healthworks - Emerson Hospital

healthworks
Emerson Hospital
| Winter 2016
Bouncing back after injury
WITH ON-SITE PHYSICAL THERAPY AT SCHOOL
Tackling important
cancers in men and
women
Back to the birthing
center—with twins
Restful sleep: possible
despite restless legs
Emerson MD goes
on the road with the
Boston Symphony
A Letter from
Christine Schuster
Dear Friends:
This issue of HealthWorks is about partnerships—relationships that directly benefit you
and your family, beginning with our Mass
General Cancer Center at Emerson HospitalBethke. In the articles about prostate cancer
and breast cancer, you will see that top experts
collaborate to offer patients the most current,
appropriate treatments and help us bring worldclass cancer care to our local community.
For women who need the services of high-risk
pregnancy specialists, we offer access to physicians from Brigham and Women’s Hospital,
who are conveniently on-site at Emerson. At
Lawrence Academy in Groton, members of our
outstanding physical therapy staff provide
rehabilitation for student athletes. It’s an innovative program that is working well.
Emerson’s partnership philosophy recently
produced a unique relationship: Robert
Partridge, MD, an emergency medicine
physician, travels with the Boston Symphony
Orchestra on their overseas tours. Enjoy
reading about how Dr. Partridge provides the
BSO with the same high-quality care that our
Emergency Department patients receive.
Best wishes for a happy and healthy New Year!
Christine C. Schuster, RN, MBA
President and CEO
Emerson Hospital is an acute care medical center
located in Concord with health centers in Groton,
Sudbury and Westford. It is well known for its medical and surgical specialists, outstanding nursing care
and patient-centered services, including the Clough
Birthing Center, the Mass General Cancer Center at
Emerson Hospital-Bethke, the Polo Emergency Center
and the Clough Surgical Center.
www.emersonhospital.org
2
Restless legs
syndrome:
common and treatable
littleton resident is grateful for relief
Americans are sleeping less: on average, 6.9 hours per night—less
than we used to and less than what most sleep experts feel is optimal. For some, the problem is insomnia; others suffer from sleep
apnea, where obstructed breathing leads to fitful sleep. For others,
restless legs syndrome (RLS) prevents sleep onset, wakes them up
and ruins an enjoyable evening. There is effective treatment for RLS
that produces comfort, as well as a good night’s sleep.
Restless legs syndrome is a confusing condition; it is caused by the nervous system but, because it robs people of sleep, it is considered to be a sleep disorder.
The condition, which was referred to as “fidgets in the legs” during the 19th century, is estimated to affect about 10 percent of Americans.
According to Gary Stanton, MD, an Emerson neurologist and sleep medicine specialist, people don’t always tell their physicians about the predictable itchy, uncomfortable sensation in their legs, despite years of suffering. “It’s amazing how
many patients say to me ‘that’s just the way I am,’” he says.
But whether they seek treatment or decide to live with their RLS symptoms, they
have one thing in common: something is wrong with how their body uses dopamine, a neurotransmitter required for muscle activity and movement. “RLS sometimes begins during childhood, but it is often misdiagnosed as hyperactivity,”
Dr. Stanton notes.
RLS often runs in families; approximately 50 percent of those with RLS have a
family member with the condition. About 80 percent of those with RLS also have
periodic limb movement, a different condition that causes them to kick during
their sleep. This can wake up the individual, as well as their startled sleeping
companion.
“If someone is having a sleep test at Emerson, and we see them kicking, it’s clear
they have periodic limb movement,” says Dr. Stanton.
Since there is no diagnostic test for RLS, Emerson sleep specialists take a careful
medical history. “First we check to see if the patient has an iron deficiency,” says
Dr. Stanton. “A low or low-normal iron level can cause or aggravate RLS; iron replacement therapy may improve or even cure it. Certain medical conditions, including kidney disease, Parkinson’s disease and diabetes, can produce RLS, and
certain medications, especially antidepressants, can cause or aggravate RLS.”
