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- 1. The George Washington University Hospital health www.gwhospital.com news Summer 2006 Outpatient Surgery From Head to Toe • No Need to Shoulder Rotator Cuff Pain • Foot Surgery That’s a Step Ahead • Relief for Endometriosis or Fibroids Arthroscopic Knee Surgery Torn Rotator Cuff Hernia Bunions Eye Surgery Fibroids
- 2. The George Washington University Hospital Summer 2006 Introducing The GW Surgery Center: Outpatient Surgery From Head to Toe A dvanced medical technology and surgical techniques now make it possible to treat many conditions, such as hernias, cataracts and torn rotator cuffs, on an outpatient basis. Patients often go home an hour or so after leaving the operating room. At The GW Surgery Center, we know patients want their surgical experiences to be as efficient, convenient and stress-free as possible. Staff members at the center are dedicated to meeting these needs. Opened in Spring 2006, The GW Surgery Center is located just a few blocks from The George Washington University Hospital. It offers patients the following advantages: • Personalized care — Procedures are planned in advance, so surgeons and staff are able to give patients one-on- one attention. • Minimal waiting — Typically, patients arrive at the facility one hour before their procedures. They often depart about one hour after leaving the operating room. • A calm, welcoming atmosphere — Bright, elegant waiting areas help give patients and their families a sense of relaxation, privacy and comfort. • An experienced staff and advanced technology — Operating rooms feature equipment designed for minimally invasive surgical techniques. Staff members specialize in caring for outpatients. • GW Hospital’s commitment and support — Surgeons who had been operating exclusively at the hospital now operate at The GW Surgery Center as well. The facility is fully equipped to manage any complications. If needed, patients can be transported by ambulance to GW Hospital. “Surgeons evaluate every case individually, but in general, the factors that determine whether a procedure can be done in The GW Surgery Center are the health of the patient and the complexity of the procedure,” says Luu Nguyen, MD, Medical Director of The GW Surgery Center.“In most cases, if you could have your procedure done on an outpatient basis at the hospital, you would be eligible to have it performed at The GW Surgery Center.” In this issue of Health News, we’ll explore a few of the many procedures available at The GW Surgery Center. The GW Surgery Center is located at 2120 L Street, N.W. For more information, please call 202-715-4600. It is possible to treat many conditions, such as hernias, cataracts and torn rotator cuffs, on an outpatient basis. Patients often go home an hour or so after leaving the operating room. Minimally Invasive Treatments Have Patients Home Quickly Luu Nguyen, MD Medical Director A Wide Range of Outpatient Surgeries The center also offers procedures in the following areas: Colorectal surgery Cosmetic and plastic surgery Endoscopy General surgery Oral surgery Gastroenterology Gynecology (OB/GYN) Ophthalmology Orthopedics and sports medicine Otolaryngology Pain management Podiatry Urology • • • • • • • • • • • • •
- 3. www.gwhospital.com Summer 2006 T he rotator cuff, composed of four muscles and their tendons, is an injury-prone area of the shoulder that helps lift and rotate the arm and stabilize the shoulder joint. Trauma or repetitive overhead movements can cause these tissues to tear, resulting in pain and limited shoulder mobility. “The surgical approach we use is determined by the size of the tear, the condition of the muscles and tendons and how easily we can move the tissue in the joint,” says Robert Neviaser, MD, Chairman of Orthopedic Surgery at GW Hospital. “In the past, we needed to do an open procedure to repair a torn rotator cuff, which involved making a four-inch incision,” says Craig Faulks, MD, an orthopedic surgeon at The GW Surgery Center. “Now, we have two minimally invasive options: arthroscopic repairs and mini-open repairs.” An arthroscopic repair, the most common, requires only three ¼-inch incisions. During a mini-open repair, the first half of the surgery is done using minimally invasive arthroscopic techniques. The second half is done using a traditional open procedure, but the incision is only one inch. Dr. Faulks believes The GW Surgery Center provides an ideal environment for many patients requiring shoulder surgery.