breakthroughs fall 2014

breakthroughsLIVING WELL ON THE WESTSIDE | FALL 2014

AWASH IN HAPPINESSModern treatments for rheumatic conditions restore patients’ lives. p.26

2 breakthroughs FALL 2014

letterfrom the CEO

In January, I journeyed from my office at Swedish Health Services in Seattle to Santa Monica to be part of a transition team to listen to Saint John’s physicians. My goal was to solicit their opinions of how to effectively add Saint John’s Health Center and the John Wayne Cancer Institute to the Providence Health & Services system. During the two days I spent at the Health Center, I was able to meet many members of the staff. What a first impression! I was struck by the devotion the physicians and staff displayed and by the strong commitment to the community. I never have witnessed such a warm, welcoming environment.

Now I am privileged to be the new chief executive of this storied, outstanding health care institution. I couldn’t be prouder and more excited about my new role. Providence Saint John’s Health Center already is nationally ranked in such fields as cancer, neurosciences, cardiac care and orthopedics. The John Wayne Cancer Institute is a center for innovation and research. And yet the Health Center has never lost sight of the fact that its first priority is to care for, serve and meet the needs of its community.

In the weeks and months ahead, I’m looking forward to partnering with all caregivers to build upon this long tradition of excellence. With our talented physicians, compassionate nurses and dedicated staff and volunteers, we possess all of the characteristics for continued success. But we won’t stop there. We will strive to advance high quality and safe health care by embracing leading-edge strategies and solutions.

My wife Jane and I are eager to experience life on the Westside and become part of the fabric of this great community. We are humbled by the opportunity to join the Providence Saint John’s Health Center and John Wayne Cancer Institute families, and look forward to meeting all our new family.

Marcel LohChief Executive

SAINT JOHN’S HEALTH CENTER EDITORIAL STAFF

Chief ExecutiveMarcel Loh

Director of Marketing & Communications

Connie Matthews Barilla

VP, Branded Media Emily S. Baker

Art Director Angela Akers

EditorShari Roan

Copy Editor Laura Watts

ContributorsDawn Hoffman, Lorie Parch,

Zoe Sophos

PhotographersScott Gilbert, Michael Neveux, Lauren Pressey, Remy Haynes

Managing Partners Charles C. Koones

Todd Klawin

breakthroughsLIVING WELL ON THE WESTSIDE

FALL 2014

58 11th Street, Hermosa Beach, CA 90254

Tel 310-376-7800 Fax 310-376-0200moontidemedia.com

With utmost respect,Marcel

FALL 2014 breakthroughs 3

profiles 20 | Sharing and Caring

A long-standing support group helps people who are insulin-dependent.

24 | No Generation Gap Here Karen and Emma Register share a love of volunteering.

contentsdepartments 2 | Letter from the Chief Executive 14 | On the Horizon 31 | Happenings 34 | Shout Outs

in good health 4 | Acupuncture for Cancer Patients 5 | The Best Infection Control, Hands Down 6 | Q & A: The Emergency Department and Contagious Illness 10 | Around the Providence Health & Services Network 11 | Healthy Recipe 13 | Some Kids Still Aghast at Eating Vegetables

ON THE COVERAimee Bower has

returned to an active lifestyle after treatment of

rheumatoid arthritis.

features 16 | Brave of Heart

With new treatment options, Saint John’s cardiologists alleviate their patients’ fears.

22 | Things Are Looking UpNew screening technology and improved surgeries have altered the outlook on lung cancer.

26 | Taking the Ache out of Arthritis

Early treatment can significantly curb the risk of disability.

in good health


Many postmenopausal women with breast

cancer take a type of medication called

an aromatase inhibitor. This drug blocks

the body’s production of estrogen and is a

proven therapy for breast cancers that are

hormone-sensitive. However, aromatase

inhibitors can cause significant joint pain.

Many patients discontinue the therapy be-

cause of this side effect.

Maggie DiNome, MD, chief of general sur-

gery at Providence Saint John’s Health Center,

acting director of the Margie Petersen Breast

Center and medical director of the Cancer

Prevention Clinic, has launched a clinical trial

that will examine whether acupuncture can

successfully reduce treatment-related joint

pain. Dr. DiNome and her colleagues at the

John Wayne Cancer Institute believe the estro-

gen deprivation induced by the treatment may

trigger an inflammatory response that causes

the joint pain.

“Acupuncture has been

used for centuries to treat

inflammation,” Dr. DiNome

explains. “More recent-

ly, Western medicine has

studied the benefits of acu-

puncture. With our brilliant

immunologists at the John

Wayne Cancer Institute,

we are setting out to study,

with much more depth, the

body’s immune response to

acupuncture.”

“It’s particularly important to address

this issue because we are placing more

women on long-term aromatase inhibitor

therapy—often in lieu of chemotherapy,” Dr.

DiNome says. “Unfortunately, up to half of

the women will experience joint pains, and

almost 20% of these women will discontinue

this otherwise lifesaving therapy because of

this side effect. If women cannot derive the

intended benefit from our recommended

treatments because of intolerance, then we

are doing a disservice if we do not attempt to

address the problem with them.”

The Angels of the ER volunteer group has

received new uniforms thanks to a generous

gift by the Irene Dunne Guild. The uniforms

are blue jackets or polo

shirts with a logo incor-

porating Providence, the

Health Center’s new spon-

sor, into the design.

“We had several different

uniforms in use,” says Janie

Crane, the Angels coordi-

nator. “Some were old, and

some were new. We decided

to start fresh. We hope

everyone will look all spiffy

and nice.”

The Angels are a spiffy organization, to be

sure. The group was formed 14 years ago to

provide volunteer services to patients and

families in the emergency department.

Now composed of 43 members, two

Angels are on duty each day from

9 a.m. to 9 p.m. They check to see if patients

need reading material, a blanket, a glass

of water or would like to contact family or

friends. They communicate with the health

care team to make sure the patients’ needs

and concerns are promptly addressed.

“Our main job is to advocate for the pa-

tients,” Crane explains. “We help make their

stay at Providence Saint John’s as pleasant as

it can be. No one wants to come to the ER, but

we try to make the patient comfortable and the

experience as stress-free as possible.”

The Angels were the recipients of an

award from the American Hospital Associa-

tion in 2011 for Volunteer Excellence.

Examining Acupuncture for Side Effects of Breast Cancer Treatment

The Angels are Outfitted

in good health


All Hands on Deck

Research led by Daniel F. Kelly, MD, director of the Brain Tumor

Center and Pituitary Disorders Program at Providence Saint John’s

Health Center, adds to the growing concerns about the long-term

repercussions of brain trauma suffered by football players. The study,

published recently in the Journal of Neurotrauma, found that multiple

concussions were associated with reduced levels of some hormones

and that diminished hormones increase the risk of other disorders.

The impact of multiple concussions in athletes of all ages is one of

the most pressing issues in sports medicine and neurology. The study

by Dr. Kelly adds to the list of potential complications from multiple

concussions. He analyzed 68 retired NFL players who were, on average,

47 years old and who had an average of three concussions and a poor

quality of life based on mental component scores.

The study found deficiencies in either growth hormone, gonad-

otropin or testosterone in 23.5% of the retired players. Men with

reduced levels of growth hormone typically have high levels of fats

and cholesterol in the blood and can have an increased risk of heart

disease and diabetes. Deficiencies in testosterone and gonadotropin

can impact mood and contribute to erectile dysfunction.

Infection control is always a priority at Providence Saint

John’s Health Center. However, with the first cases of Ebola

virus infection recently confirmed in the United States, the

health care staff has been undergoing additional training

to ensure preparedness to treat an Ebola patient while

protecting the staff and other patients.

Numerous occupational safeguards are undertaken as

part of this response plan. For example, in caring for a

patient with Ebola, all donning and doffing of their personal

protective equipment—such as gowns, gloves and masks—

would be under supervision, and health care workers will not

be permitted to enter or exit a room without the approval of

a safety officer.

The Health Center also is conducting drills to familiarize

the staff with recently released government protocols

regarding donning and removing personal protection

equipment. In one exercise designed to help employees

use personal protective equipment, water color paints are

dabbed on gloves, gowns and masks before employees

practice removing their gear. The protective gear has to be

removed without paint transferring to the skin or clothing,

indicating that the protocol was followed successfully.

Numerous employees are involved in planning for a

possible Ebola patient, and Providence Health & Services

hospitals are sharing resources. One Providence hospital, St.

Patrick’s, in Missoula, Montana, is one of the four Biosafety

Level 4 facilities in the country.

Shopping on Amazon can now benefit the research at John Wayne

Cancer Institute at Providence Saint John’s Health Center. Just log

in to your Amazon account at smile.amazon.com and type “John

Wayne Cancer Institute” in the search bar. Select the Institute and

begin shopping. Amazon will automatically donate a half-percent

of your total purchase to the Institute every time you shop.

Multiple Concussions Alter Hormones

in good health


Do people know when

to use—or not use—the

emergency room?

“Most people who come

here are pretty sick. One in

four patients who visit the ED stay in the hos-

pital. So on average, the people who come here

need to come.”

Is it hard for people to know when to

come to the ER for flu symptoms?

