nation for
Cardiac Services (2010 to 2015)
Joint Replacement (2012 to 2015)
• Five-Star Recipient for Coronary
• Top 10% in the Nation for Overall
4 breakthroughs SPRING 2015
in good health
Cardiac Study Appears in Prestigious Journal
Providence Saint John’s
Health Center cardiologists
co-authored a study published
late last year in the influen-
tial Journal of the American
Medical Association showing
the success of a tiny cardiac
device in treating a type of
atrial fibrillation.
The four-year study com-
Gene is Linked to Triple pared the Watchman device
Negative Breast Cancer with use of the oral medication
warfarin in preventing stroke,
Researchers at the John Wayne Cancer blood clots and cardiovascular
Institute at Providence Saint John’s Health death in people with nonval-
Center, working with colleagues in the vular atrial fibrillation. People
Genome Institute of Singapore, Biopolis, with this type of A-fib are at
have found a gene that is strongly associ- higher risk of stroke. The study
Shephal K. Doshi, MD
ated with estrogen-negative breast cancer was performed to determine if
and a particularly dangerous form of breast the new device would prove as effective as warfarin, which may have serious side
cancer called triple negative. effects and which also can be difficult to dose.
Triple negative accounts for 10% to 17% Compared to long-term warfarin therapy, the Watchman device resulted in:
of all breast cancers and is more common • A 40% relative risk reduction for stroke, cardiovascular/
in African-American women. The study, unexplained death and embolism
published on December 1, 2014, in the • A 32% relative risk reduction in stroke
Journal of Clinical Investigation, provides • A 63% relative risk reduction in fatal or disabling stroke
new information concerning which women • A 60% relative risk reduction in cardiovascular death
may be at higher risk for the disease or for Among 59 hospitals, Providence Saint John’s enrolled the largest number of pa-
worse outcomes. tients, says Shephal K. Doshi, MD, a cardiologist who led the trial at Saint John’s.
Patients with over-expression of the Dr. Doshi is the director of cardiac electro-physiology and one of the world’s top
gene had worse disease outcomes. The experts in this procedure.
gene is also over-expressed in patients with “This speaks highly not just of Saint John’s but also of the Providence system,
aggressive ovarian cancer. which is dedicated to new ideas in patient care, all aimed at providing the best
There are no effective long-term ther- possible outcomes,” Dr. Doshi says.
apies for triple negative breast cancer. Utilizing a minimally invasive procedure, the Watchman is inserted via a thin
Moreover, women with triple negative tube into the left atrial appendage, the major source of blood clots in patients with
breast cancer have higher rates of relapse atrial fibrillation. The device continues to be under review by the Food and Drug
and metastasis. The research will affect Administration, and three advisory committees have recommended its approval.
how patients with aggressive breast cancer
subtypes are assessed.
SPRING 2015 breakthroughs 5
in good health
More Pregnant Women Are at Risk for Stroke
Childbirth is a joyous and safe event for the vast Massachusetts General Hospital ana- STROKE AND PREGNANCY
majority of women. However, a recent study lyzed data from about 82 million preg-
showed that strokes—a malady usually associat- nant women to arrive at their findings.
ed with people older than age 65—are occurring Doctors and pregnant women should STROKE AMONG PREGNANT
WOMEN WITH HYPERTENSION*
more often in pregnant women. be aware of the risk factors for stroke,
The research, published in the journal Obstet- says Nicole Weinberg, MD, a cardiologist 1994–95 2010–11 INCREASE
rics & Gynecology, found that strokes during who specializes in women’s health at the 0.8 1.6 103%
pregnancy, while still rare, have increased 61.5% Pacific Heart Institute in Santa Monica.
from the mid-1990s to 2011. Researchers from “What’s surprising is that the rates
STROKE AMONG PREGNANT
of stroke in pregnancy have grown so
WOMEN WITHOUT HYPERTENSION*
significantly,” Dr. Weinberg says.