The right medications do the trick
There is effective treatment, as Cindy Legault found out. The Littleton resident
suffered with RLS for years, but things turned around when she was referred to
Overlapping syndromes make sleep a challenge
There are a number of conditions that
result in tossing and turning—and make
a good night’s sleep almost impossible.
Sometimes these conditions travel
together.
Obstructive sleep apnea (OSA) is all too
common, says Anthony Bohnert, MD, an Emerson pulmonologist
and sleep medicine specialist. “Up to 7 percent of adults have OSA,
and the majority are undiagnosed; untreated sleep apnea is associated with heart disease, high blood pressure, stroke and increased
blood sugar.” A sleep study, either at home or at the Emerson sleep
lab, can diagnose the condition, for which there are several treatment options.
Dr. Bohnert gets concerned when OSA overlaps with chronic obstructive pulmonary disease (COPD). “Patients with obstructive disease, such as emphysema, or restrictive disease, such as pulmonary
fibrosis, may become dependent on the use of accessory muscles to
aid in normal breathing,” he explains. “During sleep, these muscles
may not work as efficiently or even become nonfunctional, resulting
in decreased oxygenation, increased carbon dioxide and subsequent
sleep arousal.”
“People with depression or anxiety often are made worse if they
have disturbed sleep,” notes Eliot Gelwan, MD, an Emerson psychiatrist. “We see a lot of OSA among our patients with depression.
Dr. Stanton. “He was very thorough,” she
recalls. “Dr. Stanton checked everything—
every medication I take, my daily activities
and what my sleep was like.”
The medication regimen he prescribed required some adjusting, but the combination
of gabapentin, also known as Neurontin,
taken in the early evening, and low-dose
Mirapex, which regulates dopamine, a few
hours later, does the trick. The timing is
critical, notes Ms. Legault, a financial planner and investment advisor. “I set an alarm
on my phone because I don’t want to take
my medication late. If I miss that alarm, I’m
going to have a really bad night.”
Successful treatment may require a bit of experimentation, says Dr. Stanton. “I find that
different regimens work for different people.
I encourage patients to vary the time they
take their medication. We can increase the
dosage or add another medication.”
We don’t have much success in treating their depression if their
sleep problem isn’t addressed.”
Insomnia can present challenges to patients and physicians. “If
someone needs help with transient insomnia—caused by a personal
or financial problem, for example—we might prescribe a sleep medication such as Ambien, but only for two or three weeks,” Dr. Gelwan
explains. “These medications suppress non-REM sleep, which is
the natural, restful sleep we require for good health. Also, patients
require an increased dose in order to sleep.”
Chronic insomnia can lead to depression, says Dr. Gelwan. “It is
often true that people worry about their sleep, which prevents them
from sleeping. When someone becomes demoralized and feels the
physiological effects of not sleeping, they are vulnerable for
depression.”
Although an antidepressant medication should be effective in treating someone’s sleep disturbance, as well as the symptoms of low energy and despair, that is not always the case. “It’s a challenge to
treat depression or anxiety in individuals who have disturbed
sleep,” says Dr. Gelwan. “We sometimes suggest that a patient come
to Emerson for a sleep study so that we can better understand the
nature of their sleep deficit.”
Worried about your teen’s sleep habits? See page 13.
Ms. Legault appeared to have more than one
sleep problem, so Dr. Stanton suggested she
have an overnight sleep study performed
at Emerson. It revealed that she also has obstructive sleep apnea (OSA), typically characterized by snoring and gasping for breath,
as well as periodic limb movement.
“I wear a dental device, which corrects my
sleep apnea,” she says. “I get a good night’s
sleep now.”
She travels regularly to meet with clients.
“The two things I won’t travel without are
my dental device and my RLS medications.”