“It can be hard to know. If they have symp-

toms of the flu or common cold and it’s some-

thing similar to what they’ve had before, they

usually don’t need to come to the emergency

department. They should call their primary

care doctor. But if they think its qualitatively

different and they aren’t feeling particularly

well, especially if they are older or have a co-ex-

isting illness like diabetes or an autoimmune

illness, they should come to the emergency

department. But even as a mere courtesy, peo-

ple should call their primary care provider and

let them know they are going to the emergency

department, because their doctors may want to

provide important information to us about how

to best manage the patient.”

How do you manage the emergency

department during particularly

challenging flu seasons when things

get very busy?

“We’ve had flu seasons where there have

been epidemics. We’ve instituted careful

measures for the waiting room and in triage.

For instance, we put a mask on anyone with flu

symptoms. We take pains to make sure they

don’t infect other patients, and we keep them

in an isolated part of the emergency depart-

ment. We try to run a rapid screen on them

to see if they have influenza. Then, if they are

really unwell and have something else going

on like dehydration or pneumonia, then they

would get admitted.”

Do you practice for outbreaks of

communicable diseases, like flu or

measles or pertussis?

“Yes. We get regular updates from the

Los Angeles County Communicable Dis-

eases Agency to keep us updated on what is

going on in the county. Right now, there’s

an outbreak of measles and pertussis, so

I’m constantly updating our nurses and

doctors on those illnesses. I also get Centers

for Disease Control and Prevention updates

about communicable diseases, such as the

Ebola virus. We have a plan to manage any

of these diseases. I’m always circulating the

criteria for diagnosis among the emergency

department staff and what one would do if

they thought they had a patient with a serious

communicable disease. We also have disaster

management teams for any type of disaster,

whether that’s a disease outbreak or a bomb

or radiation leak. A lot of planning goes into

running an emergency department!”

What’s your best advice for avoiding

the flu or a communicable disease?

“The most important thing you should do is

get the flu shot. Just yesterday, an article came

out that said in an office setting, a virus spreads

within two to four hours of the sick person

entering the building. The best possible advice

to give people is that they really can’t wash

their hands enough. Hand-wash every time

you touch common objects. That is the most

effective way to stop getting sick.”

The emergency room at Providence Saint John’s Health Center can be a busy place, especially during the cold and flu season. We asked

Russ Kino, MD, director of emergency services, how he manages the ER during oubreaks of infectious disease and potential threats like Ebola.

Russ Kino, MD

Making Good Use of the Emergency Department During Flu Season

in good health


LOCATION

Providence Saint John’s Health Center’s emergency

room is now located on Arizona Avenue on the first

floor of the Howard Keck Center. The ER is situated

close to imaging and diagnostics and is a straight elevator ride up to

surgery, the cath lab and labor and delivery.

PARKING

Having the ER’s entrance facing Arizona Avenue

has also greatly improved parking. Valet parking is

available 24 hours a day, seven days a week.

FAST TRACK TREATMENT FOR MINOR AILMENTS

Fast Track is designed to improve the experiences

of emergency room patients who come in for minor

ailments, such as a laceration or sprained ankle. These patients are

directed to a dedicated area where they can be treated and discharged

without waiting for more complex or serious patients to be seen. The

goal is to expedite care so we can get patients in, out and home.

YOUR GUIDE TO THE EMERGENCY DEPARTMENT AT PROVIDENCE SAINT JOHN’S HEALTH CENTER

ARIZONA AVENUE

21ST

22N

D

23R

D

ST JOHN’S HEALTH CENTER

ER

The emergency department sees more than 30,000 patients each year and strives to provide the best possible treatment and experience for patients. Here’s a snapshot of what makes this ER special.

STATE-OF-THE-ART CARE

The emergency department is equipped with the latest

technology to handle a vast range of critical condi-

tions. These include:

• Critical airway equipment that allows physicians superb visualization

of the airways when a patient is experiencing respiratory difficulty

requiring intervention.

• Arctic Sun hypothermia technology that is used to carefully and grad-

ually lower body temperature in cases of cardiac arrest. The cooling

minimizes damage to tissues that have been starved of oxygen.

COMFORT

Saint John’s Health Center’s emergency room features

27 spacious private exam rooms with TVs, phones

and Wi-Fi access. The rooms are designed to allow

procedures to be performed at the bedside and provide patient privacy

throughout the procedure. Our patients also receive attention from

members of the award-winning Angels of the ER volunteer group. The

volunteers assist with patient comfort and communicating with relatives

and the medical staff.

PRIVACY

Bedside registration allows emergency department

personnel to gather patient information while patients

are resting in a private area, rather than waiting for

assistance in the reception room.

PHYSICIAN PERFORMANCE

Providence Saint John’s Health Center emergency

room physicians are ranked in the 94th percentile in

patient satisfaction by Press Ganey, an independent

health care consultation company that provides comparative hospital

data nationwide.

in good health


Nationally known hospital administrator Marcel Loh took the reigns in Septem-ber as chief executive of Providence Saint John’s Health Center and the John Wayne Cancer Institute.

Loh previously served for 14 years in executive roles with Providence affiliate Swedish Health Services, a five-hospital, not-for-profit system in greater Seattle. He holds a master’s degree in hospital administration and served as an Army officer in the Medical Service Corps, retiring from the Army Reserve as a lieutenant colonel.

Loh also has been active in regional and national health care industry groups. He is the past chairman of the Washington State Hospital Association, a fellow in the American College of Healthcare Exec-utives (ACHE) and serves on the ACHE national Board of Governors. We sat down with Loh after his first week on the job to learn more about the new chief.

What led to

your interest in

health care?

“I knew I wanted

to be in health care

and, as a third-year

medical technician student, realized that

the business classes I was taking on the side

were more intriguing to me. It was then that

I found a way to put medicine and business

together and knew I could still focus on a ca-

reer that could help people. Health care and

medicine are about the patient and improving

care to the patient.”

Introducing Marcel Loh, the Health Center’s New Chief Executive

in good health


Did you learn anything from your

military experience that has helped

in your health care career?

“I took a lot of lessons away from my

experience in the military. People think

if you’re in the military all you do is bark

orders. But it allowed me to be in leadership

positions and learn leadership skills much

earlier than I normally would have. I also

had the opportunity to serve my country.”

What excites you the most about join-

ing the leadership team at Providence

Saint John’s Health Center?

“I was fortunate to be part of a fact-finding

team exploring the possibility of adding Saint

John’s to the Providence Health & Services

system. Through this process I visited with

about 20 to 25 physicians over a few days.

There was something special about Saint

John’s that I had not seen in my 30-plus years

in health care. It was the passion and commit-

ment and loyalty of the physicians and others

I met. It almost gave me goose bumps. Saint

John’s has this welcoming family feel I never

have seen before. My wife Jane and I are both

very excited to be joining the Saint John’s

family and being a part of the very special

and unique Santa Monica community. We’re

humbled by the opportunity.”

What do you see as the Health

Center’s strengths?

“I see many strengths: the family feel,

impressive physicians, a dedicated and pas-

sionate board of directors and Foundation

board of trustees, the national recognitions

of quality and safety, and most of all, the

focus on the patient.”

It’s been called a community

hospital with academic medicine.

Is that your impression?

“Yes, and in my short time here, I would

describe Saint John’s as a community hos-

pital on steroids. There is much more going

on than a typical community hospital: the

education, the research, the John Wayne

Cancer Institute, and the degree of commu-

nity support. All of this was an added bonus,

which attracted me to Saint John’s.”

Do you see the John Wayne Cancer

Institute as an example of combining

research, education and health care?

“Yes. The John Wayne Cancer Institute

is probably one of the most unique insti-

tutes of the whole Providence system. The

physicians and researchers have been part

of many firsts in cancer breakthroughs. I

think there is a tremendous opportunity for

growth, and I’m excited to be able to work

with the Institute team.”

At Swedish Health Services, you were

involved in many innovations in health

care. Can you tell us about some of the

projects you oversaw there?

“I was the executive leader that helped

develop the Swedish Neuroscience Institute

and the Swedish Heart & Vascular Institute.

Now both are nationally recognized. I’m

very proud of that. As I look at Saint John’s,

we already offer world-class health care in

many areas and we have all the elements to

expand our world class services.”

You’ve been involved with the Amer-

ican College of Healthcare Executives

in leadership positions. What are some

of the most pressing issues today for

healthcare administrators?

“I’ve been a long-time member of the

American College of Healthcare Execu-

tives, and I’m a fellow, which is considered

board-certification for health care leadership.

A challenge for health care leaders today

is the major pace of the change. With the

Affordable Care Act and health care reform,

we’re all learning what the new environment

looks like—with population health manage-

ment, challenges with reimbursement and

physician alignment. My association with the

ACHE allows me the opportunity to not only

speak about these challenges but to learn

from my colleagues.”

Can you tell us a little about your family?

“Jane and I have been married for 36

years, and Jane has been a very active hospi-

tal volunteer. In Seattle, she volunteered at

the hospital one day a week and was active

in the fundraising of the foundation. Jane is

a retired teacher who taught both elementa-

ry education and music. We have two grown

children, Ashley and Aaron. We enjoy the

arts, music and theater and are avid boaters.

I’m an avid Seattle Seahawks football fan.

Since Los Angeles doesn’t have a team, I will

remain a Seahawks fan.”

Are you looking forward to

Southern California life?