“The whole surgical process, from registration to recovery, is streamlined and efficient,” he says.“Consequently, patients get to go home quickly and start healing, and they’re back to normal activities before they know it.” To schedule an appointment with an orthopedic surgeon, please call 1-888-4GW-DOCS. Tears of the rotator cuff muscles or tendons may be caused by severe tendinitis or a sudden injury. In some cases, only a small bit of tendon will tear (partial tear). Or, the tendon may tear all the way through (complete tear). This can result in pain and may cause shoulder weakness. Rotator cuff tendons Humerus (arm bone) Rotator cuff tear There’s No Need to Shoulder Rotator Cuff Pain Arthroscopic and Mini-Open Repairs Are Available Craig Faulks, MD Orthopedic Surgeon M inimally invasive surgical techniques for knee procedures are getting patients back to their daily activities more quickly than ever. “Injuries and normal wear and tear of the knee may cause conditions ranging from torn cartilage to instability or abnormal alignment of the kneecap,” says James H. Graeter, MD, an orthopedic surgeon at The GW Surgery Center. The key device that makes minimally invasive knee surgery possible is the arthroscope: a thin, telescope-like device inserted through a one- to two-inch incision.The arthroscope has a miniature video camera on one end that transmits images to a television monitor, allowing the surgeon to see inside the joint.The surgeon may insert instruments through neighboring small incisions to perform the surgery. “Most knee arthroscopy patients don’t require general anesthesia that renders them unconscious; they require only enough anesthetic to completely numb the knee joint. In fact, some of my patients enjoy watching the television monitor as I perform the procedure,” says Kenneth Fine, MD, an orthopedic surgeon at The GW Surgery Center who operates on many athletes ranging from professionals to weekend warriors. Knee arthroscopies take approximately one hour. During a 60- to 90-minute stay in the recovery area, trained staff members fit patients with crutches and provide post-operative instructions. In many cases, doctors encourage patients to start putting as much weight as possible on their repaired knees to encourage healing. Arthroscopic surgery has many benefits over traditional open surgery. Because the image on the monitor is magnified, surgeons can closely examine it to detect very small defects. Due to smaller incisions, arthroscopic procedures cause much less tissue damage than open procedures, which reduces the risk for infection and promotes faster, safer and less painful recoveries. To schedule an appointment with an orthopedic surgeon, please call 1-888-4GW-DOCS. Arthroscopic Knee Surgery Can Get You Back on Your Feet Faster James H. Graeter, MD Director, The Joint Replacement Center Kenneth Fine, MD Director, Sports Medicine Assistant Professor of Orthopedic Surgery Robert Neviaser, MD Chairman, Orthopedic Surgery Front View of Shoulder Illustration©TheStaywellCompany.Allrightsreserved.
- 4. T oo often, we take our feet for granted while lavishing attention on our footwear. Unfortunately, fashionable shoes are often tight, narrow and high- heeled. Over time, wearing these shoes may yield ugly results, such as painful bone and tissue deformities. “When conservative treatment and sensible shoes fail to fix the problem, surgery may provide long-term relief,” says Michael S. Stempel, DPM, FACFAS, a podiatrist and Director, Division of Podiatry, Department of Surgery, at The George Washington University Hospital. Dr. Stempel, who is board certified in foot surgery, performs a number of outpatient podiatric procedures at The GW Surgery Center, including bunion and hammertoe surgeries. Bunion Surgery A bunion is a misalignment in the joint that connects the big toe to the foot. It causes the base of the big toe to swell and protrude. According to the American Orthopaedic Foot and Ankle Society, more than half of the women in the United States have bunions, often caused by shoes that squeeze toes into unnatural positions. Arthritis and heredity may be contributing factors. “Bunion surgery involves removing excess bone, repairing damaged joint surfaces and realigning the toe joint,” Dr. Stempel says. “Most patients