providence health: summer 2014

THE PURSUIT OF WELLNESS IN SOUTHERN CALIFORNIA | PROVIDENCEHEALTHONLINE.ORG | SUMMER 2014

Removing Tumors Without Disturbing the Brain

Hospital Food Goes Gourmet

A San Pedro Nurse is a Breath of Fresh Air

WHEN FITNESS IS

FUNNeighborhoods get healthier with the

help of Providence community programs.

2 PROVIDENCE SUMMER 2014

Summer is beckoning—vacation time, lazy days at the beach and time to celebrate your health. At Providence we offer a full continuum of care, providing healing for the most serious illnesses to the more routine.

Providence Saint John’s Health Center in Santa Monica is home to the Brain Tumor Center, where medical advances have changed the lives of thousands. Utilizing the “keyhole” surgical approach—through a tiny incision in the skull or even through the nostril—our neurosurgeons are experts at re-moving tumors, helping to ensure fewer complications and quicker healing. Read about our successes inside this issue of Providence.

Across Providence Southern California our orthopedic surgeons, too, are experts in minimally invasive surgery to replace joints. New hips and new knees (and

more!) can mean new life. Tiny incisions allow many procedures to be done in an outpatient setting, and patients can get back to doing the things they love, sooner.

For those who do have to spend some time in the hospital, Providence Little Company of Mary Medical Center Torrance offers a bit of pampering. We all know hospital food usually isn’t on any critics’ awards lists, but Providence has made an effort to offer healthier, tastier—even gourmet—selections. The food services team at our Torrance hospital created At Your Service, allowing patients the choice of when they want to eat and providing a new menu of tempting dishes.

You’ll also read about our Cleft Palate Center at Providence Saint John’s Health Center, where we take a team approach to help children with cleft palate and sim-ilar abnormalities. Lastly we’d like to share the success of the 157-year-old Provi-dence Mission of compassionate care to the poor and vulnerable. Read inside about the community benefit programs we offer to our neighbors most in need.

letterfrom the Chief Executive

Michael HunnSenior Vice President, Regional Chief Executive

OUR MISSION

Core Values

CompassionCaring for each person as part of

our family.

JusticeWorking for a fair and equitable

society.

RespectAffirming the God-given dignity and

worth of each person.

ExcellenceContinually improving all that

we do.

StewardshipWisely caring for and sharing

human, environmental and financial resources held in trust.

As people of Providence, we reveal God’s love for

all, especially the poor and vulnerable, through our compassionate service.

Senior Vice President and Regional Chief Executive Michael Hunn

Providence Editor-in-ChiefNancy Franklin

58 11th Street, Hermosa Beach, CA 90254Tel 310-376-7800 Fax 310-376-0200

moontidemedia.com

VP, Branded Media, Emily S. Baker; Art Director, Ajay Peckham;Editor, Shari Roan; Copy Editor, Laura Watts;

Managing Partners, Charles C. Koones, Todd Klawin

Providence Managing Editors

Patricia AidemJennifer Fagnani

Connie MatthewsKirk McDonald

Robert Lehner Natasha ShowsAndrew Werts

ContributorsAnn BeurskensTiffany DeVallBrenda GoettemoellerGail MalloyJuanita PereaKathryn SpragueEllen Wise

SUMMER 2014 PROVIDENCE 3

in good health 5 | Drowsy Driving 6 | A Prescription to Move 7 | Snazzy Room Service 8 | Recipe: Lentil Loaf 9 | Spotlight on the Ears, Nose

and Throat

features 12 | Joints That Last

Orthopedic surgeons offer a variety of joint replacement surgeries.

18 | Beyond the Hospital WallsProvidence funds novel programs to improve health in underserved communities.

24 | Demystifying Brain TumorsSophisticated new strategies are used to remove brain tumors while minimizing trauma.

profiles 22 | Finding Her Place

San Pedro nurse Kris Brust is a breath of fresh air.

28 | Calling All Faiths Tarzana Rabbi Sara Berman attends to the spiritual needs of all.

departments 2 | Letter from the Chief Executive 10 | On the Horizons 30 | Happenings 34 | Shout Outs

ON THE COVERAide Silva and her third-grade

students at Gulf Avenue Elementary in Wilmington

celebrate fitness.

contents

10

22

12

At Providence, we know what it takes to care for even the smallest, most fragile of patients. You’ll also find that same dedication and caring in such vital areas as cancer and cardiology; women’s services; stroke care and neurosciences; rehabilitation and emergency services.

When you give to Providence, you’re helping create not only better medical facilities but also a better community — one person or one family at a time. You may not know them, but your generosity will change their lives for the better, forever. That’s the power of giving.

At 4, Kaylee Chiang picked up her first violin.

At 6, she played Carnegie Hall.

To make a donation or for more information about our Providence hospitals and hospice services, visit us online at providencepowerofgiving.org.

You’d never guess she spent her first 10 weeks

of life in a Providence neo-natal intensive care unit

funded by your generous donations.

california.providence.org 1-888-HEALING (432-5464)

Providence Holy Cross Medical Center | Mission Hills

Providence Little Company of Mary Medical Center | San Pedro

Providence Little Company of Mary Medical Center | Torrance

Providence Saint John’s Health Center | Santa Monica

Providence Saint Joseph Medical Center | Burbank

Providence Tarzana Medical Center | Tarzana

Providence TrinityCare Hospice

Providence Affiliated Medical Groups

in good health


Wide Awake at the WheelAs many as 6,000 crashes a year in the United States are attributed to drowsy driving, according to the National Highway Traffic Safety Administration. While commercial drivers, shift workers and drivers with medical conditions are more likely to be tired behind the wheel, the major cause of drowsy driving can affect almost anyone: inadequate or poor nighttime sleep. In a recent survey of 150,000 adults, 4.2 percent said they had fallen asleep while driving at least once in the previous 30 days.

Sources: Cheryl A.M. Anderson, UC, San Diego; Wisc. Public Instruction.

Herbs Have a Place at the TableFor years health experts have urged Americans to put away the saltshakers and avoid processed foods that are high in salt. Now new research suggests a way to make salt reduc-tion more palatable—by using herbs. About 95 percent of Americans consume too much salt.

The study by researchers at University of California, San Diego, assigned participants to a 20-week program that taught them how to reduce salt intake by substituting salt with spices and herbs. Another group of people was left on its own to attempt sodium reduction. At the conclusion of the study, the people who received the instruction on using herbs and spices consumed about 966 fewer milligrams of sodium per day than the group that did not get the extra help.

Tips for replacing salt with herbs and spices:• Make a rub consisting of olive oil, coffee extract, cherry

extract, smoked paprika and smokehouse pepper.• Blend garlic powder into olive oil and spread it on

unsalted bread for grilled sandwiches.• Try a marinade of lime juice, black pepper, garlic powder,

smoked paprika, onion powder and honey.• Add a bit of dry mustard or a dash of Tabasco sauce to

egg dishes instead of salt.• Instead of using salt when cooking pasta, rice, beans or

hot cereals, add lemon rind or lemon juice.• To flavor vegetables, try adding basil, garlic, onion,

lemon or lime juice, oregano and paprika.• To flavor meat and poultry, try adding bay leaves, basil,

cinnamon or cloves, garlic, ginger, mustard, oregano, parsley, rosemary, sage or thyme.

DID YOU KNOW?Being awake for 18 hours

causes impairment similar to a blood alcohol concentration (BAC) of .05%. Being awake 24 straight hours is similar to

having a BAC of .10%

WHAT TO DO:The only sensible strategy is to pull off the road to rest or

change drivers. Turning up the radio and opening the windows

have not been shown to be effective ways to stay alert.

CHARACTERISTICS OF ADULTS WHO SAID THEY FELL ASLEEP WHILE DRIVING

WITHIN THE PAST 30 DAYS:

Sources: Centers for Disease Control and Prevention

8.5%

3.4%

5.2%

2%

Snores at night No Snoring

Fewer than 6 hours of sleep

7 to 9 hours of sleep

in good health

in good health


When was the last time you talked to your doctor about exercise? For some people, the answer may be “never.” In fact you should make a discussion about physical activity a priority as part of your annual well checkup. Moreover patients should feel free to ask questions about exercise at any doctor’s visit.

“A discussion about exercise often is overlooked” in doctor’s offices, says Moin Salahuddin, MD, primary care sports medicine physician at Providence Medical Institute’s Torrance Urgent Care and Primary Care Clinic. “But exercise is a great, proactive measure that can help you in so many ways. The adage I live by is: Exercise is the best medicine.”

According to the Centers for Disease Control and Prevention, adults ages 18 to 64 should aim for 150 minutes a week of moder-ate-intensity aerobic activity (or 75 minutes of vigorous-intensity aerobic activity) plus muscle-strengthening activities on two or more days a week. Adults ages 65 and older who are generally fit and have no limiting health condition can adhere to the same guidelines.

Some people may be reluctant to discuss physical activity with a doctor because they feel it’s not as important as other issues, such as health problems they may be having. Others don’t want to admit that they don’t work out. But the annual exam is the perfect time to discuss exercise, says Brenda Shen, MD, a primary care provider at Providence Medical Institute in Redondo Beach.