“One thing about living in Seattle is we

have a lot of overcast days. I’m going to

enjoy seeing more sunshine.”

in good health


Community Connections: Getting to Know Providence Health & Services

Providence Health & Services has

named Patrick Soon-Shiong, MD,

as the new global director for cancer

services and bioinformatics. Dr.

Soon-Shiong is a physician, surgeon

and scientist known globally for

applying the limitless potential of

collaborative science and technology

to improve the health and well-

being of patients battling life-threatening disease. He will work

closely with oncology clinicians and researchers at Providence and

its affiliates to ensure every member of our communities, especially

the poor and vulnerable, has access to the latest and most promising

cancer treatments.

Genomics and molecular data represent the most innovative

approach to cancer risk prevention and treatment, providing

physicians with information needed to personalize cancer care.

“We are living our commitment to clinicians and patients alike,”

Dr. Soon-Shiong says. “Partnering with Providence and the many

clinicians treating cancer patients across its five-state system will

dramatically advance how we care for people facing cancer.”

Dr. Soon-Shiong is a longtime supporter of the John Wayne Cancer

Institute at Providence Saint John’s Health Center. He is also the

chairman of the Chan Soon-Shiong Family Foundation, chair and

CEO of the Chan Soon-Shiong Institute for Advanced Health, and

of NantHealth—a health care company that focuses on innovative

technologies to improve care.

Providence also is entering into a partnership to create the

country’s first clinical network for whole genomic sequencing. This

effort is a collaboration among Providence, NantHealth and the Chan

Soon-Shiong Institute of Molecular Medicine.

Providence Health & Services,

Southern California, is establishing

a center devoted to research on

end-of-life care and changing the

conversation around how to best

meet the needs of the dying. The

Institute for Human Caring will

support patients, families and

clinicians across the five states with

Providence facilities and will serve as a national resource.

Based at Providence TrinityCare Hospice in Torrance, the Institute

will be led by Ira Byock, MD, as chief medical officer. Dr. Byock is a

leading authority on end-of-life care. He has been recognized as a

visionary by the Academy of Hospice and Palliative Medicine and has

received the academy’s Lifetime Achievement Award.

The institute represents a major commitment by Providence to

accelerate value-based and whole-person health care for frail elders

and seriously ill or otherwise vulnerable patients and their families.

The goals of the center include generating greater attention to the

personal side of illness, dying, caregiving and grieving.

“There really is a crisis in the way we die,” Dr. Byock says. “When

patients are faced with a crisis and they have not discussed their

wishes with family and care providers, there is a tendency to bring

the best medical treatment to bear without considering that there is a

whole human being with personal needs.”

Part of the institute’s mission will be to help the entire Providence

system embrace the full range of end-of-life care responsibilities—

including meeting the needs of family members, managing the

patient’s pain and addressing the patient’s spiritual needs.

Providence Focuses on End-of-Life Care

Dr. Patrick Soon-Shiong to Direct Cancer Genomics Services

Earlier this year, Saint John’s joined Providence Health & Services and is now part of an expansive

health care network featuring six hospitals and other ancillary health services. Here’s a look at

some of the resources available within the Providence network.

Ira Byock, MD Patrick Soon-Shiong, MD

in good health


Healthful EatingThis festive salad is filling enough to serve as a side dish or dessert at your holiday dinner. Packed with fruit and nuts, it’s a delicious alternative to traditional Waldorf salad or a high-calorie dessert.

Courtesy of Mary Rotolo, RD, Nutrition & Diabetes Education, Providence Saint John’s Health Center

Cranberry-Waldorf Molded SaladServes 16

1 package sugar-free Jell-o, either cherry or cranberry (8-serving size box)2 cups boiling water2 cups cold water4 cups fresh cranberries 2 large (about ¾-pound) oranges, peeled and seeded

2 large (about ½-pound) red apples, cored2 cups celery, chopped1 cup chopped walnuts or almondslettuce leaves, rinsed (optional)

Mix Jell-o with boiling water, stirring until dissolved. Add cold water. Chill until thick, about 20 minutes. Coarsely chop cranberries (a mini-food processor works great). Chop oranges, apples and celery into ¼-inch cubes. Mix fruit with thickened gelatin. Add celery and nuts. Spoon into a large, fancy glass bowl or two 5- to 6-cup Jello molds. Chill for at least 4 hours or until the next day.

Serve in the bowl or un-mold onto a platter. To remove salad from mold, dip mold in warm water and wait until salad breaks away from side of mold when gently shaken, about 2 minutes. Invert serving platter on top of mold. Holding tightly together, flip mold over onto platter. Remove mold. Tuck lettuce leaves under edge of salad.

Nutrients per serving:Calories: 84Fat: 4.5 grams Carbohydrates: 10 gramsDietary fiber: 3 grams

DID YOU KNOW? Cranberry is one of only three fruit species that are native to North America. It belongs to the same family of fruits as blueberry and bilberry, which also are plants native to North America. Juice and extracts from the fruit were used as medicine by Native Americans, and the fruit was prized as a treatment of urinary conditions. Even today, cranberry is used to pre-vent urinary tract infections. Scientists believe that some of the chemicals in cranberries keep bacteria from stick-ing to the cells that line the urinary tract where they can multiply.Source: National Institutes of Health

in good health


Providence Saint

John’s Health Cen-

ter is now home to

a clinic specifically

devoted to the

diagnosis, treat-

ment and research

of a mysterious

condition called

normal pressure hydrocephalus. Normal

pressure hydrocephalus (NPH) is caused

by a build-up of cerebrospinal fluid in the

crevices of the brain.

The condition causes dementia,

difficulty walking and incontinence.

But unlike many other diseases that

cause dementia, NPH can be treated

if caught early, with many patients

recovering full cognitive function.

The condition occurs if the normal flow of

cerebrospinal fluid throughout the brain and

spinal cord is blocked in some way, such as

by a tumor, infection or hemorrhage. This

obstruction causes the ventricles to enlarge,

putting pressure on the brain.

It’s not clear how many people develop

NPH; however it’s most common in people

age 70 and older. With proper screening

by their primary care physicians, patients

with this disorder can be identified for fur-

ther evaluation.

The new Adult Hydrocephalus and Neu-

roendoscopy Center at Providence Saint

John’s Health Center will provide an ob-

jective, systematic course of treat-

ment and follow-up. Data will be

compiled to help measure and

monitor progress.

There are similar cen-

ters, but typically at aca-

demic medical centers.

The program at Provi-

dence Saint John’s will

provide expertise and

research in the com-

munity, making it

simple for patients

to be treated

and return for

follow-up visits.

There are

many advantages

for patients who seek

care at a dedicat-

ed center for this

condition, says Garni

Barkhoudarian, MD, a

neurosurgeon and assis-

tant professor of neuroscience and neuro-

surgery at the John Wayne Cancer Institute.

Patients receive multidisciplinary—neuro-

surgery and neurology—evaluation and

treatment for normal pressure hydroceph-

alus as well as other disorders. Dr. Bark-

houdarian manages the clinic with David

Franc, MD, a neurologist who specializes in

dementia and neuroimaging.

“We have a formalized protocol for diag-

nosis, work-up, treatment and post-surgical

evaluation, including metrics, to monitor the

progress of each patient,” Dr. Barkhoudarian

says. “For adult patients with hydrocephalus

due to lesions in the brain, such as colloid

cysts or tumors, our neuroendoscopic tech-

niques allow for appropriate and minimally

invasive methods to surgically treat these

patients. Finally, differentiating between

NPH and non-NPH conditions is critical with

regards to assessing the patient and identi-

fying the correct diagnostic and treatment

pathways for each patient.”

Dr. Barkhoudarian, who is also director of

the skull-base and endoscopic microdissec-

tion laboratory, treats NPH patients at Prov-

idence Saint John’s, some with remarkable

results. There are two standard courses of

treatment: the surgical placement of a shunt

to drain fluid to the abdomen where it can

be absorbed as part of the normal circula-

tory process, or utilizing an endoscope to

bypass the blockage in the brain.

Treatment can help improve ambulation,

memory and incontinence by decreasing

the size of the brain ventricles. Regular

follow-up care by a physician is important in

order to identify subtle changes that might

indicate problems with the shunt or bypass.

Physicians will continue to research

the condition to improve their under-

standing of it and will follow patients to

assess outcomes.

Clinic Specializes in Normal Pressure Hydrocephalus

Dr. Garni Barkhoudarian

in good health


Kids and Those Darn Vegetables

Can good health habits spread throughout a community?

According to a new study, the answer is yes—and the way these

health habits spread may surprise you.

Previous studies suggest that environments can clearly

affect poor cardiovascular health. For example, residents of

neighborhoods with lots of fast-food restaurants, high crime

rates and few safe parks often have increased rates of heart

attacks and strokes.

The new study looked at something called “neighborhood

cohesion.” This measure reflects whether people feel their

neighbors are trustworthy, friendly and would help them during

times of trouble.

The study examined data from more than 5,000 American

adults and tracked their cardiovascular health for four years. The

researchers found that the more social cohesion in a neighborhood,

the lower the risk of having a heart attack. The association was true

despite other neighborhood characteristics, such as socioeconomic

status and individual household social support.

Tight-knit neighborhoods, the authors wrote, may help reinforce

positive health behaviors and discourage negative ones. The

research was published in the journal BMJ.