1994–95 2010–11 INCREASE
“It’s a trend, and there is no sign of
2.2 2.3 47%
this changing.”
Stroke rates among older Americans
have fallen over the past decade. To-
* rate per 10,000 pregnancies
day, however, more pregnant women Source: Obstetrics and Gynecology, Jan. 2015, Vol. 125, Issue 1
are overweight or obese, sedentary or
in their late 30s or 40s—all factors that
increase the risk of stroke. she says. “It’s a testament to the women’s
High blood pressure, or hypertension, is heart disease guidelines that have been
a major cause of ischemic stroke. Women put out in the cardiology literature. What
with hypertensive disorders of pregnancy those studies show is that if you have had
were 5.2 times more likely to have a stroke. pregnancy-induced hypertension, it is a risk
“These strokes usually occur closer to factor equivalent to smoking cigarettes. This
delivery when hormones are surging and person has a risk in potential, subsequent
blood pressure is going up,” Dr. Weinberg pregnancies and later in life.”
says. “These are life-threatening events.” Women who are thinking about becoming
Physicians in the Santa Monica commu- pregnant should have preconception coun-
nity are very proactive in addressing the risk seling with a physician to prepare for the
factors that may lead to stroke in pregnan- healthiest pregnancy, Dr. Weinberg advises.
cy, she adds. “You can be on blood pressure “There is so much that can be done
medications that are safe for the baby.” before pregnancy. You can get a genetic
The take-home message for pregnant workup, get fit and healthy. Pregnancy is
women who have high blood pressure or already a time of extra stress on the body.
pre-eclampsia in pregnancy is to be aware Your blood volume changes. Your heart
of their future risk for cardiovascular dis- needs to adjust to that. So before pregnan-
ease, Dr. Weinberg says. cy, you can think of it as being in training.
“You may be in your 20s, 30s or 40s, but You’re getting your body ready for some
this is a window into your future health,” big things.”
6 breakthroughs SPRING 2015
in good health
Drug Use Drops in Teens—Except for Nicotine
TEENS AND
E-CIGARETTES
The annual, national survey of youth substance alcohol use has declined by one-third.
use is largely good news—with the exception of • Use of synthetic marijuana, known as K-2 or 8TH GRADERS
kids’ growing fondness for e-cigarettes. The 2014 spice, has fallen among 12th-graders from
University of Michigan Monitoring the Future 11% in 2011 to 6% in 2014.
6.3% 2.2%
survey found that alcohol and cigarette use hit • Marijuana use decreased slightly in teens in
their lowest levels since the study began in 1975. 2014 after five years of steady increases.
However, the survey showed that for the first The bad news is that 9% of 8th-grade students
time, more teens use e-cigarettes than tradition- reported using an e-cigarette in the past 30 days.
10TH GRADERS
al tobacco cigarettes or other tobacco products. That rate rose to 16% for 10th-graders and 17% for
While substance use trends typically change 12th-graders. E-cigarettes are battery-powered
slowly in teens, the rapidity with which teens have devices with a heating element that allows users 11.9% 4.3%
embraced e-cigarettes is stunning, the authors of to inhale nicotine vapor. Some health experts
the report noted. have expressed concern that e-cigarettes may lead
First the good news: to tobacco cigarette smoking.
12TH GRADERS
• The percentage of students in all three grades Only e-cigarettes that are marketed for ther-
reporting any alcohol use in the previous 12 apeutic purposes are currently regulated by the
months of the survey dropped from 43% to Food and Drug Administration.
9.9% 7.3%
41%. The peak rate was 61% in 1997. Thus
 Used e-cigarettes  Used regular cigarettes
in past 30 days in past 30 days
Source: 2014 Monitoring the Future Survey
Your Eyes Need Good Care Too
Nearly 1 million Americans each year make • Wash hands with soap and water and
a trip to the doctor or emergency room dry well before touching lenses.
for an eye infection, according to new • Take contacts out before bed,
research. The study focused on keratitis, showering or swimming.
an infection of the cornea that causes pain • Rub and rinse contacts in disinfecting
and inflammation. solution each time they’re removed.