experience a dramatic reduction in pain after surgery.” Hammertoe Surgery A hammertoe occurs when the second, third or fourth toe bends at the middle joint, giving it the appearance of a miniature hammer. Often, shoes with narrow toe boxes are the primary cause. Eventually, the toe becomes frozen in this bent position, causing the knuckle to rub painfully against the tops of shoes. “Hammertoe surgery involves removing a small portion of bone from the toe. That allows it to lie flat again,” Dr. Stempel says. Podiatric surgery generally lasts from 30 minutes to two hours, and patients stay in the recovery area for about an hour. The GW Surgery Center provides a perfect place for these procedures, says Dr. Stempel.“Patients have a cheerful, calm environment in which to relax and recover from anesthesia, and they’re usually ready to leave three to four hours after they enter the doors,” he says. To schedule an appointment with a podiatric surgeon, please call 1-888-4GW-DOCS. Find Footwear That Fits Pay attention to comfort and fit when you are shoe shopping. The American Academy of Orthopedic Surgeons offers these tips: Have both feet measured every time you purchase shoes, since foot size may change as you get older. Because feet tend to swell during the day, shop for shoes in the afternoon or evening. Avoid shoes with heels higher than 2¼ inches. There should be a ½-inch space from the end of your longest toe to the end of the shoe. Make sure shoes are comfortable enough to wear when you buy them. There is no such thing as a “break-in period.” • • • • The George Washington University Hospital Summer 2006 Foot Surgery That’s a Step Ahead Procedures Help Correct Damage From Ill-Fitting Shoes, Arthritis and Heredity Michael S. Stempel, DPM, FACFAS Director, Division of Podiatry Bunion Bone removed Screw Hammertoe Part of the bone removed Illustrations©TheStaywellCompany.Allrightsreserved.
- 5. www.gwhospital.com Summer 2006 F or women with excessive menstrual bleeding, monthly periods can be an ordeal. However, in general, women with this problem are healthy and hospitalization is not required. “At The GW Surgery Center, we offer effective, minimally invasive procedures that enable women to be treated for their bleeding problems and leave in a few hours,” says Damian P. Alagia, MD, MBA, Director of Minimally Invasive Gynecologic Surgery at The George Washington University Hospital. Fibroids Are Common Causes About 40 percent of women who have excessive menstrual bleeding can trace the problem to fibroids, a noncancerous growth in the uterus. These fibroids can protrude from the uterine lining into the uterine cavity, or they can be buried in the uterine wall. Thermal Balloon Ablation as Treatment Dr. Alagia’s preferred method for treating heavy bleeding is thermal balloon ablation. This technique thins out the uterine lining and hinders the ability of the endometrium (the uterine lining that sheds during the menstrual cycle) to grow. The procedure is only appropriate for women who do not want to bear children. Here’s how it works: • A mild sedative is given to the patient, and anesthesia is used to numb the cervix. A small, flexible balloon attached to a thin tube is then passed through the vagina to the uterus (no incision is required). The balloon is filled with fluid so it conforms to the size and shape of the uterus. • The fluid is heated and circulated in the uterus for eight minutes. The heat alters the composition of the endometrium. • When treatment is complete, the fluid is withdrawn from the balloon and the balloon is removed. The treated uterine lining sheds, like a period, over the next few days. Following treatment, most women have much lighter periods, and 20 to 30 percent of women stop having periods altogether. Treatment for Protruding Fibroids For women whose bleeding is caused by uterine fibroids that protrude into the uterine cavity, the surgeon may remove the fibroids first, using a procedure called a myomectomy, then perform thermal balloon ablation. The procedures may be performed back-to-back, according to Dr. Alagia. To schedule an appointment with a gynecologic surgeon, please call 1-888-4GW-DOCS. Effective Solutions for Excessive Menstrual Bleeding Fibroids are almost always benign and do not increase the risk for uterine cancer. Fibroids are growths in the uterus composed of muscle cells and other tissue. They grow singularly