Americans need to eat more fruits and vegetables to

become healthier. Recent statistics from the federal

government show modest improvements in fruit

intake among children ages 2 to 18 over the past

decade, although vegetables are still largely sitting

untouched on kids’ plates.

The study was part of the expansive National Health

and Nutrition Examination Survey released every two

years in the United States. Between 2003 and 2010,

whole fruit intake among kids increased 67% while

intake of fruit juice declined slightly. Still, 60% of

children consume fewer fruits than recommended.

The findings on veggies were worse. There was no

change in total vegetable intake from 2003 to 2010—

despite a growth of programs, including healthier

school lunch programs, meant to encourage

vegetable intake. About 93% of kids consume fewer

vegetables than recommended. White potatoes

accounted for an average of 30% of total vegetable

intake over the study period and were consumed

mainly as less healthy forms of potatoes, such as

fried potatoes and potato chips.

Get Healthy Santa Monica

WHOLE FRUIT

FRUIT JUICE

VEGETABLES

03-0

40

3-04

03-0

40

9-100

9-100

9-10

0.40

0.24

0.31

0.22

0.55

0.54

Cup equivalents per 1,000 calories

Source: Vital Sings: Fruit and Vegetable Intake Among Children —United States, 2003-2010, MMWR, Vol. 63, Aug. 5, 2014.


on the horizon

NOVEMBER—DECEMBER The Type 1 Diabetes and Insulin Pump Support Group Providence Saint John’s Health Center

People with type 1 diabetes and insulin pump users are welcome at this monthly meeting of education, infor-mation sharing and discus-sions on managing therapies. This support group helps make living with diabetes eas-ier. Please feel free to bring dinner or a snack.

Tuesday November 25, 6:30 to 8 p.m.Tuesday December 30, 6:30 to 8 p.m.Please see information on the room location at the Health Center information desk. For more information: Dalia Dvoretsky, 310-829-8077

Childbirth Preparation Classes and Maternity ToursProvidence Saint John’s Health Center

Two-part childbirth educa-tion classes: December 2 and 9, 5:30 to 8:30 p.m. One-day class: December 6, 10 a.m. to 4 p.m. Classes meet in the Howard Keck Center, third floor.

Maternity tours begin at the Howard Keck Center and are approximately two hours long:November 20 – 11 a.m. & 2 p.m.November 22 – 10 a.m. & 12:30 p.m.November 26 – 3 p.m. & 6 p.m. December 11 – 11 a.m. & 2 p.m. December 13 – 10 a.m. & 12:30 p.m. December 16 – 3 p.m. & 6 p.m.December 18 – 2 p.m. & 4 p.m.December 20 – 10 a.m. & 12:30 p.m.December 30 – 11 a.m. & 2 p.m.

Three-hour breastfeeding class to help prepare expecting women: December 23, 2 to 5 p.m.

Three-hour baby care class for expecting parents: December 3 – 5:30 to 8:30 p.m. December 7 – 10 a.m. to 1 p.m. December 7 – 1:30 to 4:30 p.m.

For more information or for reservations: Elsa Ruedas, 310-829-8887 or [email protected]

JANUARY 31, 2015California Hormonal and Pituitary Patient Health SymposiumLoew’s Santa Monica Beach Hotel1700 Ocean Avenue, Santa Monica, 8 a.m. to 5 p.m.

The Pituitary Network Association and Saint John’s Brain Tumor

Center will sponsor a patient health symposium for people with hormonal and pituitary disorders. The day-long sym-posium will feature presenta-tions by physicians as well as patients and family members. Patients will learn how to be their own best advocate in obtaining high-quality health care. Continental breakfast and lunch are included with the $30 registration fee. For more information: pituitary.org/events

HOSPITAL EVENTS


on the horizon

NOVEMBER 1 THROUGH JANUARY 22, 2015ICE at Santa Monica1324 5th Street, Santa Monica

Enjoy beachside ice-skating during the holiday season at the ICE outdoor rink on the corner of 5th Street and Arizo-na Avenue. The 8,000-square-foot rink also has a private event cabana, and begin-ners can sign up for skating lessons. The Grand Opening celebration will be held on November 6.For more information: 310-260-1199 or downtownsm.com/ice

NOVEMBER 11STEAM MachineSanta Monica PierNoon to 5 p.m.

The second annual event celebrating science, technol-ogy, engineering, arts and mathematics with a special Rube Goldberg machine competition on the Pier.For more information: 310-458-8901 or santamonicapier.org

NOVEMBER 222014 Southern California MG WalkOcean View Park9 a.m. to noon

All ages are invited to participate in this charity walk to raise funds and awareness for Myasthenia Gravis Foundation of America.For more information: mgwalk.org

DECEMBER 5Montana Avenue Holiday WalkMontana Avenue5 to 9 p.m.

Walk Montana Avenue from 6th to 17th streets to find gifts, have your photos taken with Santa, listen to live music and indulge in great food and drinks! This annual night is a wonderful way to spend time with neighbors, friends and family.For more information: montanaave.com/event/montana-ave-holiday-walk

DECEMBER 6Main Street Holiday PartyMain Street6 to 9 p.m.

You’re invited to the Main Street Holiday Party. Following the tree lighting at the museum, take part in a candlelight walk to the famous Shopping Cart Tree at Edgemar Courtyard.For more information: mainstreetsm.com

DECEMBER 6Santa Monica-Venice Christmas Run2600 Barnard Way, Santa Monica7 to 11 a.m.

Come join the running commu-nity as it kicks off the holiday season at the 37th annual Christ-mas Run. Exhibit your brand to runners and their families before and after the race at the exclu-sive Finish Line Expo. Registra-tion opens at 6 a.m., followed by the 7:30 a.m. 10K start, 9:30 a.m. 5K start and 10:30 a.m. Kids Fun Run start.For more information: christmasrun.com

JANUARY 17, 2015Lei-Out Beach Ultimate Frisbee TournamentCentral Beach9 a.m. to 5 p.m.

The 16th annual co-ed Lei-Out Tournament will feature top beach volleyball players repre-senting more than 200 teams. For more information: leiout.com

COMMUNITY EVENTS


We are a nation of heart disease.

That’s been true for many

decades, and with high rates of

obesity, it will continue to be a fact for years

to come. Yet deaths from heart disease and

strokes in the United States have fallen, and

patients today generally suffer less disability

and discomfort from heart disease than in

previous generations.

Ranked among America’s 100 Best Hos-

pitals for Cardiac Care™ for the past four

years by Healthgrades™, Providence Saint

John’s Health Center’s cardiovascular health

team is leading the way in improving lon-

gevity and quality of life for patients. From

new minimally invasive surgical techniques

to better imaging to new implantable devic-

es, the Health Center is home to a number of

leaders in cardiology. Here’s a look at some

of the recent advances.

THE WATCHMAN DEVICE

FOR ATRIAL FIBRILLATION

Atrial fibrillation, or A-fib—a heart rhythm

abnormality affecting 6 million Americans—

occurs when the heart beats erratically. That

can lead blood to clot in the heart’s left atrial

appendage. The condition is progressive

and, if untreated, can lead to chronic fatigue,

congestive heart failure and stroke.

Patients can be treated successfully with

medications, such as the blood thinner

warfarin, but about half of all patients are

not able to control their abnormal heart

rhythms with drugs or can’t tolerate the

side effects. Warfarin lowers stroke risk, but

blood levels of the drug must be frequent-

ly monitored because they can be easily

thrown off by foods and other medications.

Blood thinners also have another more

obvious disadvantage—they increase the

risk of bleeding, posing a particular problem

as people age and the risk of falls increases.

“We’re stuck in a difficult position with el-

derly patients,” says Shephal K. Doshi, MD,

director of cardiac electrophysiology and

pacing at Providence Saint John’s Health

Center. “It’s a catch-22.”

Written by SHARI ROAN

Cardiovascular disease still affects many Americans, but the doctors at Providence Saint John’s are at the forefront of treatment and research.

PIONEERS in Heart Care

Pioneers in Heart Care


The Watchman device is an expandable

metal cage that looks like a parachute. It’s

guided through a catheter inserted into a

vein in the leg to the atrium to block the

appendage so blood can’t collect and clot.

Older patients with A-fib who take blood

thinners are ideal candidates for the Watch-

man device.

“It offers a way to seal off this pouch and

reduce the risk of stroke so people don’t

have to take blood thinners,” says Dr. Doshi,

who was a pioneer in using the device in

the United States and worldwide. “The data

show that the Watchman was better than

warfarin in reducing stroke and improving

survival. Patients get the benefit of blood

thinners without the risk of bleeding.”

Dr. Doshi spearheaded the trial at Prov-

idence Saint John’s and has performed

around 300 Watchman procedures—more

than anyone in the United States. Although

the Watchman does not have the Food and

Drug Administration’s approval yet, it could

come soon. An advisory committee already

has voted in its favor. Once approved, the

device will likely be covered by Medicare.

THERMOCOOL

The Health Center recently became the first

hospital in Southern California to offer the

Thermocool Smarttouch Catheter, the first

catheter approved by the FDA to feature

direct contact force technology for the treat-

ment of atrial fibrillation.

Catheter ablation is a minimally invasive

treatment for atrial fibrillation. Doctors

insert a catheter through a small incision in

the groin, which is then guided to the heart

through a blood vessel. Once it reaches

the left upper chamber of the heart—the

atrium—the catheter delivers radiofrequen-

cy energy to the heart wall to create lesions

that block faulty electrical impulses that can

cause heart rhythm disorders.