“People may not understand how much exercise actually im-proves their health,” she says. “Exercise touches everything. It improves your bone health, prevents you from getting early-onset osteoporosis, helps your heart. It helps anyone with diabetes, hyper-tension and cholesterol. It affects your mental health.”

Even people who are injured, have health problems or swear they don’t have time can find a way to exercise, Dr. Salahuddin says.

“There is always a way to stay active regardless of injury or medical history. There are so many exercises out there that are easy on the joints.” For example, someone with an ankle sprain can exercise in a pool or perhaps do gentle stretches or yoga.

Many Americans complain that they simply don’t have time to exercise. But it’s important to do what you can, Dr. Salahuddin says.

Get off the bus one stop early and walk the rest of the way. Walk the dog, taking along your kids and spouse. Plant a garden that requires you to spend some time tending to it.

“The most important thing is to find something that you like doing,” Dr. Shen says. “And if you have someone to do this with—a spouse, children, friends—that’s even better.”

As you become more comfortable with exercise, aim to reach your target heart rate during aerobic activity. That will ensure you’re getting the most benefit from exercise, she adds.

And don’t forget that physical fitness features two components: aerobic activity and strength training. About 2/3 of your workout should consist of resistance exercise, which involves weightlifting and building core muscles. You don’t have to lift weights to do strength straining however. Yoga and Pilates can also build the core muscles: those in your spine, pelvis, hips and abdominal areas.

“Aerobics alone will not provide the full results you need,” she says. “Sometimes the results of a fitness program are not as good if people are just doing aerobics. They get sprains, strains and other injuries because they are not building up their core muscles.”

If you are confused about how to start a program, contact your primary care doctor or a sports medicine physician. Sports medi-cine isn’t just for athletes or people who are injured, Dr. Salahuddin says. “Preventative medicine is so key. Forming an exercise plan is important, and that’s definitely something we can do.”

Putting Fitness First

Don’t forget strength training as part of your regular

exercise routine.

in good health

in good health


As members of the 56th graduating class from Providence High School say goodbye to high school and embarks on a new chapter of their lives, the faculty and staff of PHS await the arrival of the incoming class of 2018. Academic scholarships were awarded to these incoming freshmen: Brian Chan, Ryan Donnelly, Skylar

Jones, Erika Marmershteyn, Ilana Marmershteyn, Zack-ery Pikhart, Joel Cruz, Evan Straw and Tierney Ulrich.

Congratulations to these academic scholarship recipients and the entire incoming class of 2018. For more information about Providence High School, please call 1-818-846-8141 or visit providencehigh.org.

Cleft Palate Center Nears 50th AnniversaryThe Cleft Palate Center at Providence Saint John’s Health Center will celebrate its 50th year in 2015 and is begin-ning a new era with Mark M. Urata, MD, DDS, serving as medical director.

Cleft lip and cleft palate are birth defects that occur when a baby’s lip and mouth do not form properly, result-ing in openings or splits in the upper lip, the roof of the mouth (known as the palate) or both.

The multidisciplinary Cleft Palate Center team has treated thousands of patients of all ages. Patients and their families meet all the team members, including clin-ical specialists; plastic surgeons; pediatricians; ear, nose and throat specialists; speech pathologists; audiologists; social workers; and orthodontists.

The team repairs the defect, creates an aesthetic ap-pearance and ensures proper dental function and speech.

Although the center treats patients from all over South-ern California, it is ideal for families on the Westside, Dr. Urata notes. Surgery and related rehabilitative services often mean several visits to the center. “Families on the Westside can go to the Providence Saint John’s Cleft Palate Center and avoid having to pull their kids out of school on the days when they need treatment,” he ex-plains. “These families find a nice home at Saint John’s.” Call 1-888-HEALING for more information.

Extra Care for High-Risk InfantsFor years families who have newborns admitted to the neonatal intensive care unit at Providence Tarzana Medical Center have been able to lean on the NICU staff even after their babies go home. They have a High-Risk Infant Follow-up Clinic to help address the unique issues faced by infants who have been hospitalized in the NICU or other surrounding hospitals. This summer Providence Holy Cross Medical Center in Mission Hills also will open its own High-Risk Infant Clinic.

The clinic staff evaluates children to assess neuromotor function, muscle tone, growth and nutrition, language development, social interaction, emotional behaviors, developmental milestones, overall health, and family support. The first formal assessment is recommended at 6 to 8 months corrected age (which is the child’s age minus the number of weeks the child was born prematurely) with subsequent assessments at 12 to 14 months and 18 to 24 months.

Assessments are conducted by pediatric physical and occupa- tional therapists. Call 1-888-HEALING for more information.

Fine Dining, Hospital-StylePatients at Providence Little Company of Mary Medical Center Torrance now can order the food they want, when they want, with the introduction in April of “Cuisine Request,” a room service dining guide. The menu features tasty meals delivered by an elegantly attired waiter. The menu includes heart-healthy foods, vegan selections and even a kids menu.

A good deal of thought preceded the launch of the program, including many hours devoted to menu planning and preparing and sampling dishes, says Tom Harney, director of food and nutrition services. So far some of the patient favorites are filet of beef tenderloin, perfect pasta bar, build your own omelet or burrito, a vegan Mediterranean wrap and Chinese chicken salad.

Providence High School Announces Incoming Freshman Class Scholarship Recipients

in good health


Healthy EatingLentils are on just about every list of healthy foods to add to your diet. But lots of people have questions about how to prepare tasty dishes featuring lentils. Here’s a terrific recipe for lentil loaf that’s easy and delicious.

Jane Boylan, RD, Providence Holy Cross Medical Center

Lentil Loaf

½ cup walnuts2 tablespoons vegetable oil1 onion, diced1 large garlic clove, minced1 large carrot, peeled and grated2 celery ribs, diced2 cups cooked lentils1 cup dry whole wheat bread crumbs¼ to ½ cup tomato juice, as needed1 heaping tablespoon flax seed meal½ teaspoon dried sage¼ cup minced fresh parsley1 teaspoon Italian seasoning1 teaspoon salt

Preheat the oven to 350°. Spray a loaf pan or 8”x 8” square baking pan with nonstick spray and set aside (an 8”x 8” pan makes a crisper loaf). Grind the walnuts into a coarse meal using a food processor or spice/coffee grinder. Place in a large mixing bowl and set aside.

Sauté vegetables in the vegetable oil until soft. Add to the large mixing bowl along with all the remaining ingredients. Mix and mash together well, adding only as much liquid as needed to create a soft, moist loaf that holds together and is not runny (you may not need to add any liquid if the grains and protein are very moist). Add more flax seed as needed if the loaf seems too wet.

Press mixture into the prepared pan and bake for 45 minutes to 1 hour or until cooked through.

QUICK FACTS ABOUT LENTILS

Brown lentils — This is the type most often found in the grocery

store. They are mild in flavor and can be used

in many types of recipes. They soften when

cooked.

Green lentils — This type also is called French

lentils. They’re found in specialty food stores. Green lentils have a

nuttier, more flavorful taste and can take

longer to cook. Since they tend to stay firm,

they are good in salads.

Red lentils — This fast-cooking lentil often is found in Indian and

Middle Eastern dishes. They have a milder,

sweeter taste compared to other lentils.

in good health


What is interesting about this specialty of ENT?“I think the field of ENT gives us the opportunity to work with a broad range

of problems and to potentially see rapid improvement from treatment.”

What do you like best about your job?“Ninety-nine percent of the problems an

ENT sees, we can fix. It’s very gratifying to help patients feel better and enjoy their lives better. There has been a number of treatment advances that have helped our patients tremendously. And in medicine, there is an art as well as a science to taking care of patients. It’s not about just fixing the problem. It’s about making people feel better.”

What are some of the changes in treating sinusitis?

“Over the 20 years I’ve been in practice, there have been major changes. Most conservatively, you can now purchase over-the-counter, sterile nasal saline sprays, which can be an inexpensive, effective, benign and quick way to rinse your nose. Washing your nose several times a day may help decrease allergies and improve a mild sinus problem or help resolve it. You can use nasal steroid sprays once a day for weeks, months or years, and these sprays decrease swelling and allergies and help control chronic sinus problems.”

What has changed in terms of sinus surgery?

“Over the past five years, balloon sinus surgery has become available. This is a leading-edge technique. For patients who have not improved with medical therapy

and do not want or need traditional endoscopic surgery, this is a great option. The procedure is performed in-office with a topical anesthetic. A small balloon is placed in the nose and inflated without any cutting or removal of tissue. The balloon is then removed, and the opening to the sinuses will end up bigger. A small change in the opening makes a world of difference in the sinuses.”

What are the benefits of balloon sinus surgery?

“With traditional sinus surgery you may have to take a few days off work. With balloon sinus surgery you can be back to work the next day. There is less bleeding, less risk of infection and lower cost. There is a large population of people who don’t need endoscopic sinus surgery under general anesthesia but who still keep getting sick. This may be a viable option for those people.”

Is sinus surgery easier for patients than in the past?