or in clusters and range in size from as small as a raisin to as large as a grapefruit. Not all women with fibroids experience symptoms, but in some cases fibroids cause heavy bleeding during or between periods, a feeling of fullness in the pelvic area or low back pain. The cause of fibroids is not certain.They are more prevalent in women of childbearing age and African American women. Fibroids may be diagnosed during a pelvic exam. However, imaging tests, such as ultrasounds or X-rays, sometimes may be required to confirm their presence. Medications may shrink problematic fibroids, but they are most often treated with surgery. • • • • • • Other Gynecologic Procedures Performed at The GW Surgery Center Hysteroscopy — A diagnostic procedure in which the surgeon inserts a thin, telescope-like device called a hysteroscope through the cervix to view the inside of the uterus Ovarian cystectomy — A procedure to remove fluid-filled growths in the ovaries Dilation Curettage (DC) — A procedure that involves dilating the opening of the cervix and scraping tissue away from the lining of the uterus Bladder neck repairs — A procedure to strengthen the opening of the bladder and correct incontinence by implanting a sling-like support • • • • Damian P. Alagia, MD, MBA Director of Minimally Invasive Gynecologic Surgery Facts About Fibroids Insertion Treatment and Monitoring Deflation and Removal
- 6. Y our abdominal muscles continuously work to assist with breathing, support the muscles of your spine and hold your abdominal organs in place. Over time, these muscles may weaken, bulge or rip, leaving you susceptible to a hernia. A hernia occurs when the inner lining of the abdomen pushes through the weakened abdominal wall, forming a sac.A portion of the intestine or abdominal tissue slips into the sac, often causing it to bulge beneath the skin. Inguinal (groin) hernias account for 80 percent of all hernias and are most common in men.They usually occur when weakened abdominal muscles are strained from heavy lifting, sudden twists or pulls, or chronic constipation. Surgery Is the OnlyTreatment Option Symptoms of a hernia include a visible bulge, a dull ache, and weakness or pressure in the groin. Surgical closure of the hole in the abdominal wall is the only treatment option for a hernia. “Hernia procedures are tailor-made for outpatient surgery facilities because they’re relatively quick and easy to recover from,”says Juliet Lee, MD, a general surgeon who operates at The GW Surgery Center. “At The GW Surgery Center, we have everything we need to give patients advanced medical care and a streamlined, personalized experience.” Many hernias do not require immediate treatment. In rare cases, the abdominal muscles squeeze off the blood supply to the protruding tissue, causing it to die and become infected.This is called a strangulated hernia, and it requires emergency surgical treatment, which is done in the hospital. In most other cases, hernia surgery may be scheduled at The GW Surgery Center. ThreeTypes of Procedures “Any of the three types of hernia repair will yield good results,”says Gordon H. Hafner, MD, FACS, a general surgeon.“The hernia repair itself takes about 45 minutes to an hour. Patients then spend about 90 minutes in post-op recovery, after which they are ready to go home.” Surgeons at The GW Surgery Center offer three types of hernia procedures: • Conventional method — An incision is made at the hernia site, and the protruding tissue is gently pushed back into the abdominal cavity.The hole in the abdominal wall is stitched shut. • Open mesh repair — The surgeon covers the hole with a piece of biocompatible mesh that gradually becomes a permanent part of the abdominal wall. • Laparoscopic mesh repair — A laparoscope is a telescope-like device that is passed through a small incision, allowing the surgeon to see the hernia on a video screen.The surgeon inserts instruments through neighboring incisions and sutures a mesh covering to the inside of the abdominal wall. To schedule an appointment with a surgeon who does hernia repairs, please call 1-888-4GW-DOCS. Turn to Us for HerniaSurgery “Any of the three types of hernia repair will yield good results. The hernia repair itself takes about 45 minutes to an hour. Patients then spend about 90 minutes in post-op recovery, after which they are ready to go home.” — Gordon H. Hafner, MD, FACS “At The GW Surgery Center, we have everything we need to give patients advanced medical care and a streamlined, personalized experience.” — Juliet Lee, MD The George Washington University Hospital Summer 2006 Gordon H. Hafner, MD, FACS General Surgeon Juliet Lee, MD General Surgeon