Ms. Legault, who is 55, has several family
members with RLS. “My first recollection
that it was a family problem was when I was
in my twenties. I realized my grandmother
was up at night, walking around in her bedroom,” she says. “I was up walking, too.
My grandmother said ‘I think you got this
from me.’ RLS became a family conversation, even though we didn’t know what to
“I get a good night’s sleep now,” says
Cindy Legault, who has restless legs
syndrome, among other sleep disorders.
call it. My grandmother never got the treatment she needed.”
Ms. Legault did, and it has made a world
of difference. “RLS used to keep me up at
night, but not anymore.”
3
Tackling important cancers in men and women
A team approach
to prostate cancer
westford resident benefits from specialized expertise
Prostate cancer behaves differently from other cancers. In at least 50 percent
of diagnosed cases, the cancer cells divide so slowly that the appropriate
treatment is active surveillance—being monitored regularly. Then there is
the other category of prostate cancer, which is aggressive and fast-growing.
At Emerson, experienced urologists and specialists at the Mass General
Cancer Center at Emerson Hospital-Bethke collaborate to assure that men
receive the right treatment, delivered in a personalized way.
When James Walsh called his primary care
physician’s office to renew a prescription
one spring day in 2014, a member of the staff
told him he would first need to stop in for a
blood test. The routine blood test showed
that his PSA level was suddenly quite high.
An elevated prostate-specific antigen (PSA)
may indicate the presence of cancer.
“I was told that I needed to see a urologist,
so I made an appointment with Dr. Schloss,”
says Mr. Walsh, referring to Stephen
Schloss, MD, an Emerson urologist. “He
wanted me to have a biopsy performed right
away.” Once the biopsy was performed,
Mr. Walsh headed to his home on the Cape
in time for Memorial Day weekend.
Back at Emerson, Dr. Schloss reviewed the
biopsy report and called Mr. Walsh with
difficult news: he had prostate cancer, and
it was not the type that grows slowly. “Jim
had an aggressive, fast-growing cancer,”
Dr. Schloss explains. “I wanted him to come
into the office after the long weekend so that
we could discuss a treatment plan.”
It was not the carefree long weekend that
Mr. Walsh, a 56-year-old lawyer who resides
in Westford, had planned. “I went in that
Tuesday to meet with Dr. Schloss hoping
that, if I had to have treatment, it could
wait,” he recalls. “After all, the summer
was coming.”
But Dr. Schloss explained his concerns,
namely that Mr. Walsh’s biopsy revealed a
high Gleason score—an indication of how
aggressive prostate cancer is. Surgery to
remove the prostate, called a prostatectomy,
was the best treatment; ideally, it would
return Mr. Walsh to good health.
“I felt overwhelmed by the whole thing and,
before my next appointment, wrote down
at least 25 questions to ask Dr. Schloss,”
(Left to right) Jon DuBois, MD,
medical oncologist, Stephen
Schloss, MD, urologist, and
John McGrath, MD, radiation
oncologist, collaborate on the
care of men who are diagnosed with prostate cancer.
4
he recalls. “He answered every one of them
and didn’t rush me. I like Dr. Schloss very
much; he is very friendly and has a sincere,
caring manner.”
When it comes to prostate cancer, there is
plenty to cover. “The side effects of treatment, such as imperfect urinary control and
erectile dysfunction, are a big part of the
discussion,” says Dr. Schloss. “Most men
need reassurance.”
Treatment designed to prevent a
recurrence
Dr. Schloss performed Mr. Walsh’s surgery the following week, after which he spent
three days at Emerson. “The nurses were
outstanding,” he says. “I wrote a letter describing how impressed I was.” Although
he was weak and couldn’t lift anything, he
slowly returned to the legal work that was
waiting for him.
Six weeks after his surgery, Mr. Walsh had
a repeat PSA test and saw Dr. Schloss for a
follow-up appointment. “I expected to hear
that everything was fine, and I was done
with treatment,” he says. “Instead, Dr.