Researchers from the Centers for Disease • Rub and rinse the case, dry with a
Control and Prevention found that many clean tissue and store upside down
infections are related to wearing contact with the caps off after each use.
lenses too long or overnight or not cleaning • Replace contact lens cases at least
or replacing storage cases. Keratitis usually once every three months.
clears up easily with treatment; however, • Do not “top off” solution in the case.
severe cases can lead to vision loss. • Carry a back-up pair of glasses in case
Here are their tips to prevent contact lenses have to be taken out.
lens-related eye infection:
SPRING 2015 breakthroughs 7
in good health
Robot Revolutionizes
Hip and Knee
Replacement Surgery
Written by Shari Roan
for patients whose knee damage is limited to
one compartment in the knee. That proce-
dure is going to be available to patients at
Saint John’s this spring.
The MAKO also can be used now in
hip replacement surgery. Later this year,
Saint John’s orthopedic surgeons will also
offer MAKO robotic surgery for total knee
replacement—a development with far-reach-
ing consequences for patients.
“Total knee replacement can be done now
very accurately, but it requires a standard
Dr. Kevin M. Ehrhart inspects the new MAKO. robot.
incision. The vast majority of rehabilitation
Robotic surgery has made a huge differ- mensional picture of the joint. Based on this following knee replacement surgery deals
ence in several areas of medicine. This is model, the surgeon programs the robot to with getting the muscles back into shape,”
seen especially in areas such as urology and make precise movements to resurface the Dr. Ehrhart says.
gynecology. Soon, the same will be said for joint and insert an implant. “In the past, knee replacement attempted
orthopedic surgery. Real-time visual and tactile feedback through a minimally invasive procedure
Providence Saint John’s Health Center assists the surgeon in proper placement of would oftentimes result in less-than-accu-
recently obtained the state-of-the-art MAKO the implant. This choreographed, highly rate implant placement. With the robot, in
robot to treat patients requiring hip and controlled procedure results in sparing as the future, we’ll be able to guarantee accura-
knee replacement surgery, the first such much healthy bone and surrounding tissue cy while using a less-invasive procedure.”
device available on the city’s Westside. The as possible. Knee replacement surgery patients could
technology is a major step forward in bring- “The robot has a game plan,” Dr. Ehrhart experience shorter hospital stays due to less
ing all of the advantages of robotic surgery— explains. “With the information from the CT pain, Dr. Ehrhart says. “This has the poten-
greater precision, smaller incisions, faster scan, the robot can be programmed to deter- tial of making recovery a whole lot easier.
recovery—to a variety of joint replacement mine exactly where the cut should be made The majority of the pain associated with
procedures, says Kevin M. Ehrhart, MD, an and where the implants should be placed. total knee replacement is the exposure to the
orthopedic surgeon at the Health Center. It’s like a GPS.” muscle. In the future, robotic knee surgery
“Patients are going to love this,” he says. Using the MAKO robot, the implant fail- should be quadriceps sparing.”
“It will be part of our comprehensive ortho- ure rate at two years post-surgery appears Orthopedic surgeons at Saint John’s have
pedic program at Saint John’s.” to be even better than conventional surgery, undergone extensive training on the MAKO
The MAKO robot is a surgeon-controlled according to early studies. robot. “I think we’re in the infancy of robotic
robotic arm. Prior to surgery, patients will The MAKO robot is available now for par- surgery,” says Dr. Ehrhart. “It’s going to
undergo a CT scan to produce a three-di- tial knee resurfacing, a procedure designed become bigger and bigger.”