- 7. www.gwhospital.com Summer 2006 W hen it comes to outpatient surgery, ophthalmic medicine is, in a word, visionary. Ophthalmic procedures were some of the first surgeries to be performed on an outpatient basis. Today, they continue to be the most common outpatient surgeries. These procedures especially are suited for outpatient surgery centers because: • They involve relatively little pain or bleeding. • They usually last no more than an hour. • Recovery generally is easy. At The GW Surgery Center, ophthalmic surgeons perform many procedures, including cataract surgery and glaucoma procedures, to help restore and maintain clear vision. Cataract Surgery During a cataract procedure, the surgeon removes one or both of the eyes’ lenses, which may become cloudy with age or illness. The cloudy film makes it difficult for light to reach the back of the eye, resulting in blurry or dimmed vision. The surgeon breaks up the lens using sound waves (a process called phacoemulsification), then collects the fragments with a tiny vacuum device. The lens is replaced with an artificial implant that may, in some cases, correct the patient’s nearsightedness or farsightedness, as well as give clear, unclouded vision. Glaucoma Procedures Glaucoma procedures relieve fluid pressure inside the eye that degrades the optic nerve and causes vision loss.The surgeon may perform a trabeculectomy, a procedure in which a laser beam is used to stretch the eye’s drain, allowing excess fluid to filter out of the eye.Also, the surgeon may implant a shunt to create an extra passageway for the fluid to drain. David A. Belyea, MD, FACS, is an ophthalmic surgeon who performs glaucoma and cataract procedures at The GW Surgery Center.“Even complex cases, such as a procedure that involves both a cataract extraction and a glaucoma operation, can be performed in this facility,”he notes. Seeing a New You Oculoplastic procedures include cosmetic, corrective and reconstructive surgery of the eyelids and area surrounding the eyes. Several of these procedures are performed at The GW Surgery Center: • Blepharoplasty involves removing excess skin, muscle and fat from the upper and lower eyelids. It may be done for functional reasons to fix sagging eyelids that interfere with vision, or it may be done for cosmetic reasons to redefine the shape of the eye for a more youthful appearance. • Ptosis repair involves fixing eyelids that droop due to muscle paralysis or weakness. • Ectropion and entropion repairs correct eyelids that turn outward or inward, which causes irritation or excessive tearing. “The new facility has an operating room dedicated to eye procedures with the advanced equipment surgeons need,” says Craig E. Geist, MD, FACS, an oculoplastic ophthalmic surgeon at The GW Surgery Center.“Also, patients’ needs are catered to at every turn. For example, we have reclining, rolling chairs that patients can remain on from pre-op to recovery, so they don’t have to climb onto and off of the operating table. This is especially important for older patients with mobility issues.” To schedule an appointment with an ophthalmic surgeon, please call 1-888-4GW-DOCS. See What Eye Surgery Can Do for You Outpatient Procedures Can Improve Vision and Appearance “Even complex cases, such as a procedure that involves both a cataract extraction and a glaucoma operation, can be performed at The GW Surgery Center.” — David A. Belyea, MD, FACS Removing a cataract During phacoemulsification, an ultrasound probe is inserted into the lens through a corneal incision. Sound from the probe breaks the cloudy lens into pieces that are removed with a tiny vacuum device. “The new facility has an operating room dedicated to eye procedures with the advanced equipment surgeons need. Also, patients’ needs are catered to at every turn.” — Craig E. Geist, MD, FACS David A. Belyea, MD, FACS Ophthalmic Surgeon Craig E. Geist, MD, FACS Oculoplastic Ophthalmic Surgeon Lens Cornea Ultrasound probe Illustration©TheStaywellCompany.Allrightsreserved. Iris Small corneal incision