Schloss told me that my PSA was still high,
and I needed to have radiation.”
Dr. Schloss says he considered all the
factors. “The pathology report after Jim’s
surgery showed that the tumor was locally
advanced, meaning that the surgery did not
remove every cancer cell. His high PSA
level convinced me that having a course of
radiation was necessary.”
“I’m not a ‘woe is me’ guy,” Mr. Walsh says.
“But I got emotional when I heard that I
needed more treatment.” He managed to
schedule himself for the first treatment of
the day and began the six weeks of radiation
at Emerson.
Mr. Walsh quickly became attached to the
radiation oncology staff, who made him feel
comfortable and cared for. “They’re my
friends now, including Dr. McGrath,” he
says. “They’re wonderful people, and
they are doing God’s work. I still stop in
to visit them.”
In addition to providing personalized care
and attention, John McGrath, MD, medical
director of radiation oncology, and the staff
are committed to delivering treatment with a
high degree of precision. “When we treat
prostate cancer, we regularly perform imaging to assure that everything is aligned,” Dr.
McGrath explains. “For example, even the
presence of fluid in the bladder will affect
the precision of where we aim the radiation.
We make regular adjustments in order to
treat the patient with the utmost precision.”
Mr. Walsh’s physicians conferred regularly
on his treatment plan. Midway through his
radiation therapy, Dr. Schloss and Dr.
McGrath decided that adding a testosteronelowering medication would be prudent.
“We don’t want Jim to develop a recurrence
of prostate cancer,” notes Dr. Schloss.
With Dr. Schloss, Dr. McGrath and Jon
DuBois, MD, medical director of the Mass
General Cancer Center at Emerson HospitalBethke, collaborating on his care, Mr. Walsh
knew he was in good hands. He will continue to see all three physicians periodically.
Dr. DuBois attends the urologic oncology
conferences at Mass General, where patients
are discussed. “The conference allows me
to build relationships with urologists and
radiation oncologists at MGH, which makes
consultations and referrals with our
Emerson patients more streamlined and
rewarding,” says Dr. DuBois.
Much progress has occurred in the treatment
of prostate cancer: during the past 30 years,
five-year survival has increased from 73
percent to 99 percent. “With respect to
advanced or metastatic cancer, the last few
years have seen the FDA approval of more
treatments than ever,” says Dr. DuBois.
“They include molecular therapies and
vaccine technology.”
Dr. DuBois also helps lead the twicemonthly multidisciplinary oncology conference at Emerson with Dr. McGrath, Dr.
Schloss and other specialists in attendance.
They review newly diagnosed patients together and determine the best course of
management.
By November 2014, with treatment well
behind him, Mr. Walsh’s PSA was down to
normal. He is grateful—for the expertise
that was available nearby and the outstanding, personalized care he received. “When
I look back, it was a better experience than I
could have imagined,” he says. “I wouldn’t
have gone anywhere else.”
Benign prostatic hyperplasia:
predictable and treatable
The symptoms are annoying, but they are predictable. After age 60,
one-third of men develop benign prostate hyperplasia (BPH), enlargement of the prostate. The annoying part occurs when the prostate’s
growth blocks the urethra, which causes problems with urinating.
Normal
“The typical symptoms include a slow stream when urinating, more
frequent urination, the feeling you are not emptying the bladder completely and having difficulty initiating urination,” Dr. Schloss explains.
In the overwhelming majority of cases, Dr. Schloss is able to assure
men that these symptoms do not indicate prostate cancer. Then, the
question is whether or not treatment is needed. “Early on, the best
approach to BPH is often to monitor symptoms,” he says. “We have
good medications that help many men. When medication doesn’t
work or the urethra appears to be increasingly blocked, I often suggest
a procedure—either electro-surgery or laser—to open the
blockage.”