The Thermocool catheter enables doctors

to more accurately control the amount

of force applied to the heart wall during

radiofrequency ablation procedures, thus

improving safety and efficacy.

“Consistent and stable application of

contact force against the heart wall has been

demonstrated to have a significant impact

on patient outcomes during catheter abla-

tion,” says Dr. Doshi. “Without this technol-

ogy, doctors have to estimate the amount of

force being applied to the heart wall through

other indirect measures that have been

shown not to be as effective.”

MINIMALLY INVASIVE TREATMENT

FOR PERIPHERAL VASCULAR

DISEASE—INTRODUCING TAVR

Peripheral arterial disease is a type of

cardiovascular disease that causes restricted

blood flow due to obstructions in the

arteries and veins of the legs. It affects more

han 8.5 million Americans. Today, however,

a number of surgical advances have made

treatment of arterial occlusive disease easier

than ever, says Rajeev Rao, MD, a vascular/

endovascular surgeon at Providence Saint

John’s Health Center.

Doctors are using minimally invasive

endovascular techniques to treat these

conditions, sparing patients from open

surgery. Endovascular surgical techniques

used for arterial occlusive disorders include

catheter-based treatments that require only

puncture wounds and spare the patient from

an open surgery requiring large incisions.

“With endovascular repair, the risks

of treatment have gone down,” Dr. Rao

explains. “In the past, these patients had to

manage with bigger surgeries, and there was

a higher risk with those open surgeries. But

now that we can do it minimally invasively,

we can try to treat these patients instead of

managing it with medication alone.”

Dr. Rao and his colleagues can also treat

peripheral aneurisms—a weak area of a

blood vessel that expands or bulges—with a

minimally invasive technique called periph-

eral endovascular aortic repair.

“Especially with aneurisms, these patients

would have been told they were not surgical

candidates at all,” Dr. Rao says. “Now we

can treat them with minimal risk, and most

can be treated as an outpatient. That’s a big

advance. The need for a big hospitalization

and major recovery are a thing of the past.”

MINIMALLY INVASIVE HEART

VALVE REPLACEMENT

The Health Center’s valve clinic has in-

troduced a new type of valve replacement

called transvascular aortic valve replace-

Peter Pelikan, MD Nicole Weinberg, MD Shephal K. Doshi, MD



ment (TAVR). This minimally invasive pro-

cedure involves repairing a damaged valve

without removing it.

To perform TAVR, surgeons place a

collapsible replacement valve through a

catheter into the old valve, similar to placing

a stent in an artery. Once the new valve is

expanded, the old valve is crushed out of the

way and the new valve takes over the job of

regulating blood flow.

Traditional surgery requires opening the

sternum and putting the patient on a heart-

lung machine, and thus completely stopping

the heart, while surgeons replace the faulty

valve with an artificial one.

“TAVR is far less stressful for the patient,”

says Peter Pelikan, MD, medical director of

Saint John’s Cardiac Catheterization Lab-

oratory. “Valves are put in either through

an artery in the groin or a small incision in

the chest. The heart keeps beating, and the

patient avoids all the trauma of opening the

chest and cardiopulmonary bypass.”

In addition to suffering less pain, patients

typically experience a quicker and easier re-

covery. Carefully selected candidates for the

procedure are people for whom open-heart

surgery is too risky, generally older patients.

To properly assess prospective patients,

the hospital is laying the groundwork for

a multi-specialty valve clinic. The clinic

will allow “one-stop shopping,” Dr. Pelikan

says. Patients will be evaluated by differ-

ent practitioners—cardiologists, surgeons,

nurse practitioners—and receive needed

tests, including ultrasounds of the heart

and CT scans.

Importantly, the clinic will allow pa-

tients with valve disease to be assessed

over time—and treated appropriately. The

plan for a multi-specialty valve clinic also

calls for a hybrid operating room, which

combines the functions of a catheterization

lab and an operating room and is equipped

with the advanced medical imaging devices

required to perform minimally invasive

cardiac procedures.

SPECIALIZED CARDIAC CARE

FOR WOMEN

Providence Saint John’s Health Center has

specialists dedicated to treating women with

cardiovascular disease. Heart disease is the

leading cause of death for both men and

women, according to the American Heart

Association. However, women often experi-

ence different symptoms than men.

For example, instead of chest pain and

pressure—one of the traditional symptoms

of a heart attack—women may experience

shortness of breath, pressure or pain in the

lower chest or upper abdomen, lighthead-

edness, upper back pressure or extreme

fatigue. Moreover, some heart condi-

tions, such as coronary microvascular

disease, are more common in women than

in men.

“The message is out there that heart

disease is a leading cause of death among

women, but I don’t think women realize the

magnitude of it,” says Nicole Weinberg, MD,

a cardiologist who specializes in women at

the Pacific Heart Institute in Santa Monica.

“It kills more women than all of the cancers

combined and has some insidious disease

states associated with it that can be ex-

tremely risky.”

Heart disease often develops in women

about 10 years later than men. But women

whose fathers or brothers have been diag-

nosed can take advantage of that informa-

tion to prevent problems linked to heredi-

tary forms of the disease. All women should

understand that their risk for heart disease

rises after menopause.

“We educate women about hormone

changes and what that means,” she says.

“We talk to them about why they are OK for

now but that they can’t just wait for a prob-

lem to come along. You want to attack their

risk factors head-on."

Women often benefit from seeking cardiac

care with a specialist in women’s health,

says Dr. Weinberg, who is board-certified in

echocardiography and nuclear cardiology.

“We don’t feel like we do cookie-cutter

cardiology,” she says. “We take the time to

sift through a patient’s very specific issues

and figure out if there is a test for them that

meets their needs or find an explanation for

something that may be happening. We feel

we are able to sift through a lot of the minu-

tia to get to the root of the patient’s issues.”

STEMI

The Health Center is part of the STEMI

Program—a nationwide initiative developed

TAVR is far less stressful for

the patient.”



0 5 10 15 20 25 30

by the American College of Cardiology and

the American Heart Association to improve

the treatment of patients with symptoms of

a heart attack. STEMI is an acronym for ST

segment elevation myocardial infarction, a

severe type of heart attack that occurs when

the coronary artery is completely blocked.

The program is a collaboration among

hospital emergency departments, cardiolo-

gists and paramedics to ensure that patients

experiencing STEMIs are diagnosed, trans-

ported and treated quickly. The patient is

received in the emergency room and trans-

ported to a team waiting in the cath lab.

The Health Center was named one of the

top 14 hospitals in California for outstanding

heart attack outcomes by the Office of State-

wide Health Planning and Development.

CHANGE OF HEART

600,000Annual U.S. deaths

from heart disease

$108.9 BILLION

Annual cost in health care, medications and lost productivity from

heart disease

#1Stroke is the leading

cause of serious long-term disability

92% Americans who

recognize chest pain as a symptom of heart attack

47% Rate of sudden cardiac

deaths that occur outside a hospital

U.S. deaths attributed to stroke

1 IN 19Americans aware of all

the major symptoms of a heart attack

27%

WHO’S AT RISKAbout half of all Americans have at least one of three key risk factors for cardiovascular disease. Other medical conditions and lifestyle factors also can put people at higher risk of heart disease.

Key risk factors:• High blood pressure• High LDL cholesterol• Smoking

Other risk factors:• Diabetes• Overweight or obesity• Poor diet• Physical inactivity• Excessive alcohol use

Source: Centers for Disease Control and Prevention

DID YOU KNOW?Lifestyle factors have an enormous impact on heart disease. The landmark National Health and Nutrition Examination Survey III Mortality Study, published in 2011, examined the impact of four lifestyle factors in reducing death from cardiovascular disease. People who had these four behaviors had a 65% reduced risk of death from cardiovascular disease: healthy diet, adequate physical activity, never smoked and moderate alcohol consumption.

Source: Ford ES, Zhao G, Tsai J, Li C. Am J Public Health. 2011 Oct;101(10):1922-9.



HEART DISEASE IS THE LEADING CAUSE OF DEATH FOR PEOPLE OF MOST ETHNICITIES IN THE UNITED STATES.

18.0%

24.5%

23.2%

20.8%

25.0%

25.1%

African-Americans

American Indians or Alaska Natives

Asians or Pacific Islanders

Hispanics

Whites

All

BY THE NUMBERS

profiles in health


Lean on MeMembers of an insulin therapy support group find help and camaraderie. Written by ZOE SOPHOS | Photographed by REMY HAYNES

Caution, concern and constant vigilance are realities of ev-

eryday life for individuals living with type 1 diabetes or who

depend on insulin pump therapy. One Thursday evening

each month, Providence Saint John’s Health Center hosts a special

support group for these patients, providing comfort and common

ground amid their daily struggle.

“This support group provides an opportunity for patients to foster

new relationships with others who may share the same concerns and

struggles,” says Dalia Dvoretsky, RD, coordinator of nutrition and

diabetes education at the Health Center. “It’s meant to empower and

encourage patients to manage their diabetes while promoting health.

Feeling connected and being supported is more important than ever

in our high-tech world.”