“Things have changed so much since I completed my training 20 years ago. We used to pack patients’ noses with sterile gauze after surgery. Now we use a gel that washes away and does not need to be removed. There also are gentle stents

we can place in the nose after surgery that wash and dissolve away. These help decrease scarring and keep the sinuses open and may help prevent the recurrence of polyps. Another tool we use now is 3-D imaging during surgery. We can place instruments in the nose during surgery and see exactly where we are on three different CT images. It allows us to be safer and more accurate.”

What other conditions are particular to our Southern California market?

“Southern California is a major market for TV and the arts where people rely on their voices in their profession. For those who develop or have voice problems, we now have video stroboscopy equipment that helps us see the vocal cords as they move and helps us diagnose problems previously not easily seen, such as a cyst, nodule or scar that interrupts the normal vibration of the vocal cords and affects voice quality. We also work with speech therapists and singing coaches to optimize our patients’ vocal abilities.”

Call 1-888-HEALING for information.

Otolaryngologists are the doctors who treat a wide range of problems that afflict the ear, nose, throat, head and neck—from swimmer’s ear to tonsillitis to head and neck cancers. We asked Brett Levine, MD, a board-certified otolaryngologist head and neck surgeon, to update us on the latest treatments in the field. Dr. Levine, who is on staff at Providence Little Company of Mary Medical Center Torrance, earned his medical degree in 1989 from the University of Southern California and completed his residency training in 1994 at the University of Pennsylvania. He specializes in sinusitis and sinus surgery.

Lend an Ear

DID YOU KNOW?

Throat Clearing“One of the things I see all the time is people who clear their throat, snort or complain of

mucus draining from their nose and say they have allergies

or postnasal drip. They don’t realize that these problems can be fixed; that this isn’t normal,

and it’s not something they have to live with.”

Dr. Levine, ENT

ONGOING BEGINNING JUNE 1Have you or one of your family members been diag-nosed with a heart murmur or valvular heart disease? Providence Saint Joseph Medical Center will be offering low-cost heart valve screenings to the community. Getting screened today could help avoid problems in the future. »To register: 1-844-MY-MURMUR (696-8768)

If hip or knee pain has limited your mobility, you should know you have options. The board-certified orthopedic specialists at all Providence Health & Services hospitals can provide advanced treatments that can help you regain function, relieve pain and experience the life you deserve.»For a free physician referral:1-888-HEALING (432-5464)

ONGOING BEGINNING JULY 1 Are you or a loved one struggling with weight issues? The nationally re-

nowned experts at the Bariatric Wellness Center would love to help you find the right option for your successful weight loss. The board-certified specialists at Providence Saint Joseph Med-ical Center provide weight loss treatments, including minimally invasive options, that may be just right for you. »To schedule a consultation:1-888-HEALING (432-5464)

JULY 4Palisades/Will Rogers 5K and 10K RunPacific PalisadesProvidence Saint John’s Health Center once again will be the title sponsor of this popular Fourth of July tradition. Foundation trustees will participate along with thousands of other race enthusiasts. All event proceeds will support Optimist Club youth charities.»For more information: 1-888-HEALING (432-5464) or providenceclasses.org

JULY 8 AND AUGUST 5Lecture: What is Lymphedema?The Roy and Patricia Disney Family Cancer Center,

801 S. Buena Vista St., Burbank, 2nd Floor Yoga Room, noon to 1 p.m.Lymphedema is a common side effect of cancer treatment. Learn about the symptoms, risk reduction practices, precautions and treatment at this free lecture. The lecture will be repeated on Aug. 5, noon to 1 p.m.»For more information or for reservations: 1-818-748-4701

ONGOING BEGINNING JULY 15Providence Little Company of Mary Medical Center Torrance will be offering valuable, low-cost heart screenings to the community. Screenings will be available during the week and weekends for your convenience. Getting screened today could help avoid problems in the future. »Register online or at 1-888-HEALING

JULY 17Providence Tarzana Foundation’s Midsummer Night’s Dream GalaFour Seasons Hotel, Westlake

Village, 6 to 9 p.m.This enchanted evening will feature Grammy-nominated pianist and composer Jim Wilson. Proceeds benefit Providence Tarzana Med- ical Center.»For more information: Patty Williams,1-818-757-4384

JULY 22Lecture: Stop Living with Shoulder, Hip or Knee PainProvidence Little Company of Mary Medical Center Torrance Del Webb Center for Health Education; 6:30 to 8:30 p.m.A free lecture will be presented by Albert Reff, MD, an orthopedic surgeon.»Register online or at 1-888-HEALING

AUGUST 12Lecture: Living a Heart-Healthy LifestyleProvidence Little Company of Mary Medical Center Torrance Del Webb Center for Health Education; 6:30 to 8:30 p.m.Attend this free lecture


on the horizon

Living with knee pain? Attend a lecture on July 22.

Providence hosts dozens of lectures,

events and classes each week across

the region. Here are some upcoming

highlights. Check our website for

more activities.


on the horizon

Learn tips for dealing with stress at a lecture on August 28.

presented by cardiologist Rishi Kaushal, MD.»Register online or at 1-888-HEALING

AUGUST 28Lecture: Stress Reduction WorkshopThe Roy and Patricia Disney Family Cancer Center, 801 S. Buena Vista St., Burbank, 2nd Floor Yoga Room, noon to 1 p.m.Learn how to access your inner calm through imagery and muscle relaxation at this free lecture.»For more information or for reservations: 1-818-748-4701

SEPTEMBER 9Lecture: Preventing and Detecting Skin CancerProvidence Little Company of Mary Medical Center Torrance Del Webb Center for Health Education; 6:30 to 8:30 p.m.Attend this free lecture pre-sented by dermatologist Stephanie Chan, MD.»Register online or at 1-888-HEALING

SEPTEMBER 28Providence TrinityCare Hospice Foundation’s 24th Annual Sunday by the Sea Gourmet Food and Wine Tasting GalaPresented by City National Bank2 to 5 p.m.Sample fine food and beverages and participate in a silent and live auction at a Palos Verdes cliff-side estate. Proceeds benefit the programs and services of Providence TrinityCare Hospice.»For more information: Stephanie Turner, 1-310-543-3440

OCTOBER 25Join the experts from the Hycy and Howard Hill Neuroscience Institute’s Movement Disorders Cen-ter at the National Parkin-son’s Foundation’s Moving Day Walk in Griffith Park. Support Providence Saint Joseph Medical Center’s “Team Provi-dence” by clicking on moving-dayla.org to join our team.»For more information: Ulli Draper, RN, Movement Disorders Center, 1-818-847-3271

VISIT US ONLINEFrom support groups to fitness classes, Providence provides the programs you need to live healthfully. View our many classes, events and screenings online at ProvidenceClasses.org or call 1-888-HEALING (432-5464)


Working together, patients and their health care providers are making hip and knee replacement surgery easier than ever before. Written by LORIE A. PARCH Photographed by LAUREN PRESSEY

Building BetterJoints

Janet Catalano has resumed golfing after knee replacement

surgery earlier this year.

SUMMER 2014 PROVIDENCE 13SUMMER 2014 PROVIDENCE 13

ur bodies put up with a lot over the years, but our joints—knees, hips, ankles, shoulders, elbows—really take a beating. Injuries, extra weight, arthritis and the normal wear and tear of living all contribute to the breakdown of cartilage, the shock absorber of joints.

All too soon, it’s bone on bone (ouch!), and your doctor starts mentioning surgery. So it’s probably no surprise to hear that about 719,000 Americans have knee replacements (called total knee arthroplasty) every year, and 332,000 get hips replaced (total hip arthroplasty)—the two most common types of joint replacement procedures. »O

Building Better Joints


Both still are considered major surgery, but getting a new knee or hip never has been as straightforward or as relatively easy and painless as it is now, says Umesh T. Bhagia, MD, an orthopedic surgeon at Providence Tarzana Medical Center. “One of the biggest changes we’ve seen over the last six or seven years in knee and hip replacement is minimally invasive surgery,” he says.

Minimally invasive surgery uses much smaller incisions, leaving smaller scars. A knee replacement scar is now about 4 to 6 inches, compared to an average of 8 to 10 inches previously.

“In one type of minimally invasive knee surgery, we’re not cutting the quadriceps, which are the thigh muscles,” says Dr. Bhagia. “We used to cut it to enter the knee joint, and now we preserve that muscle. This muscle-sparing surgery can make recovery much easier and faster.”

Similarly, more hip replacements are using an anterior surgical approach. “That’s the biggest difference in the last few years,” Dr. Bhagia explains. “This type of hip replacement is done from the front of the hip rather than the back. Just 20 percent of surgeons in the country are doing anterior hip replacements, which result in faster recovery times because no muscle is cut.”

The anterior approach was pioneered in the United States by Joel Matta, MD, founder and director of the Hip & Pelvis Institute at Providence Saint John’s Health Center in Santa Monica. The approach also reduces the risk of later hip dislocation, a potential complication that can result in the need for revision surgery, says Dr. Matta.

“With the anterior approach, the problem of hip dislocation is greatly solved,” he explains. “The patient recovers more quickly after surgery, has less pain after surgery and we can be more accurate with leg length.”

Dr. Matta also is a recognized expert in hip preservation, which can spare patients from hip replacement surgery.