Enlarged prostate
5
Tackling important cancers in men and women
At the Breast Cancer Conference, specialists
discuss specific cases, examine test results
and share their opinions about treatment.
Breast Cancer Conferences
bring all the expertise together
discussion and analysis is focused on patients
The overwhelming majority of breast cancer is diagnosed at an early stage,
is relatively easily treated, and patients have an excellent survival rate. For
complex situations, Emerson physicians regularly break away from their busy
clinical schedules and bring their collective knowledge and experience to bear
on treating difficult cases, such as the ones described here. At these Breast
Cancer Conferences, as well as at the weekly thoracic conference and biweekly
tumor panel, specialists discuss specific cases, examining test results and
sharing opinions. The goal is to develop the most effective treatment plan
for each patient who seeks care at Mass General Cancer Center at Emerson
Hospital-Bethke.
On this particular afternoon, the group is reviewing several challenging patients—cases
that are not straightforward and require their
varying perspectives, along with their considerable experience in diagnosing and treating breast cancer.
Patient 1
Robin Schoenthaler, MD, radiation oncologist, describes a new patient, an elderly
woman who has cancer in both breasts.
6
David I. Rose, MD, chair of radiology, points
out the lesion on the left—a small area of
ductal carcinoma in situ (DCIS)—and the
more worrisome tumor on the right. “It is an
invasive, 12-millimeter lesion, hormone-receptor-positive, and there are 2 negative
nodes,” says Richard Geller, MD, a
pathologist.
After the group agrees that the best initial
treatment will be lumpectomies on each side
and biopsy of the right sentinel node,
Sadhna Vora, MD, a medical oncologist from
Massachusetts General Hospital, notes that
the risks and toxicities of chemotherapy
may outweigh potential benefits in this case.
“However, the patient should be advised
to take an aromatase inhibitor,” suggests
Dr. Vora, in reference to an estrogen-lowering cancer medication.
“With such a small tumor, clinical trials
have shown that her risk of recurrence is
quite low, and the benefits of radiation therapy are minimal,” adds Dr. Schoenthaler,
who notes that the patient has a fairly serious medical condition and may not opt for
radiation.
“In cases like this, patients often help us
with the medical decisions,” says Susan
Sajer, MD, a medical oncologist who specializes in breast cancer. “Once she understands her excellent prognosis, she may
choose not to have radiation and instead
receive an aromatase inhibitor.”
Patient 2
A young woman who had been successfully
treated for colorectal cancer with surgery,
radiation and chemotherapy was found
to have a small, grade 1 breast cancer.
Dr. Schoenthaler mentions there is a history
of cancer in the patient’s immediate family.
“Well then, the first thing we’ll need is genetic testing,” says Dr. Sajer. “Once we have
those results, then we can move on to appropriate surgical and radiation recommendations, as well as potential hormone therapy.
The moral of the story is, as patients are
cured of one cancer, they are at risk for other
cancers and should receive standard cancer
screenings, including mammography.”
Patient 3
The group then discusses a patient who had
come to Emerson with stage IV breast cancer
that had metastasized to her lung. “She has
been on hormone therapy—an aromatase
inhibitor—for more than two years,” notes
Dr. Sajer. “I see her on a regular basis, but
last month my exam showed a new 8-millimeter breast tumor. It appears her hormone
therapy is losing its effectiveness.”
Conference reviews a range of images,
considers a range of treatments
There is much information to consider at
Emerson’s Breast Cancer Conference—not
just an individual patient’s situation and medical history, but all the diagnostic information
in a variety of formats and numerous options
for treatment.
Imaging tests are presented to the group, including mammograms, ultrasounds, chest CT
scans, breast MRIs and bone scans, as well as
PET/CT images. The pathology reports that
are presented may be based on tissue taken
during biopsies or surgery, with or without
lymph node sampling. Treatment may include
each or all of the following: surgery—lumpectomy, mastectomy or re-excision—radiation
therapy, chemotherapy, hormone therapy and
targeted therapy, including in the context of a
clinical trial.