Unlike type 2 diabetes, type 1 cannot be prevented and is most

commonly diagnosed in adolescents rather than in adults. Individu-

als with type 1 diabetes are completely unable to produce their own

insulin, a hormone responsible for regulating sugar and energy lev-

els. Without insulin, the body cannot absorb glucose—energy stored

in food—and the patient’s cells quickly starve.

Individuals with type 1 diabetes combat this deficiency by giving

themselves insulin, either through injections administered through-

out the day or through an electronic pump that provides the body

Cameron Hall, a longtime member of the insulin-dependent dtiabetes support group (left) and Dalia Dvoretsky, RD

profiles in health


with a continuous supply of insulin. Some

people with type 2 diabetes find more flex-

ibility using insulin pump therapy and are

welcome to join the group.

Because the body’s response to insulin

varies based on a number of factors, in-

cluding food, exercise, stress and emotions,

knowing exactly how much insulin to take at

a given time can be a challenge. Every hour

of the day, patients must perform a com-

plicated balancing act with their immediate

and long-term health at stake.

“Diabetes has the ability to really dictate

your lifestyle from beginning to end,” says

Cameron Hall, a member of the support

group since its inception and a patient at the

Health Center for nearly four decades. “You

can find yourself having a lovely day, but you

may have forgotten to eat, and all of a sud-

den you’re having a hypoglycemic incident

where your blood sugar level drops. You are

literally unable to function properly, and it

puts you at a serious disadvantage.”

All type 1 diabetes patients who use

traditional insulin injections, as well as all

patients with either type of diabetes who

use insulin pump therapy, are welcome to

attend the two-hour-long meetings. Partic-

ipants include men and women, ages of 17

and 70. While their perspectives are unique,

these patients are united in their common

concerns and their determination to live life

to the fullest.

“We’ve talked about exercise, eating

during the holidays, preparing to travel

either domestically or internationally,

sleeping, highs and lows of the day, stress,

and the fact that you cannot ever be without

your insulin supplies because a disaster or

accident could occur,” Hall says. “These are

people who are experiencing the same things

you are. It makes you very comfortable to

know that it’s not just you.”

At these regular meetings, patients can

bring their questions, problems and feelings

to people who will understand. “They live

with diabetes day in and day out. They only

see the physician every few months,” says

Dvoretsky. “It’s good to know what other

people are doing and not feel isolated.”

In addition to providing a forum for open

discussion, the Health Center also brings in

guest speakers such as nutritionists, physi-

cians or diabetes device representatives.

No matter how many or how few people

show up on Thursday nights, the meetings

still go forward. Hall attributes the longevity

of the support group—nearly eight years—to

this type of dedication and attention to the

needs of patients.

“We will provide continuing education so

that patients can learn about different as-

pects of managing diabetes—from new prod-

ucts on the market to carbohydrate counting

that’s specific to type 1,” Dvoretsky explains.

“The group is growing, and we are inviting

people from the community to check it out.

The fact that the group has been around for

so long means it works.”

The support group typically meets the last

Thursday each month, but the schedule can

vary during the holiday season. For more

information on this support group for peo-

ple with type 1 diabetes and those who use

insulin pumps, contact 310-829-8077.

These are people who are experiencing the same things you are. It makes you very

comfortable to know that it’s not just you.”


First the bad news: Lung cancer is

still a really big killer. It’s the #1

cause of cancer deaths in the world.

“Lung cancer deaths exceed those of

breast, colon and prostate cancers com-

bined,” says Clark Fuller, MD, a thoracic

surgeon at Providence Saint John’s Health

Center. “It also used to be a disease almost

entirely of men; that’s completely untrue

now. Women now exceed men in new cases

of lung cancer.”

While the death rate from lung cancer

among men has dropped 21% over the last

35 years, it’s jumped 116% among women,

reports the American Lung Association.

Stopping smoking—or not starting—

remains the single best thing you can do

to avoid developing this often devastating

cancer. (Secondhand smoke, though, can be

an important risk factor as well, particular-

ly if your parents smoked indoors when you

were young.)

However, “Smoking cessation doesn’t

make you immune,” notes Dr. Fuller. “The

latency period between stopping smoking

and the appearance of a first cancer is about

15 to 20 years.”

Like any kind of cancer, the earlier you

detect it, the better your odds of survival.

That’s the main reason that survival rates

remain so poor for this type of cancer. More

than half of people die within a year of

being diagnosed; we’re simply catching the

great majority of cases far too late.

“Most lung cancers are found in the late

stages—Stage III or Stage IV unfortunate-

ly,” says Ali Mahtabifard, MD, a thoracic

surgeon at the Health Center. “A lot of those

patients don’t even see a thoracic surgeon

like myself because it’s already too late.”

To make matters more complicated, says

Dr. Mahtabifard, most malignancies don’t

produce any obvious symptoms, so they’re

found by accident. “Someone may cough

or see a doctor for an unrelated reason,

and they get an X-ray and the doctor says,

‘We saw this on your X-ray.’ They may pick

up lesions on your lung that turn out to be

lung cancer.”

So if that’s the dark side of lung cancer,

the bright side is getting brighter all the

time. For starters, there’s now a significant-

ly better way to screen for this cancer.

“The lungs are a part of the body that’s

GAINING GROUND ON LUNG CANCER

Advances in both screening and surgery can mean much-improved odds for those with this devastating cancer.Written by LORIE A. PARCH

Gaining Ground on Lung Cancer


not easily examined, and a chest X-ray

gives a false sense of security,” because it’s

not very accurate at detecting lung cancer,

says Dr. Fuller. But the recent introduction

of low-dose CT screening, which allows

for multiple, highly detailed images of the

chest using minimal radiation, should help

improve doctors’ ability to find lung cancer

much sooner, when it’s far more curable.

“The results of recent studies show that

low-dose CT scans may reduce deaths due

to lung cancer by 20%” among current and

heavy former smokers, adds Dr. Fuller.

“This is probably going to represent our

main weapon in the arsenal to shift that

paradigm to earlier detection and thus

better outcomes.”

When lung cancer is caught at its earliest

stage (when it’s still just in the lungs), the

five-year survival rate is nearly 75%—a vast

improvement over the 4% survival rate

when the cancer is diagnosed at its most

advanced stage. Lung cancer surgery is

improving as well.

Traditionally, an operation required a

large incision called a thoracotomy that

meant cutting through muscle and spread-

ing the ribs, explains Dr. Fuller. “Then the

patient would spend six months recovering

from that. It’s a big deal; it’s the most pain-

ful incision we do in medicine.”

Quite a few patients would end up with

post-operative pneumonia, he adds, further

lengthening their recovery time. Now,

though, there’s a procedure called video-as-

sisted thoracic surgery (nicknamed VATS),

a minimally invasive surgery that has

numerous benefits for patients.

“We can now do the exact same operation

through three little incisions,” Dr. Fuller

says. “The hospital stay is cut down by

one-third, and recovery and return-to-work

times are greatly accelerated. So it has truly

changed the landscape.”

During a VATS procedure—currently per-

formed in only about one-third of hospitals

in the U.S., including the Health Center—a

thoracic surgeon uses a tiny camera to

obtain a better, more detailed, view of the

chest and lungs when removing the cancer.

“It’s like arthroscopic surgery, but it’s in

the chest. So if someone needs radiation or

chemotherapy after surgery, they also get

to that faster because they recover from the

operation faster,” adds Dr. Mahtabifard,

who is co-author of a leading medical text-

book on VATS.

Lung cancer surgery at the Health Center

can also be done with the help of robotics,

adds Dr. Fuller, who came to Saint John’s

in 2010 and has been doing robot-assisted

surgery for a couple of years.

“Surgical robots used to fill a room, and

now they’re much smaller and the visual-

ization, instrumentation and accessibility

have been dramatically improved,” he says.

“It’s becoming a useful adjunct to chest

surgery at Saint John’s as well, and as with

VATS, this surgery offers a shorter hospital-

ization, lower risk of complications and an

earlier return to full function.”

Such big improvements in surgery can

go a long way toward making a diagnosis of

lung cancer less overwhelming for patients.

“My experience is that it’s not so much

cancer that people are frightened of; it’s

what’s going to happen next,” Dr. Fuller

says. “When a hospital has a good lung

program, you can say, ‘This is what we’re

going to do, and this is the order that we’re

going to do it in.’ That takes a lot of the fear

out of it and people take encouragement

from that.”

Should You Be Screened for Lung Cancer?

Catching lung cancer early is the key to survival, and now there is a reliable way to do just that. In 2011 a landmark study called the National Lung Screening Trial was published, showing people at high risk for developing lung cancer who got low-dose CT had a 20% lower chance of dying from the disease than high-risk individuals who got chest X-rays.

According to December 2013 guidelines from the U.S. Preventive Services Task Force, you should be screened annually for lung cancer with a low-dose CT scan if: you’re between the ages of 55 and 80 and are a current smoker; have quit smoking in the past 15 years; or have a 30-pack-year smoking history. (Pack years are computed by multiplying the number of packs of cigarettes you smoked per day by the number of years you smoked. So if you smoked three packs per day for 10 years, that would equal 30 pack years.)

Right now Medicare and most insurance companies don’t cover screening, so you will likely have to pay out-of-pocket for the test. However, a decision on Medicare reimbursement is expected soon.

Low-dose CT scanning to screen for lung cancer is available at Providence Saint John’s Health Center. For more information call: 310-829-8000, option 2.