“The idea behind the Hip & Pelvis Institute is that patients can get different viewpoints for their treatment,” Dr. Matta explains. “Is there something we can do to fix your hip or do we have to go to replacement?”

Likewise, patients with knee problems have more choices today, says Andrew G. Yun, MD, a board-certified orthopedic surgeon at Providence Saint John’s Health Center.

“Partial knee replacement is done only by those surgeons who have pursued specific training in it and have made a commitment

to mastering the technique,” he says. “The result of partial knee replacement—in appropriate patients and by skilled surgeons—is equivalent or can exceed that of total knee replacement. Recovery can be faster and safer. Patients often are more active after partial knee replacement compared to total knee replacement.”

If you’re in the market for a new knee, you’re also likely to find that the implant your surgeon uses is customized to you, adds Dr. Bhagia. “It’s more patient-spec-ific, so the sizing is better. There used to be seven or eight sizes, and now there

“With the anterior approach, the problem of hip dislocation is greatly

solved. The patient recovers more quickly after surgery, has less pain after surgery and we can be more accurate with leg length.”

Providence Health & Services, Southern California, has

joined the prestigious California Joint Replacement Registry.

The registry provides important information for several

stakeholders, including providers who are given tools to

analyze their performances and make quality improvements.

Moreover, the registry assists health insurance groups and

patients in seeking high-value providers.

The registry was established in 2010 by the California

HealthCare Foundation in partnership with the Pacific

Business Group on Health and the California Orthopaedic

Association. With more than 90,000 joint replacement

procedures happening annually—requiring more than

$8.5 billion in annual hospital and surgeon charges—

joint replacement surgeries have a significant impact on

Medicare and private payer resources. The number of such

surgeries is expected to rise over the next two decades

prompting health care experts nationwide to call for a

constant, transparent assessment of the devices, treatment

protocols, surgical approaches and patient factors that

influence outcomes.

The registry will help providers statewide fulfill that

mission. The registry collects detailed case information on

approximately 140 data elements related to performance,

such as patient demographics and aspects of clinical and

surgical care. The registry is one of the few in the nation

that collects and reports feedback obtained directly

from patients concerning outcomes of their hip and knee

replacement surgeries.

PROVIDENCE JOINS THE CALIFORNIA JOINT REPLACEMENT REGISTRY



are 23. So you’re more likely to have an implant that is a closer match to your natural joint.”

He adds that the materials that make up knee and hip prostheses have improved a lot as well. That’s significant because there’s always a risk that the polyethylene, the plastic in the implant, could wear out, requiring a “revision” surgery to replace the prosthesis. (This is fairly uncommon with the new prosthetic materials).

The new implants are impressive, says Charles R. Young, MD, a Facey Medical Group orthopedic surgeon at Providence Holy Cross in Mission Hills who primarily does knee replacements. “The longevity of the new implants is at least twice as long as it used to be. That allows patients in the

typical age range to do this procedure once and have a usable knee for the rest of their life without revision.”

Dr. Young says that even better prosthe-tics may be coming soon. “Implants in- fused with vitamin E may extend the life

of prosthetics even longer. Part of what makes plastic wear out is oxidation; like metal that rusts, the plastic can oxidize in your body.” Vitamin E can help quench oxidation, potentially allowing a new knee or hip to perform longer.

Dr. Bhagia is excited about where very personalized implants are headed, too. “We foresee custom-made knees for each patient. We would scan the knee and create a customized knee for each patient. That’s what 3D printing is doing. We’re trying it out now on a few patients.”

All six Providence Health & Services hospitals in Southern California offer joint replacement surgery. A team approach to care means that physicians, surgeons, nurses, physical therapists and other

health professionals work collaboratively to provide seamless care tailored to each individual. That continuum of care at Providence hospitals can help lead to faster recoveries, less pain and more satisfied patients.

(From left) Dr. Joel Matta, Dr. Shahan Yacoubian and Dr. Charles R. Young

“The longevity of the new implants is at least twice as long as it used to be. That allows

patients in the typical age range to do this procedure once and have a usable knee for the rest of their life without revision.”

More than 4.7% of Americans ages 50 and older have had total knee replacements.

Women have higher rates of joint replacement surgeries compared to men.

Patients today are younger. In 2008, patients younger than age 65 accounted for 41% of all knee replacement surgeries.

Among Medicare beneficiaries, partial knee replacement surgery increased 6.2-fold between 2000 and 2009.

Sources: Journal of the American Medical Assn, Sept. 26, 2012; The Journal of Bone & Joint Surgery, Nov. 20, 2013; American Academy of Orthopaedic Surgeons

JOINT REPLACEMENT SURGERY is one of the most common types of operations in the United States. As Baby Boomers age, even more people are likely to seek hip and knee replacement surgery.



Indeed a shorter, easier recovery time may be the most important advance in joint replacement surgery in recent years. Janet Catalano appreciates that fact. In January, the Burbank resident had her right knee replaced by Shahan Yacoubian, MD, an orthopedic surgeon at Providence Saint Joseph Medical Center—a follow-up to her left knee replacement five years ago.

“I put off the second surgery for quite a while,” says Catalano. “But it got to the point where my leg was so irritable that I had to go in and do it. My doctor said, ‘You have bone on bone. There’s nothing you can do but have a replacement.’”

Though Catalano didn’t have any complications with her first surgery, “the second was still much easier,” she says

emphatically. She didn’t need pain pills, and her nurses commented on how quickly she bounced back.

“I went in the hospital on Tuesday and was home by Friday,” Catalano recalls. “They said I could go home on Thursday, but I said, ‘I think I’ll stay one more day to get some more physical therapy.’”

Nearly a month after surgery, her incision has healed. “The recovery was 10 times better this time,” says Catalano, an avid golfer who’s anxious to get back on the links. “If I had one more leg that needed it, I’d do it.”

Just a few months since surgery, Catalano’s excruciating pain is gone and she talks cheerfully about the procedure.

“We want to make sure we really deal with patients’ pain,” says Shelly Kormondy, physical therapy supervisor

“There used to be the thought

that, ‘I’m going to be incapacitated after surgery; why get healthy now?’ That’s gone away. We want them in the best physical and mental state.”



Some patients may be able to avoid

total knee replacement surgery with the

help of an innovative robotic device now

available at Providence Little Company

of Mary Medical Center Torrance. The

hospital is the only facility in the South

Bay to utilize the MAKO robotic arm for

minimally invasive partial knee resurfacing.

The procedure, called MAKOplasty, is

ideal for people with early- to mid-stage

osteoarthritis in one part of the knee and is

less invasive than total knee arthroplasty.

Using a surgeon-controlled robotic arm,

the surgeon is able to resurface the knee

in a highly controlled manner with the aid

of three-dimensional visualization. This

approach spares as much healthy bone and

surrounding tissue as possible. Computer

modeling using the patient’s CT scan

taken prior to surgery, and real-time visual

and tactile feedback assist the surgeon in

proper placement of the implant.

The result, for many patients, is a more

natural-feeling knee with less postoperative

pain and a faster recovery. Patients are

often walking soon after surgery and can

drive a car within a week or two.

“The robot is an extension of me. But

with the robot, I’m able to determine

precisely where I want to place the

implant,” says Michael B. Banffy, MD, an

orthopedic surgeon

with Providence

Little Company

of Mary Medical

Center Torrance

who uses the

technology.

“The recovery

can be so much

faster,” he says. “It’s

a minimally invasive

incision. Many people

walk out of the hospital the

same day as their surgery

or the day after, and a

week later their pain may

be completely gone.”

The knee has three

main components. Partial

knee replacement, known as

unicompartmental knee resurfacing,

is suited for people with arthritis

that has not progressed to all three

compartments of the knee.

“Unicompartmental knee

resurfacing is great for the right

type of patient,” Dr. Banffy says.

“You keep the major ligaments (anterior

cruciate ligament, posterior cruciate

ligament and collateral ligament). The knee

can feel so much more normal.”

MAKO ROBOTIC KNEE SURGERY

at Providence Little Company of Mary Medical Center San Pedro. “When someone’s in pain, they can’t move. The big emphasis is to get the patient up and moving as fast as possible while keeping the patient safe.”

Dr. Young points to a new pain management program at Providence Holy Cross that’s helping to make swift recoveries possible. “It includes pre-operative, intra-operative, and post-operative pain injectables around the knee, and a regional nerve block, which lasts about three days. Patients have less pain and less need for narcotics—without inhibiting their walking.”

Getting mobile—pretty much right away—is an essential part of state-of-the-art care when you’ve got a new hip or knee. “We get patients up and walking the same day they have their surgery, and that blows people’s minds,” says Tad Norton, director of therapy and non-invasive cardiology at Providence Tarzana Medical Center. “Pain control is so much better now, and pre-surgical prep has made leaps and bounds.”

Pre-surgical prep focuses on educating patients on how to get ready for the operation through exercise and diet and preparing for rehab and recovery. “There used to be the thought that, ‘I’m going to be incapacitated after surgery; why get

healthy now?’” says Norton. “That’s gone away. We want them in the best physical and mental states.”