- 8. You may have received this mail because your address appears on a purchased mailing list. The companies from whom we purchase mailing lists are responsible for removing your name if you do not wish to be listed. To add or remove your name and address from our mailing list, please contact The George Washington University Hospital Marketing Department; the Direct Marketing Association, Farmingdale, N.Y.; or log on to http://www.dmaconsumers.org/consumerassistance.html. The George Washington University Hospital 900 23rd Street, N.W. Washington, DC 20037 Prsrt std U.S. Postage PAID Long Prairie, MN Permit 372 Richard B. Becker, MD Chief Executive Officer Carlos A. Silva, MD Medical Director Lisa Saisselin-McDonald Director of Marketing and Business Development Information in Health News comes from a wide range of medical experts. If you have any concerns or questions about specific content that may affect your health, please contact your healthcare provider. Models may be used in photos or illustrations. Any opinions expressed by an author whose article appears in this publication are solely the opinions of the author and do not necessarily reflect the views of The George Washington University Hospital or Universal Health Services, Inc. Physicians mentioned in this publication are on the medical staff of The George Washington University Hospital but, with limited exceptions, are independent contractors who are not employees or agents of The George Washington University Hospital. ©2006. All rights reserved. Printed in the U.S.A. health news Postmaster: Please deliver within July 18 and 22. Legs for Life! Free Screening for Peripheral Vascular Disease (PVD) Tuesday, Sept. 12, 8 AM – 4 PM, Free If you have leg pain when walking or exercising, don’t assume it’s a normal part of aging. You may be suffering from a disease of the arteries called Peripheral Vascular Disease (PVD). Symptoms may include cold feet and/or legs, numbness and tingling in your feet and/or legs, pain in legs while moving but no pain at rest. Location: Hospital Lincoln Room. If you are age 55 or older, join us for this important screening. Please call 1-888- 4GW-DOCS to schedule your PVD screening appointment. Frequent Urination? Simple and Effective Solutions for an Enlarged Prostate Wednesday, Sept. 27, 7 PM – 8:30 PM, Free Presenters: Michael H. Phillipps, MD, FACS, Clinical Professor of Urology and Ramez Andrawis, MD, FRCS, MSc, Assistant Professor of Urology. If you’ve been changing your lifestyle to accommodate urinary problems, we invite you to a seminar that will detail the latest procedures that could help you regain your freedom. New, minimally invasive surgical treatments may reduce prostate size and relieve urinary obstruction without damaging surrounding tissue — resulting in faster recovery and fewer side effects. Location: Hospital Auditorium. To register, please call 1-888-4GW-DOCS. Senior Health Expo 2006 Saturday, Oct. 28, 9 AM – 4 PM, Free Senior Citizens won’t want to miss this year’s FREE Senior Health Expo. Enjoy informative exhibits on health, fitness and finance. Register for FREE cholesterol, glucose and blood pressure screenings. Win door prizes and more! Sponsored by the GW Senior Advantage Program. Location: Hospital first floor. For more information, please visit www.gwhospital.com or call 1-888-4GW-DOCS. Free Prostate Screenings in September September is Prostate Cancer Awareness Month. The GW medical community is hosting free prostate screenings by appointment on designated days during September (includes a PSA test and digital rectal exam). Screenings are suggested for all men age 50+ and African American men age 40+. African American men and those with a family history of the disease are at increased risk for prostate cancer. This is a screening appointment and not to be used for a second opinion. Space is limited, so register today by calling 202-741-3100. October is Breast Cancer Awareness Month Look for the GW Mammovan in your community during October and get your screening mammogram. Oct. 9, Springfield/Franconia Family Resource Center, 7224 Commerce St., Springfield, VA Oct. 18, Chartered Family Health Center, 3924 Minnesota Ave., N.E., Washington, DC Oct. 25, Casa of Maryland, 34 University Blvd., Silver Spring, MD To schedule your screening mammogram, or for a complete calendar of upcoming screening sites, please call 202-741-3270. Fall Seminars 2006 To register, please visit our Web site at www.gwhospital.com or call 1-888-4GW-DOCS.