8 breakthroughs SPRING 2015
in good health
Healthful Eating
Spring is a terrific time to improve your diet. Farmers
markets and grocery stores are stocked with fresh
vegetables, and the warmer weather makes us want to
eat lighter. Here are a couple nutritious side dishes to
dress up your menus.
Courtesy of Dalia Dvoretsky, RD, coordinator of nutrition and
diabetes education at Providence Saint John’s Health Center.
Vegetable Casserole
3 carrots 1 tablespoon flour or
1 onion breadcrumbs
cauliflower ½ teaspoon salt
1 potato ½ teaspoon pepper
3 zucchini
DID YOU KNOW?
3 eggs
Ancient roman texts mention the
value of fennel for its aromatic seeds
Grate all vegetables. Squeeze to remove fluid. In a bowl, mix
and succulent edible stalks. The ruler
vegetables with eggs, flour, salt and pepper. Put in a greased
Charlemagne (745-815 A.D.) promot-
casserole dish. Bake for 1 hour or until top is golden brown
ed fennel’s use during the medieval
in a 375º preheated oven.
time. He cultivated the herb on his
imperial farms. The Americas were
introduced to the herb in the 1700s.
Fennel Salad
Fennel is grown in France, Germa-
2 fennel bulbs
ny, Italy, India, Japan and America.
1 tablespoon oil
The root of the plant was one of the
salt and pepper to taste
flavorings used in “sack,” an alcoholic
fresh lemon juice
drink featuring mead that was popular
during Shakespearian times.
Cut the fennel bulb in half. Remove the core. Cut into small strips.
Source: herbinfosite.com Dress with oil, salt, pepper and lemon juice.
SPRING 2015 breakthroughs 9
in good health
No more sneezing and wheezing
Spring is a beautiful
Are some allergy seasons worse How can people distinguish allergies
time in Southern
than others? from colds or viral infections?
California—except if
you’re one of those “Rainy seasons are worse. For example, a “Colds will give you a fever, plus or minus
people who are hard rain will come in and break up the bio- muscle aches. Allergens on their own should
plagued by seasonal
mass—the pollen particles. A day or two after not do that. The five main organs that aller-
allergies. If sneezing, Raffi Tachdjian,
wheezing, watery MD, MPH a rain, if the winds kick up, people can be re- gies affect are the skin, eyes, sinuses, gastro-
eyes and headaches ally miserable because they are now inhaling intestinal tract (food allergies) and the lungs.”
torment you this time of year, it’s time
finer particles that can go deeper. Alternaria
to be proactive and take measures to
overcome your allergies. We asked Raffi mold can circulate in dry, Santa Ana winds. Why do some people do fine and then
Tachdjian, MD, MPH, an allergist with For someone with allergies to both Alternaria develop an allergy later in life?
AIRE of Los Angeles, for information
and weed and tree pollen, they are a total “I see people of all ages develop allergies.
and advice on handling spring allergies.
mess. It’s a double-whammy hit.” But a lot of environmental allergies occur in
the late teens and early 20s. Older people
Are spring allergies dif- How do allergies develop? are less likely to develop allergies because
ferent than fall allergies? “You get exposed to the allergen, which is their immune systems are winding down.”
“Yes, and Southern Cal- usually a protein. Your body decides if the
ifornia has a longer spring protein is an innocent signal or dangerous Once you have an allergy, do you
allergy season than most signal. The protein from tree pollen can always have it?
other places. The typical look like protein from bacteria or viruses. So “Technically, yes. Some people think their
spring allergen is tree pollen. Trees are what happens next? The second time you’re children outgrow allergies. But essentially
spewing pollen to reproduce. Year-round exposed, your immune system has built up what happens is their nasal and airway pas-
the most common allergens are dust mites, memory of the exposure. People are misera- sages get bigger as they grow, and they will
mold and animal dander.” ble and they’re saying, ‘What happened?’” drain better. But they may still wheeze or
have difficulty with aerobic activity. Often-
10 breakthroughs SPRING 2015