That most definitely includes home care once the operation is over. “A patient can take up to three months for a full recovery,” Kormondy notes. “The people who take the pre-op class prepare their home environment so it’s safe. They know who’s going to help them after their joint replacements. If they have all this in place, it will be a more successful process for them. We believe the patient is a team member with their health care providers. So what they put into it, that will be their outcome.”


THE HOSPITAL WALLS


ide Silva’s third-grade class at Gulf Avenue Elementary in Wilmington hits the playground as if school had just let

out for summer. It hasn’t, of course. It’s a Tuesday morning in May, and many more weeks of reading and writing remain.

But the skipping and laughing boys and girls are elated. Today is their twice-monthly COPA (Creating Opportunities for Physical Activity) class, a teacher-training program launched by Providence Health & Services, Southern California, to impart a love of movement and physical fitness in children who reside in economically disadvantaged neighborhoods.

“They love this,” Silva says, after instructing her class in a game of straddle ball. “If we don’t have the class, they are so disappointed. For any child, this type of program would be valuable. But in our area, parks are so limited. Children don’t get the physical activity they need.”

“Creating healthier communites together” is the Providence core strategy, and programs such as COPA turn those words into action. The program is one of dozens designed to reach beyond the walls of the hospitals.

By collaborating with government agencies, local churches and schools, charitable foundations, and research organizations, the Community Benefit programs focus on preventive health needs and fill gaps in community health care services. Since 2010 Providence Health & Services, Southern Califor-nia, has funneled more than $578 million into the programs (which also includes charity health care and the unpaid costs of Medi-Cal).

“It’s a huge piece of who we are,” says Sister Colleen Settles, OP, chief mission integration officer for Providence Saint John’s Health Center. “We know in this day and age that not everyone is going to be able to access the health care they need—except when they need an emergency room visit. There are people who would not have access to our care unless we went out to them where they reside.”

The programs include mobile health vans that travel to underserved communities to provide checkups for people with chronic conditions, putting school nurses in select schools, community health fairs and outreach to sign up the previously uninsured who can now access coverage under the Affordable Care Act.

Funding for the Community Benefit programs comes from grants and hospital revenue. Programs are funded based on a meticulous selection process. Every three years the two directors of the service area programs conduct a community needs

assessment, seeking input from the community on its most pressing needs.

“Our programs are developed in such a way that they can morph with the health needs of the community,” Settles says. “If we find hypertension or diabetes in a certain area, we can address that.” They do so with programs such as the mobile health van.

Partnering with community members is a key to the programs’ success. Recently the assessment showed a growing need for mental health care. The Community Outreach program partnered with Tar-zana Treatment Center, a behavioral health care and addiction treatment facility, which applied for a grant to train community health care workers on how to conduct basic mental health screen-ings. The screenings help identify individuals who should be referred for treatment and links people with mental health resources.

“We also found that children are witnessing a lot of violence that’s exacerbating their mental health needs,” Settles adds. “We partnered with California State University Northridge and Los Angeles and their schools of social work and counseling for students to do their residencies in the schools. It’s a wonderful, creative way to address that need.”

ne of the longest-running projects is the Latino Health Promoter Program, launched in 1993 in the

San Fernando Valley. The program aims to bring health care education and services to people who are not connected to a doctor’s office or clinic.

Program staff identify and train community members—health promoters or, in Spanish, promotoras—who have an interest in health and wellness. During the six-month training process, the promoters learn how to conduct educational seminars and steer people to services they may need, says Ronald Sorensen, director of the Providence Center for Community Health Improvement for the San Fernando Valley.

The promoters lead diabetes support groups, organize health fairs and assist with various health screening events. Some of the promoters are paid workers, while many are volunteers.

“Because we recruit people from the local com-munities, they are culturally sensitive and speak the same language,” Sorensen explains. “People have a strong trust and bond with individuals who live in the local community.”

Over the years, the program has identified people with serious disease and connected them

Written by SHARI ROAN

Photographed by LAUREN PRESSEY

Providence’s Community Benefit program brings targeted services to needy neighborhoods.

Beyond the Hospital Walls


with medical care. “When we do health fairs, we see people who come back year after year and say, ‘I look forward to this because this is when I get my screenings done,’” Sorensen says. “We know it’s providing an important service to people who can’t otherwise get their cholesterol or bone density checked.”

The Latino Health Promoters Program has emerged as a model for the concept of population health—the idea that the American medical system must focus on the health of entire communities with aggressive preventive care strategies, rather than just focus on treating individuals once they become ill.

“I’m excited about the Latino Health Promoter Program. I think it’s a forerunner of a new professional caregiver,” Settles says. “They are the caregivers who will help people stay healthy at home. They can check on the patients to make sure they’re doing okay.”

Enlisting the help of devoted people who care about their communities is what makes the program a success, she adds. “A lot of this would not happen if not for the volunteerism of people.”

ilva’s class of huffing-and-puffing third-graders are gathering the rubber balls, beanbags and Hula-Hoops after an energetic,

30-minute session.“This is not the same old exercises we

learned when we went to school, like jump-ing jacks,” she notes. “The kids don’t think about how much they’re sweating or how much their hearts are racing. They’re just having fun. I participate as well. If they see me doing the activity, they want to do it.”

COPA is designed to teach the teach-ers about physical activity. At the start of the school year, teachers are trained on the curriculum, which is based on the state public school standards for physical education instruction. COPA’s physical education specialists come to the schools to assist the teachers.

But over time the teachers conduct greater portions of each lesson. At the end of the three-year program, the COPA in-structors will leave, but the equipment and instructional manuals remain at the school, says James Tehan, director of community partnerships who oversees programs in the South Bay.

“The goal of the peer coach model is to help teachers gain the confidence to be independent in physical education for their grade levels,” Tehan says. “This is accomplished by providing them the COPA Teacher Guide, and together the Providence PE specialist and teacher partner to achieve the goal. As an ever-larger group of teachers

at a school gains independence, they collectively begin to organize school-wide events, projects and pilot projects designed to increase daily physical activity.”

At Gulf Avenue Elementary, child obesity rates are high, and many kids suffer from asthma that is worsened by the proximity of smoke-belching oil refineries. Families are grateful for the efforts to keep their children healthier, says Freddie De Leon, a COPA physical education specialist

“This is not about throwing out a

kickball and standing back. This is fun, and it’s creating a culture of fitness.”

With games that focus on fun, children in the COPA

class learn the value of lifelong physical activity.

Beyond the Hospital Walls


who is assisting Silva this day. “I hear from parents that their

children are beginning to lose weight,” he says. “This program is so important because the kids are sitting for hours in school and may not even move around enough at recess.”

Teachers could opt in or out of the COPA program, but almost every one of them chooses to participate, says Gulf Avenue elementary principal David Kooper. “This has created a commitment from our teachers to make physical education a priority. This is not about throwing out a kickball and standing back. This is fun, and it’s cre-ating a culture of fitness.”

Ultimately the aim of all of the Community Benefit programs is to leave positive footprints behind, says Sorensen. “We are out there on the front lines and know that what we’re doing in the community is in direct re-lationship to our mission statement and what the Sisters of Providence intended when they started our system in the mid-1800s.”

He continues, “It’s about being in the community, looking at what the needs are and then responding to those needs as best we can.”

Since 2010 Providence Health & Services, Southern California, has provided more than $578* million to programs benefiting local communities.**

* Includes charity health care and the unpaid costs of Medi-Cal.

** Excludes Providence Saint John’s Health Center which joined Providence this year.

$91 million

$138 million

$167 million

$183 million

2010

2011

2012

2013

profiles in health


hen Kris Brust graduated from nursing school, the wardrobe for RNs included white caps and

white hosiery. In the 30-plus years she’s been with Providence Little Company of Mary Medical Center San Pedro, her attire has changed a lot, but her love for her job and the community hasn’t diminished one iota.

Brust spent her first year as an operat-ing room nurse. “I didn’t like it, and I’m a firm believer that you have to find your bliss,” she says.

Her next stop was as a pulmonary nurse specialist helping patients cope with asthma, COPD, emphysema and other breathing disorders. “I loved it, loved it, loved it.”

Being a pulmonary nurse so appealed to Brust that she eventually helped develop an exercise program for people with breathing disorders. For many years, Brust and colleague Rick Hamil-ton—whom she calls a “brilliant respi-ratory therapist”—ran a program at the medical center called Lively Lungs.

When funding for the program ended, they transitioned the concept to the San Pedro YMCA. Brust and Hamilton run the two-hour, twice-weekly pro-gram called Beyond Rehab, where 25 to 30 community members navigate an exercise circuit of weights (as light as 1

Airing Her

Talents

W

Kris Brust loves being a pulmonary nurse—both at work and in her cherished San Pedro community.Written by SANDI DRAPER

Photographed by LAUREN PRESSEY

profiles in health


pound), a step machine and a treadmill that can go 1/10 of a mph.

Brust checks blood pressure, listens to lungs, checks ankles for swelling and even has oxygen and an EKG machine on standby. The program also caters to people dealing with heart problems, strokes and surgical recovery. “They have to learn a way to move that works for them so they can stay active and have a life,” Brust said.

Her work on behalf of her patients draws positive comments from supervisors and co-workers. Karen Fredericks, past director of rehabilitation, respiratory and neurodiag-nostics, calls Brust “a bright shining star in nursing. She has a highly infectious energy and is passionate, creative and dedicated to her patients and all things breathing-related.”