November is Lung Cancer Awareness Month. To find out more about screening, smoking cessation and other types of lung disease, go to the American Lung Association at lung.org.

The lungs are a part of the body that’s

not easily examined, and a chest X-ray gives a false sense of security.”

profiles in health


K aren and Peter Register of Santa Monica

brought their two children, Emma and John,

into the world at Saint John’s Health Center.

Today, nearly two decades later, Karen and

Emma are right back where they started—but this time as

hospital volunteers.

“I knew immediately that Karen and Emma were spe-

cial,” says Grenda Pearlman, director of volunteer services

at the Health Center. “They are warm, genuine and friend-

ly. We are really blessed to have them here.”

A FAMILY VALUESeventeen years after Karen gave

birth to Emma, both return to the Health Center to serve others.

Written by ZOE SOPHOS

Photographed by LAUREN PRESSEY

Emma Register (right) and Karen Register

profiles in health


Inspired by Karen’s younger sister, who volunteered as a candy

striper in the 1970s, Emma attended a volunteer meeting at the

Health Center in September 2013, hoping to get involved. Even

though she had already fulfilled her high school’s volunteer

requirement, the 11th-grader was considering a career in health

care and enjoyed working with people. She thought the Health

Center might be a good fit.

Karen accompanied Emma to the meeting, but once she got to

the hospital and listened to Pearlman’s presentation, something

clicked. “It was like a lightbulb going off,” Karen says. “I had this

‘ah-ha’ moment, and I thought, ‘Wow, this sounds amazing.’ I

asked Grenda if she could put me down as a volunteer, too, and it

just snowballed from there.”

The mother-daughter duo soon after received their assign-

ments: Emma in the postpartum unit and Karen as a greeter at

the front desk. Even though they don’t work together directly,

they received training for each other’s roles so they can cover for

one another in a pinch.

“It’s something we can bond over,” says Emma. “I think it’s a nice

time to set apart where my mom can help me or I can help her.”

Karen agrees that there is something special about volun-

teering with her daughter. “A lot of folks are surprised that we

volunteer together. It’s rare to find a 17-year-old and her mom

doing that. It’s nice that Emma sort of puts up with me,” she says,

laughing. “The times that we do overlap, it’s really fun.”

Together, mother and daughter make a one-of-a-kind team,

but it’s their unique personalities that make them ideal volun-

teers. As the first person who patients and family members see

when they enter the Health Center, Karen plays a key role in

directing individuals to the proper place. She volunteers one

morning a week and sometimes works with up to 200 people

over the course of her four-hour shift.

“It’s very busy, which I love, and it’s all about helping people

figure out where they need to be and calming their nerves,” Karen

says. “You feel like you made a lot of people’s visits better just by

being there.”

Pearlman emphasizes the positive role Karen plays at the

Health Center’s Information Desk, a job she does with just the

right mix of kindness, patience and empathy. “Karen’s warm

smile and greeting are a treat for all who enter the Health Center.

She happily escorts visitors to their destinations and never hes-

itates to go above and beyond to meet the needs of people who

approach the Information Desk.”

Just like her mother, Emma also goes above and beyond as

a volunteer in the postpartum unit. Her responsibilities in-

clude passing out hats and booties, making name bracelets and

checking on new moms. The nurses who work with Emma are

most impressed by her ability to read people and quickly size up

any situation—skills that help keep the patients comfortable and

content, Pearlman notes.

“I’m learning how to approach people, and it’s definitely helped

my conversational skills,” Emma says. “I think the reason the moms

enjoy it here is the same reason I enjoy it: the all-around vibe that

you get from the people who work at the Health Center.”

For Karen and Emma, the Health Center and the people who

work there will always be an important part of their lives. “I feel

like I get so much more out of volunteering than the hospital

does for having me there,” Karen says. “It’s very rewarding.”

It’s something we can bond over.”


When Aimee Bower’s feet started hurting during her recreational hikes in the fall of 1999, she didn’t take it too seriously–and neither did her primary care physician. She was diagnosed with metatarsalgia, a sports-related condition marked by inflammation in the balls of the feet.

Her doctor said the pain would go away with the help of foot soaks, well-padded shoes

and some Advil. But over the next few months the pain spread far beyond Bower’s feet, to

her knees, arms, elbows, shoulders, fingers and jaw.

“My symptoms were just getting worse and worse,” says Bower, 44, of Venice, who

works in data analysis. “Everything was hurting. I couldn’t turn the key in my car ignition.

I couldn’t walk upstairs. It hurt to lift my arms to wash my hair. It hurt just to roll over in

bed. It was very scary and extremely painful.”

Bower didn’t get any relief until the following spring when, due to the severity of her

symptoms, she finally was referred to Orrin M. Troum, MD, a rheumatologist at Providence

Saint John’s Health Center. He immediately began treating Bower for rheumatoid arthritis,

an autoimmune condition that attacks the joints and affects an estimated 1.5 million

Americans, mostly women.

The disease usually strikes between the ages of 40 and 60, but it can appear in people

of all ages, even children, according to the Arthritis Foundation. If not detected early,

rheumatoid arthritis can be an extremely painful and debilitating condition.

Without treatment, patients have a 50% chance of total disability within 10 years, says

Dr. Troum, who is a member of the Doctors of Saint John’s medical group. But through

early diagnosis and proper care with the range of effective tools and powerful treatments

available today, patients like Bower can maintain active, healthy lives with remarkably little

or no pain.

Overall, the prognosis for today’s patients getting the standard of care is excellent, Dr.

Troum says. “My goal as a doctor is to get all of my patients in remission or at the point of

The Big Hurt

Rheumatologists have answers for the aches of arthritis.

Written by DAWN HOFFMAN | Photgraphed by MICHAEL NEVEUX

The Big Hurt


low disease activity.”

Much to her pleasure, Bower is now back

to hiking and more. “I can go play volleyball

on the beach for hours and go backpacking

too,” she says. “I’m as active as I’ve ever

been, with no pain or impairment.”

It’s critical for people who suspect a

joint problem to seek early treatment with

a rheumatologist. Many people make the

mistake of brushing off recurring aches,

pains and joint stiffness, especially those that

occur in the mornings, as mere annoyances

that simply will go away on their own.

“Recognize that it’s not just a little

stiffness or a little arthritis,” Dr. Troum

says. And make sure your doctor isn’t hastily

ruling out more serious issues either. “Don’t

let your symptoms be dismissed.”

The pain and suffering of rheumatoid

arthritis results when the immune system

goes haywire and starts attacking the

synovium, the thin membrane that lines

the joints. No one knows the cause of

rheumatoid arthritis, though doctors suspect

that genetics plays a role, as well as smoking

and poor dental hygiene.

When the joints are attacked, fluid can

build up and cause pain, inflammation

and swelling, progressively damaging the

cartilage and bone, decreasing mobility and

potentially causing joint deformities. In

some patients, symptoms may periodically

improve, with periods of mild disease

activity followed by “flares” of increased

disease activity and more symptoms.

Eventually, poorly controlled disease can

affect other areas besides joints, including

the heart, lungs and skin.

The ultimate goal with treatment is to

eliminate disease activity or reduce it to very

low levels. Thankfully, physicians now have

The Big Hurt

an arsenal of medications to help do just

that, including newer medications called

disease-modifying antirheumatic drugs, or

DMARDs, that inhibit inflammation and

work to alter the course of the disease and

prevent joint destruction.

For the last few years, Bower has been in

remission while on a treatment regimen of

methotrexate, a DMARD, and etanercept

(brand name Enbrel), a drug in a subset

of DMARDs called biologic response

modifiers, or biologics. Bower also takes fish

oil supplements for their purported anti-

inflammatory properties.

She couldn’t be happier with her

treatment results. “I feel fine, with no pain,

tenderness or any problems,” she says.

Like many patients, Bower initially used

nonsteroidal anti-inflammatory drugs

and the corticosteroid prednisone to help

control joint inflammation.

Over the years, she also found that Iyengar

yoga has helped. “It felt good, especially in

the beginning when I was really in a lot of

pain,” she says. “It just felt good to stretch

and do something healthy for myself.”

Along with the introduction of the powerful

disease-modifying medications for rheumatoid

arthritis, doctors today also are using newer

imaging technologies to better assess the

health of joints in order to specifically tailor

treatments to individual patients and monitor

their disease progression. In the past, doctors

have used X-rays to view joint damage.

But X-rays aren’t as good at revealing all of

the signs of rheumatoid arthritis—such as

inflammation and bone erosion—compared to

ultrasounds and MRI, and additionally expose

patients to a small amount of radiation, notes

Dr. Troum.

Dr. Troum, current president of The

International Society for Musculoskeletal

Imaging in Rheumatology (ISEMIR), is a

big advocate of the newer imaging scans for

rheumatoid arthritis treatment, especially

in the early stages. Ultrasound and MRI

imaging show how active the disease is in a

patient and how much damage has occurred,

FACTS ABOUT RHEUMATOID ARTHRITIS

Nearly 1.5 million Americans have RA.

The disease affects nearly three times as many

women as men.

RA usually develops between the

ages of 30 and 60 in women and later in life in men.

The severity of RA can vary widely among individuals.

There is no cure for RA, but there are many medications that help

ease symptoms.

Early diagnosis is important to prevent joint damage.