Hamilton agrees. “She takes each and every patient to heart. She not only educates them on their disease,

medications, etc., she does it in a way that lightens their anxiety and makes them a partner in their disease management,” he notes. “Kris goes out of her way to ensure that the patients not only have the tools they need but have a better quality of life—from basic, everyday activities of daily living, such as housework, shopping, making the beds, to outings, intimate relations and travel. Her goal is to make sure the patients live life to the fullest despite their health issues.”

In January 2013 Brust became the med-ical center’s disease-management coordi-nator. “I make sure people with chronic diseases have the information and the help they need to stay out of the hospital,” she says of her position.

She still runs a group called Better Breath-ers, which has monthly meetings and twice yearly luncheons and outings. In April she supervised the group on a chartered bus trip to the Segerstrom Center in Orange County to see a live performance of Mamma Mia! “You should have seen us dancing in our seats!” she exclaims.

Brust encourages the Better Breathers to

stay engaged in the community. “Life can’t be about, ‘Oh poor me,’” she says. “One meeting, we may ask them to bring tooth-brushes and toothpaste or socks to donate to homeless shelters.”

When the group has a surplus of cash from outings or memorial donations, Better Breathers funds a college scholarship to a San Pedro High School senior who will be majoring in science. Since 2002, the group has donated a total of $18,000 to the fund. Better Breathers also donates $4,000 to $5,000 per year to the medical center’s pulmonary department; a total of $58,700 since 1978.

Lest you think Brust is all work and no play, she is quick to discuss the joy of being a Girl Scout leader. She began leading her daughter’s troop from first grade through the senior year of high school.

“Then they had the nerve to go off to

college,” joked Brust, who found herself at loose ends. When she learned she didn’t need her own scout to lead a troop, she organized a troop at a nearby elementary school. Those girls are now high school seniors, and Brust recently took them on

an Ensenada cruise. “And we had enough money left over from cookie sales that we went to Disneyland and spent the night at the Disneyland Hotel.”

Her troops have gone caroling at the medical center and also explored “Winter Holidays Around the World,” studying Kwanzaa, Hanukkah and Ramadan among others. Most Girl Scouts tend to drop out of the program in middle school, when competing interests and boys draw their attention elsewhere. But not Brust’s scouts. She managed to keep 17 girls together throughout high school.

Brust won’t be at loose ends when this latest group heads off to college or careers. She’s lucky enough to be leading a grand-daughter’s troop. “I think I have one more group in me.”

Brust and her husband of 32 years have raised their daughter and twin sons. When she’s not working, she enjoys her three grandchildren, her rose garden and “trying to improve my cooking skills,” which she admits are not very good.

To support that claim, she mentions an employee potluck at which a supervisor went around the room thanking each work-er for the dish he or she brought. When he got to Brust, he said: “And we have to thank Kris for bringing the party atmosphere.”

And that she does.

Her goal is to make sure the patients live life to the fullest despite their health issues.”

Kris Brust, RN, specializes in helping

people with chronic breathing disorders.


t was the dead of winter—January—when Chantale Vante, MD, a 37-year-old internist in Huntington,

N.Y., got an excruciating headache. She typically didn’t suffer from headaches, and this one persisted for nearly a week.

Though she was busy with a full docket of patients and her family (her sons are ages 4 and 2½), she knew she had to get checked out. Dr. Vante scheduled an examination, which led to an MRI. She was stunned by what it revealed. She had a meningioma, the most common type of benign brain tumor.

Meningiomas grow from the meninges, the covering of the brain between the brain and skull. If diagnosed and treated early, the prognosis is generally quite

good. But Dr. Vante still had trouble digesting the news.

“At first I just couldn’t believe it. It was sort of surreal,” she says. “Any diagnosis of a tumor is frightening but especially when it’s so close to your brain.” And naturally, that diagnosis is pretty worrisome when you have two young children.

Dr. Vante knew that having the tumor removed sooner rather than later was the best bet for total recovery. “If meningiomas get too large you can have all sorts of problems, and it may mean you start reducing your options for the types of procedures that will be effective,” she explains.

The search for a neurosurgeon led Dr. Vante west to see Daniel Kelly, MD,

director of the Brain Tumor Center and Pituitary Disorders Program at Providence Saint John’s Health Center in Santa Monica.

For patients like Dr. Vante, a new era of advances in neurosurgery is resulting in better outcomes and faster recoveries. Today, leading neurosurgeons can remove brain tumors and those of the skull base through smaller, more precise openings. In Southern California, Providence Health & Services neurosurgeons practice the latest techniques for brain, skull base and pituitary tumors.

Brain tumors, which can develop in people of all ages, are diagnosed in almost 70,000 Americans each year. The majority of cases, about 45,000, are benign (not

Top neurosurgeons reach deep into the brain, leaving barely a stitch behind.

Written by VICTORIA CLAYTON

Illustrated by ELENA LACEY

I

New Minimally Invasive Surgery Options for

BRAIN TUMOR PATIENTS

New Minimally Invasive Surgery Options for Patients With Brain Tumors


cancerous) tumors. But these tumors can still be life-threatening because they can grow and impair brain and central nervous system functions.

Brain tumors that originate in the brain are called primary tumors; the most common types are meningiomas and gliomas (which grow from the supportive tissue in the brain). Metastatic tumors spread to the brain from cancerous tumors elsewhere in the body. Metastatic tumors are more common than primary brain tumors and most commonly come from lung cancer, breast cancer and melanoma (a skin cancer).

Whatever the type, neurosurgeons have made great strides in removing tumors while avoiding damage to the brain. Minimally invasive surgery—also known as keyhole surgery—is the concept of removing brain and skull base tumors in a way that minimizes the risk of collateral damage to the normal brain, nerves and critical blood vessels. It typically involves approaching tumors through smaller, more precise, openings in the scalp and skull or through the natural opening of the nose. Large, bony openings of the skull

(known as a craniotomy) now are needed infrequently to remove tumors of the brain and skull base.

“The concept of keyhole surgery is really about sneaking in and out,” says Dr. Kelly. “We want to effectively remove the tumor

with the absolute minimum of disruption to surrounding normal structures, promoting a more rapid and less painful recovery.”

Depending on the location of the tumor, keyhole surgery can be done through the nose (endonasal) or through a small bony opening through the eyebrow (supraorbital), behind the ear (retromastoid) or through other scalp openings. Working through these narrow corridors is greatly enhanced by use of an endoscope—a long, thin, surgical telescope

equipped with a high-definition camera that provides surgeons with a panoramic, up-close and highly detailed view inside the head.

“Minimally invasive surgery results in faster recovery times, less pain and discomfort, a reduced risk of infection and fewer visible scars,” says Dr. Joung H. Lee, MD, who practices out of the Neurosurgery Center, a division of the Hycy and Howard Hill Neuroscience Institute at Providence Saint Joseph Medical Center in Burbank.

In recent years, leading neurosurgeons have become especially

adept at avoiding retraction injuries, which is damage to the brain that occurs during the surgery, Dr. Lee says.

“Reducing retraction injury is really about minimizing the exposure of the brain to the outside elements, when possible,

and minimizing the amount of brain manipulation while removing the tumor,” he says.

Dr. Vante had surgery through a small scalp incision in February at Saint John’s Health Center. The procedure lasted almost eight hours, but her recovery has been swift. She spent only 48 hours in the hospital.

“I was only out of work for about a month, and I was tired, of course, for a couple of months,” she says.

Patients who have skull base tumors—the most common of which are meningiomas and acoustic neuromas—also are benefiting from innovative procedures and technology. Skull base tumors, as the name implies, develop in a crowded and complicated part of the cranium below and along the sides of the brain. As they grow, they can encroach on the inner ear, the brain stem and the cranial nerves coming off the brain stem.

Acoustic neuromas, which arise along the nerves responsible for balance and hearing, can cause hearing loss in the affected ear, tinnitus, dizziness and even facial numbness. Similarly meningiomas of the skull base can cause these symptoms as well as difficulty swallowing, imbalance, difficulty walking and even visual loss or double vision.

Tumors in the skull base have been a challenge for neurosurgeons for decades. But, Dr. Lee says, “A better understanding of that region of the brain and improved surgical techniques now make tumor removal safer and more effective.”

“The concept of keyhole surgery is really about sneaking in and out. We want to effectively

remove the tumor with the absolute minimum of disruption to surrounding normal structures, promoting a more rapid and less painful recovery.”

Dr. Chantale Vante, shown with her two sons, chose Providence Saint John’s Health Center for surgery to remove a meningioma brain tumor.


Dr. Joung H. Lee (left); Dr. Daniel Kelly.

Even patients with tumors that threaten vision or hearing often can be safely removed with a very low risk of long-lasting effects. For some skull base tumors that are not able to be completely removed or are

relatively small, focused precision radiation (also known as radiosurgery) can be used to effectively halt tumor growth.

Providence neurosurgeons Kelly and Lee say their work has been assisted greatly in the last 10 to 15 years by advances in neuro-imaging, navigation techniques, ultrasound and better anatomical understanding.

Surgeons can now create detailed pictures of the tumor from imaging studies prior to the surgery, or even during surgery, to help them locate the tumor and surrounding critical structures with precision.

“Our imaging and navigation, for example, have improved tremendously. We now have the ability to place a probe on the head and pinpoint a location within a few millimeters,” says Dr. Kelly. The result is often more complete tumor removal, less manipulation of the brain and other critical structures, less pain and shorter hospital stays.

The final ingredient of success is Providence’s team approach to comprehensive brain tumor care. Several specialists, depending on the tumor type and location, are often involved. For example, pituitary and midline skull base tumors removed through the endonasal endoscopic route, are performed in collaboration with an ear, nose and throat (ENT) surgeon. If radiation is required along with surgery, a radiation oncologist will be added to the team.

“We strongly believe in the idea that

more eyes, more hands and more expertise translates into better outcomes,” says Dr. Kelly.

As for Dr. Vante, she is back to being a busy mom, wife and internist. There’s practically no evidence that she had the surgery; the incision on her scalp isn’t even visible through her hair. And the best news? Last week, a follow-up MRI three months after surgery showed no signs of any tumor.

“It’s hard to even express how elated I am – and how relieved,” she says.

“Reducing retraction injury is really

about minimizing the exposure of the brain to the outside elements, when possible, and minimizing the amount of brain manipulation while removing the tumor.”

See the website for the Brain Tumor Center at Providence Saint John’s Health Center: newstjohns.org/

braintumorcenter.aspx or call 1-310-582-7450; or the Hycy and Howard Hill

Neuroscience Institute at Providence Saint Joseph Medical Center in

Burbank: http://california.providence.org/saint-joseph/services/neuroscience

or call 1-888-HEALING.

FOR MORE INFORMATION

profiles in health


The Art of Spiritual CareRabbi Sara Berman’s work as senior chaplain at Providence Tarzana Medical Center sometimes means simply being there for patients, no matter what their religious traditions.Written by LORIE A. PARCH

Photographed by REMY HAYNES

profiles in health


ne way to describe medical science today: The daily occurrence of thousands of ordinary miracles. It’s now possible to transplant lungs,

livers and hearts. Some surgeries even can be done with robots. Millions of people who once would have died prematurely go on to survive for years or decades.

But spiritual healing in the hospital still happens much as it did a century ago—through gifted, compassionate, spiritual servants such as Rabbi Sara Berman, senior chap-lain at Providence Tarzana Medical Center.

Since her arrival at the hospital in September 2008, Berman has ministered in a truly nondenominational way—to Jewish, Catholic, Protestant, Muslim, agnostic and atheist patients and their families, and to the medical center’s staff. The special nature of the community where she works isn’t lost on her.

“One thing that makes Providence Tarzana very unique is that it’s a Catholic hospital,” she notes. “But we put a mezuzah on every door. We provide Shabbat candles every Friday, and we do a lot for the Jewish holidays.”

But, she adds, when she or any other member of the spiritual care team are on call, “we serve any patient, any code that comes in, any prayer request, any death.”

Her day starts at 6 a.m. in order to meet with patients being prepped for surgery who may want a prayer, or to respond to any emergency. She then helps prepare her staff, which consists of another rabbi, a Protestant chaplain, two priests and a chaplaincy student. “I like to send a daily quote in the morning to the staff to get the day started,” says Berman, who was ordained in 2001 and is a board-certified chaplain with the National Association of Jewish Chaplains.

She sometimes also blesses nurses’ hands “for the work they do” and offers what she calls “tea for the soul—bringing up tea and blessings for the staff.” Later in the day she’ll visit patients on her floors—med-surg and oncology—to make sure all the Jewish patients get a visit from her.

The conversations she has can, of course, be difficult ones. “A lot of times when someone is afraid, after some kind of loss, whether it’s end-of-life or some other change, people want to discuss that fear,” she says. “Sometimes the patient doesn’t want to talk, but I’ll talk to the family. Sometimes the thing the patient wants most is just presence and si-lence. I’m often just present, and I don’t say anything.”

Cancer patients hold a special place in Berman’s heart. Her father is an oncologist, and she spent time working in a hospice where she tended to many cancer patients. As emotionally taxing as the work was, she found she liked the consistency of oncology.

“People stay longer, so you get to know them,” she explains. “It’s an amazing group of people to work with—generally positive and optimistic despite what they’re going through.”

Many hospitalized patients, whether seriously ill or not,

may not think to ask for spiritual help. “People don’t need to have any religious background to talk to us. They can be atheist. They can be angry at religion,” she notes. “Our goal is to be where the patient is.”

It’s a balance that Shawn Kiley, director of mission lead-ership at Providence Tarzana, says this rabbi strikes beau-tifully. “She’s a true person of Providence in caring and revealing God’s love for each person,” says Kiley, noting that Rabbi Berman is exceptionally gifted in helping the bereaved. “She ensures that somehow healing is brought to those in need.”

When she leaves the hospital for home, the Harry Pot-ter-loving rabbi can focus on being mom to Benjamin, 17, and Miriam, 14, and wife to David, a scientist. “I have a pretty chaotic house with two teenagers, two cats and a dog,” she says with a laugh. “But I thrive on chaos, so it’s OK.”

She added more chaos to her life in June 2007 by

deciding to become a stem-cell donor. Why did she opt to undergo the uncomfortable procedure that, in her case, took eight to 12 hours a day for two days?

“There’s a Jewish expression that one who saves a life, it’s as if he saved a universe. I thought of that and thought, ‘If I could make a difference, why not?’” remembers Berman, who also organizes Providence Tarzana’s team for Relay for Life, a race sponsored by the American Cancer Society.

The rabbi wanted to meet the recipient of her stem cells, but the registry required that both parties wait one year following the donation and that both recipient and donor needed to agree to make contact. They did.

“I think the first contact was by phone ... it was amazing to first connect with him and learn his story,” Berman says, adding that she first met her recipient in person—Mi-chael, a married father of two young children, who lives in Atlanta—in 2011.

In January Berman and her daughter met Michael and his family at the Harry Potter theme park in Orlando, Florida. “We had connecting hotel rooms and pretty much spent three full days together,” she says. “It was amazing.”

For Michael, the donation—while difficult—has meant nothing less than regaining his life. “He’s said to me a couple of times just how grateful he is that he has this time with his kids,” says Berman. “He actually gave me a necklace that has a lot of symbolism. It’s a heart and in the center is a green stone, which is supposed to be healing. He said I represented the green stone.”

O

There’s a Jewish expression that one who saves a life, it’s

as if he saved a universe. I thought of that and thought, ‘If I could make a difference, why not?’”

happenings


34TH ANNUAL GOLF CLASSIC PRESENTED BY HONDAThanks to presenting sponsor American Honda Motor Co., Inc., Ed Foundation, Susan Totten, Scott Gregory and David Conforti celebrated a successful day of golf and philanthropy on May 19 at the Palos Verdes Golf Club. The 34th annual Golf Classic benefited vital patient services at the Providence Little Company Mary Medical Centers Torrance and San Pedro. From left: Foundation; Totten, PLCM Foundation vice president; Gregory and Conforti.

ART OF HEALINGProvidence Little Company of Mary Medical Center Torrance held its sixth “Art of Healing” exhibit on May 27 with 18 physicians and employees sharing their artistic capabilities outside the hospital. More than 60 items were on display, including sculpture, photography, paintings, books, jewelry and needlepoint.

TOP 100 HOSPITAL CELEBRATIONSystem leaders from Providence came to Providence Little Company of Mary Medical Center Torrance on May 12 to congratulate the team for being named by Truven Health Analytics as one of the 100 Top Hospitals in the nation. In attendance were Rod Hochman, MD, president and chief executive of Providence Health & Services; Mike Butler, system president of operations and services; Todd Hofheins, system senior vice president and chief financial officer; and Debra Canales, who recently joined Providence as executive vice president and chief people and experience officer.

Back row (from left): Huan H. Nguyen, MD; Robert Schmit, MD; Jack Ludwick,

MD; Howard Abrams, MD; Glenn Wishon, MD; Crystal Lamirande; Jean

Gidaya; Ron Ruby, MD Front row (from left): Desmond

Nwaogu and Penny Kastagir

happenings


NURSE CELEBRATION LUNCHEONThe nurses at Providence Saint Joseph Medical Center in Burbank were treated to a Hawaiian-themed luncheon in honor of their service to the hospital and patients. Nurses also were treated to a surprise performance of the “Hularinas” (PSJMC physicians who, good sports that they are, were clad in coconut shells and grass skirts).

ART & WINEMore than $300,000 was raised to benefit the Roy and Patricia Disney Family Cancer Center at Providence Saint Joseph Foundation’s second annual evening of Art & Wine on May 3. The rooftop event featured elegant food and wine, incredible auctions and special musical guest Richard Sherman, the Academy award-winning composer of Disney classics including Mary Poppins. Sponsors included co-chairs Sheri Disney and Roy P. Disney, the Walt Disney Company and many others.