HOW RHEUMATOID ARTHRITIS ATTACKS JOINTS


Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases

(1) The ends of the bones in the joints are covered by a tough, elastic tissue called cartilage. A capsule surrounding each joint is lined with a type of tissue called synovium, which produces synovial fluid, a clear substance that lubricates and nourishes the cartilage and bones inside the joint capsule.

(2) Rheumatoid arthritis is an autoimmune disease which means the immune system, that normally helps protect the body from infection and disease, attacks joint tissues for unknown reasons. White blood cells travel to the synovium and cause inflammation. The synovium thickens and makes the joint swollen, painful and sometimes warm to the touch.

(3) As rheumatoid arthritis progresses, the inflamed synovium invades and destroys the cartilage and bone within the joint. The surrounding muscles, ligaments and tendons that support and stabilize the joint become weak and unable to work normally.


says Dr. Troum, who has published review

articles on the subject. When doctors see

the extent of the disease, they can better

determine whether medications are working

and how aggressive to be with future

treatments, he says.

In a study published last year in the

Annals of the Rheumatic Diseases, for

instance, Dr. Troum and his colleagues

used MRI to gauge the effectiveness of the

biologic drug tocilizumab (Actemra). The

MRIs reliably revealed reductions in joint

inflammation and bone erosion that would

not have been seen on X-ray.

Unlike ultrasounds, MRIs can look

inside bone to reveal inflammation that can

lead to bony erosions. But MRIs also are

more expensive and may not be as readily

available to rheumatologists, Dr. Troum

notes. Both ultrasounds and MRIs can play

an important role in helping patients get

their disease under control and their lives on

track again. Patients should ask their doctors

about the need for imaging scans, he advises.

Looking back at her early struggles with

rheumatoid arthritis, Bower is very thankful

that she found the care she needed with Dr.

Troum at the Health Center.

“When I was first diagnosed, I was in pain

and scared and wondering, ‘What’s wrong

with me?’” Bower says. “I would go online

and get information, and I would end up in

tears reading about people being completely

debilitated. I feel so fortunate to have Dr.

Troum as my doctor. He’s provided such

good care and is so kind. I feel incredibly

lucky and grateful to have him as my

rheumatologist.”

Dr. Troum says top-notch care is the

standard for all patients at the Health

Center. That’s why in addition to being on

the medical staff since 1986, he’s a patient

there, too—with his own personal doctors

on staff.

“The patient care here is superior,” says

Dr. Troum. “It’s a very unique hospital.

The vast majority of the physicians have

been trained locally at USC or UCLA.

It’s an extremely high level of care for a

private hospital.”

Recognize that it’s not just a

little stiffness or a little arthritis,” Dr. Troum says. And make sure your doctor isn’t hastily ruling out more serious issues either. “Don’t let your symptoms be dismissed.”

Orrin M. Troum, MD

The Big Hurt

happenings


Providence Mission and Values Dedication CeremonyA ceremony to unveil and bless the core values and Mission of Providence Health & Services was held September 23 in the Tarble Atrium. Providence Health & Services assumed sponsorship of Saint John’s Health Center earlier this year, and the ceremony was conducted for the Health Center staff to formally accept and adhere to the Providence Mission and values.

New Chief Executive Marcel Loh participated in the dedication by singing “You’ll Never Walk Alone.” The day was part of Mission Week, which included a Living Our Values picnic for all caregivers and Health Center employees and a Table of the King day where soup and salad was provided free of charge to all Health Center staff and visitors.

happenings


Front row, from left: Ryan Sevy, a cardiac arrest survivor; Peter Pelikan, MD; Russ Kino, MD; battalion chief Michael McElvaney; John M. Robertson, MD; Robert Klein; Sister Maureen Craig, SCL; Nicole Weinberg, MD; Irene Bristol, RN; battalion chief Jeffrey Furrows; Debbie Licht, RN; Jeff Arnett, a cardiac arrest survivor.

Dr. Russ Kino on Larry King NowRuss Kino, MD, director of emergency services, appeared on the Larry King Now show on October 11 to discuss how hospitals can prepare for patients possibly infected with the Ebola virus and the precautions and training he helped implement at Providence Saint John’s.

Your Heart and Stayin’ AliveThe Health Center hosted the Your Heart and Stayin’ Alive CPR training event September 7. The Santa Monica Fire Department, Bowers Ambulance and Health Center physicians and staff participated in the education and training of the 160 attendees in compression-only CPR.

John M. Robertson, MD, medical director of cardiothor-acic surgery, moderated the event and served as honorary chair. Heart health educational sessions were given by Providence Saint John’s cardiologists Nicole Weinberg, MD, and Shephal Doshi, MD. Chief Jeffrey Furrows of the Santa Monica Fire Department presented information about the need to call 911 immediately when a cardiac event is suspected and to begin CPR if the person is in cardiac arrest.

Survivors of cardiac arrest and family members celebrated life with remarkable accounts of heroic efforts and the power of prayer. Supported by Saint John’s Health Center Foundation, this program was planned for Grandparents Day to encourage the entire family to attend and learn compression-only CPR.

happenings


NICU ReunionAfter caring for an ill or premature baby for many days, weeks or months, it can be hard for caregivers and families to say good-bye to each other. The biannual Neonatal Intensive Care United (NICU) reunion allows doctors, nurses, parents and babies to become reacquainted. The NICU reunion was held on September 26 at the Health Center and featured a festive afternoon of music, crafts, food and clowns. Members of the Fancy Fleet Dance Studio performed, as did magician Mark Paskell.

Dr. Delphine Lee receives a check from the Avon Foundation to further innovative research on the influence of microbes on breast cancer development.

Dr. Lee with Cheryl Heinonen, senior vice president of corporate relations and chief communications officer for the Avon Foundation, and Kevin Honeycutt, executive director for marketing, Avon Foundation

Avon Walk for Breast CancerStaff members of the Health Center and the John Wayne Cancer Institute participated in the 12th annual Avon Walk for Breast Cancer on September 6–7 in Santa Barbara. A portion of the proceeds helps support innovative breast cancer research at the Institute.

At the closing ceremonies, Avon Walk leaders announced that Delphine Lee, MD, PhD, director of translational immunology at the Institute, will receive funding for a study to investigate microbial communities in the breast ducts of women. Microbes and chronic inflammation have been linked to some cancers, and Dr. Lee’s group has evidence of specific viruses or bacteria associated with breast cancer. In collaboration with Maggie DiNome, MD, and Susan Love, MD, Dr. Lee and her co-principal investigator Peter Sieling, PhD, will further investigate the association of microbes in the breast and breast cancer

shout outs


“A most excellent

health care facility.

Quick triage and, at

most times, a short

wait to be seen

[in the Emergency

Department].”

The caregivers at Providence Saint John’s Health Center pays close attention to feedback from our patients and visitors. We are proud to share some of the wonderful comments we’ve received in the past few months.

“Riza, Martha and Gracia are super. El-sie and nurse Maki are amazing. Xiomara is awesome. Dr. Bilchik is great. Debora, Sara, Martha and Marisol are great. Deb-orah and Kim in ICU are great. Nurses Helen, Marvina and Melissa are angels. Jamica, Kevin and Maria are fabulous. Shawn and Beck are wonderful. Adrianna and Maria are excellent.”

I was in the hospital July 5th for a hysterectomy. I’d never had major

surgery, and it was my first time at Saint John’s. I must tell you, the nursing staff was superb. I’ve never seen such caring, wonderful people. I want to commend all of them. The pre-op nurse was kind and attentive

and answered all my questions. My gynecologist insisted on Saint

John’s, and now I know why. I would

choose Saint John’s any day.”

“I was here for bilateral hip replacement surgery last week. The hospital and staff were stellar! Thank you so much!”

By far the best hospital I’ve ever encountered. The entire

staff was nothing but awesome! Didn’t mind being here at all. Thank you!”

“Thank you, Dr. Faries, for being the best oncologist and surgeon. Thank you, Rob, for all your help and prompt return of calls even in the evening. You are all making this much more tolerable.”

“The Caritas nurses were fantastic. I cannot say

enough about Amelia, Lau-ra, Melissa and Trish—so on-

the-ball and truly caring. Guillermo was always so

very attentive. Please thank them from the bottom of

my heart. I have never felt as physically vulnerable

and emotionally broken as I did. I’m finally starting to

feel better.”

“I love Saint John’s. This is my third stay in 2.5 years—two hips and one spine surgery. It’s a great hospital with great care and a fabulous staff. I am coming back for my knees.”

2121 Santa Monica BoulevardSanta Monica, CA 90404 USA

310.829.5511 | 1.888.healing

www.providence.org/saintjohns

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Saint John’s doctors pioneer advances in

cardiovascular care.

A family shares a

love of volunteering.p.24

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Since its founding in 1942 by the Sisters of Charity of Leavenworth, Providence Saint John’s Health Center has been providing the patients and families of Santa Monica, West Los Angeles and ocean communities with breakthrough medicine and inspired healing. Saint John’s provides a spectrum of treatment and diagnostic services with distinguished areas of excellence in cancer, spine, orthopedics, neurosurgery, women’s health, cardiac and specialized programs such as the internationally acclaimed John Wayne Cancer Institute. Saint John’s is dedicated to bringing to the community the most innovative advances in medicine and technology.

breakthroughs fall 2014

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