Left: (From left): Dale Surowitz, regional chief operating officer; Glenn Bales, PSJMC chief financial officer; Sister Sheila Browne, RSM, PSJMC director, mission leadership; Valarie Fleming, PSJMC chief nursing officer; Nicholas Testa, MD, PSJMC chief medical officer; Michael Rembis, PSJMC chief executive; David Emter, PSJMC chief operating officer; LaDonna Najieb, PSJMC human resources director; Michael Hunn, Providence Health & Services senior vice president and regional chief executive; Jennifer Fagnani, PSJMC director, marketing and communications.

PROVIDENCE SAINT JOSEPH’S HOSPITAL WEEK AWARDS CEREMONYCaregivers and Providence regional leaders attended Providence Saint Joseph Medical Center’s Hospital Week awards ceremony and celebrated its Healthgrades 2014 Distinguished Hospital Award for Clinical Excellence™.

PSJMC chief executive Michael Rembis

Val Fleming with some of our outstanding nurses

The Nurses Week festivities continued later in the week with a happy hour and Advanced Degree Recognition that paid tribute to nurses who have earned their BSN, MSN, PhD or DNP advanced degrees.

Top Left: Providence Saint Joseph Chief Executive Michael Rembis and his wife, Kris, with PSJMC director of mission leadership, Sister Sheila Browne, RSM.Top Right: Disney Family Cancer Center medical director Raul Mena, MD, and his wife Barbara, with Ed Romano, chief financial officer of Warner Bros., and his wife Murphy.

Maria Gonzalez, Disney Family Cancer Center administrator; her husband Scott Maynard; Theresa Meyers, foundation vice president of principal gifts and her daughter Alison Diamond

happenings


CHILDREN’S COMMUNITY ART DISPLAY AND RECEPTIONChildren’s art was the focus of a reception on March 27 at Providence Holy Cross Medical Center. Six schools in the San Fernando Valley participated, and more than 250 art pieces were collected. The top 20 pieces were chosen as winning entries and will be framed and hung inside the hospital until next spring.

Top: Two of the top entries by twins Angela Ren and Matthew Ren, age 5, from Castlebay Elementary in Porter Ranch.

Above: Admiring children’s art entries (from left): Helen Coulson, art committee chair and donor; Marwa Kilani, MD, director of pal-liative care; Steven Wallace, vice president, director of foundation; Brigette Loden, vice president, de-velopment and capital campaigns.

CINCO DE MAYO GUACAMOLE CONTESTThe annual guacamole contest was held on Cinco de Mayo at Providence Saint John’s Health Center. John M. Robertson, MD, led a panel of judges in selecting the Women’s Health Department as this year’s winner among 29 entries. Departments, physicians’ offices and individuals entered the contest, which included themed display booths and costumes. The contest began in 1998.

A SPECIAL DONATIONVictoria Mendoza, born at Providence Little Company of Mary Medical Center Torrance, stopped by the foundation office on May 22 with a donation: $28 in bills and coins in a plastic bag. “I thank God because I am healthy, and I want to help other kids,” says Victoria, who crafted a sign and collected donations from other children in her neighborhood.(From left): Susan Totten, foundation executive director, with Jarocho, Victoria and Lourdes Mendoza

happenings


Tom Mone, right, chief executive officer of One Legacy, presents Gerald Clute, chief executive, with a photo of the Donate Life Tournament of Roses parade float and an appreciation certificate.

Families who participated in organ donation attend the

Donate Life Flag-Raising.

Team Providence “Scrubs Out Cancer” at the 2014 EIF Revlon Run/Walk at the LA Memorial Coliseum.

REVLON RUNThe Providence team was out in full force May 10 at the 2014 EIF Revlon Run/Walk for Women. The team raised more than $20,000 from supportive friends and family. Providence Foundations, Southern California, will benefit from a substantial grant award from the Entertainment Industry Foundation in support of the Disney Family Cancer Center.

DONATE LIFE FLAG-RAISINGProvidence Tarzana Medical Center officials participated in a flag-raising on April 11 in appreciation of the Donate Life program. Each December the hospital hosts a Rose Dedication Ceremony, where families who agreed to donate organs of their loved ones are invited to attend and remember the family member. The families are acknowledged for giving the gift of life.

FOR OUR CHILDREN FOOD & WINE FESTIVALMore than 800 guests joined Providence TrinityCare Hospice and Sandpipers on April 27 for the 28th annual For Our Children Food & Wine Festival, presented by Honda.

Committee members surround the 2014 Acura ILX, generously donated by Honda and offered as this year’s opportunity prize. From left: Steve Morikawa, Barbara Roberts, Lynn Watson, Karin Baker, Sharon Martinez, Kristina Durkin, Jim Sala, Aly Cohen, Kianna Modir, Laura Lull.

shout outs


We value feedback from our patients and visitors and strive to ensure that every individual entering Providence Health & Services is treated with kindness and respect. We are proud to share some of the wonderful comments we’ve received in the past few months. We invite you to share your story with us at providence.org/share or join us on Facebook at facebook.com/Providencecalifornia.

“I felt well taken care of. Everyone explained everything that was happening and why. I really felt like the doctors and nurses honestly cared for me; not that I was just another patient they were seeing during a work shift.” — Evie Peris (Providence Holy Cross Medical Center)

From the moment I was admitted into the hospital (Providence Holy Cross Medical Center), I received only the best care from all of the staff I came in contact with. My

doctors were outstanding; nursing staff was very professional and caring. The physical therapy personnel were highly motivating,

so I was able to accomplish my goals quickly.” — Mary Jeffrey

“I was the blessed recipient of your compassionate care. I will be forever grateful for your exper-

tise, dedication, devotion, responsiveness

and attentiveness. I had never been to Providence Little Company of Mary Medical Center Torrance before and was gratified to learn just how impressive and challenging your profession is. I have tremendous respect for your skill, commitment and work ethic, not to mention your strength and stamina!” — Julie Whittaker

I can never thank you enough for taking care of a piece of my heart

when I had to leave my preemie son with you. Most people don’t know what happens behind those closed doors of the NICU, and they won’t understand how important you

are to the positive outcomes of those babies whose lives start off so critically ill. But I do. I know you now, and I will never forget you.

Thank you for your skilled work, thank you for always answering my questions even if I had

already asked them many times before, thank you for taking pictures of my baby when I was not around to share those moments, but most

importantly thank you for fighting for my baby. You will always have a special place in our

hearts.” — Anonymous (Providence Saint Joseph Medical Center)

“I had a wonderful experience with the birth of our second son. The staff was attentive and readily available for questions and assistance.” — Nancy Echeverria (Providence Little Company of Mary Medical Center San Pedro)

“The entire unit is extremely well run, thoughtfully laid out, beautifully fur-nished, quiet and wonderfully focused on providing excellent patient care. I had been dreading my hospital stay, and was so pleased that my doctor suggested Caritas (at Providence Saint John’s Health Center). It definitely made a big difference in my attitude toward my stay—and in my recovery. Please pass along my best wishes and deepest gratitude to everyone at Caritas.” — Anonymous

“I want to thank all the paramedics, doctors and nurses and Providence Little Company of Mary Medical Center Torrance for taking good care of me as I had my new pacemaker implanted.” — Michael Franks, co-owner of Chez Melange, Redondo Beach

“Providence Little Company of Mary Medical Center Torrance hospital has once again proved its weight in gold and why it got to be one of the best nationally!” — Francis Dilelio

agility.Experience

Experience Providence Orthopedic Care

Find and follow us:

1-888-HEALING (432-5464)california.providence.org

Providence Holy Cross Medical Center

Providence Little Company of Mary Medical Center San Pedro

Providence Little Company of Mary Medical Center Torrance

Providence Saint John’s Health Center

Providence Saint Joseph Medical Center

Providence Tarzana Medical Center

Providence TrinityCare Hospice

Providence Affi liated Medical Groups

Jacqui Assadi, 49 | Hip Reconstruction South Bay Resident

“My passion is playing tennis and I’ve been given a new chance to do what I love.”

Don’t let joint pain hold you back any longer. The team of experts throughout Providence Health & Services, Southern California off ers some of the most advanced orthopedic treatments, including the latest minimally invasive surgeries – resul� ng in faster recovery � mes and less scarring to get you back to doing what you love.

Our comprehensive team of physicians, surgeons, physical therapists, occupa� onal therapists and nurses provide a full range of orthopedic care, including joint replacement, sports medicine and trauma, as well as trea� ng disorders of the shoulders, hands, knees and ankles.

Experience your passion again - Experience Providence Orthopedic Care.

For more informa� on or a free physician referral call 1-888-HEALING (432-5464) or california.providence.org.

Read Jacqui’s story at providence.org/torrance.

CA14-35037

CA14-35037 - Regional_AD_Providence Health Magazine_Experience Ortho.indd 1 6/18/2014 9:30:46 AM

Innovative Brain SurgeryProvidence neurosurgeons use the latest techniques to sneak in and out of the brain.

Play Ball! A free community program helps kids embrace fitness.

Bedside Blessings

A compassionate rabbi ministers to patients of all faiths.

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Providence Health & ServicesSouthern CaliforniaAdministrative Offices20555 Earl StreetTorrance, CA 90503

providencehealthonline.org

NONPROFIT ORGANIZATIONU.S. POSTAGE

PAIDTorrance, CAPermit No. 89

providence health: summer 2014

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