Today, treatment is based on a number of factors, starting with the stage of the disease—its
size, whether lymph nodes are involved and
whether the primary cancer has metastasized
to another part of the body. The treatment
plan also considers whether or not the tumor
has hormone receptors—that is, sensitive to
either estrogen or progesterone—as well as
the HER2 status (indicating the presence of a
protein associated with a specific type of
breast cancer) and the patient’s genetic status.
For example, does the woman carry the BRCA1
or BRCA2 mutation that puts her at high risk
for developing breast cancer?
Finally, a woman’s age, medical history, overall
health and personal preferences are each considered by the Breast Cancer Conference members as they work together to develop the right
treatment plan for each patient.
Shedding light on mammography
screening guidelines
“Is it time to operate?” Dr. Schoenthaler
asks.
american cancer society is questioned by those
“No, there is no evidence this patient will
benefit from mastectomy,” says Elizaveta
Ragulin-Coyne, MD, a general surgeon, noting that the standard of care for stage IV
breast cancer is systemic therapy with hormonal therapy or chemotherapy and possibly radiation.
The recent announcement that the American Cancer Society (ACS) changed its guidelines for breast cancer screening sent many women and their physicians into another
confusing tailspin. The group says that most women should begin having annual mammograms at age 45 instead of 40 and scale back to having the screening test every other
year beginning at age 55.
“Yes,” says Dr. Sajer. “I think the patient is
a good candidate for alternate hormone therapy to help put the brakes on cancer cell
growth and division.” Dr. Vora suggests that
the patient may wish to consider participation in a clinical trial evaluating new endocrine therapies alone or with alternate
hormone therapy.
Patient 4
who care for patients
Many are asking, in the face of an overall increased survival rate for breast cancer of 90
percent—the result of early detection and improved treatment—why there should be a
change. “Here at Emerson, we have diagnosed so many women in their early 40s thanks
to mammography,” says David I. Rose, MD, chair of radiology. “We know that the greatest number of lives will be saved by having women begin mammograms at age 40.”
Dr. Rose also questions the scale-back to having mammograms every other year beginning at age 55. “A woman’s risk of developing breast cancer increases at around age 50,”
he notes. “For many women, the new recommendations will result in delayed diagnosis
and larger tumors.”
Dr. Rose then shows different imaging views
of a woman on whom he recently performed
a core biopsy. “You’ll see a small, 4-milli-
The ACS acknowledges that women who have a family history of breast cancer should be
handled on an individual basis, probably beginning mammograms earlier based on discussion with their physician. “But the vast majority of women who are diagnosed don’t
have a family history,” says Dr. Rose. “Thinking that you’re low-risk doesn’t work.”
Continued on page 8
Continued on page 8
7
Tackling important cancers in men and women
Breast Cancer
Conferences
Continued from page 7
meter lesion,” he says. Dr. Geller draws the
group’s attention to a second tumor in the
other breast—an invasive, 7-millimeter breast
cancer.
Dr. Sajer notes that the patient previously
was treated for a slow-growing gastrointestinal tumor. “Then she had an abnormal
mammogram,” says Dr. Sajer. The group discussed whether or not her previous tumor is
known to be associated with breast cancer.
Dr. Schoenthaler says that the patient will
have genetic testing, and surgery on her right
breast is scheduled, along with an ultrasound
exam to look more closely at her left breast.
The benefits of collective discussion
Before the group breaks up, Dr. Schoenthaler
notes that she recently attended a national
conference where it was reported that the
number of mastectomies performed in the
U.S. is increasing. “Bilateral mastectomies
appear to be occurring more often in women
who have had MRIs, regardless of the findings,” she says. Dr. Ragulin-Coyne asks
about the criteria for performing an MRI,
both at Emerson and Mass General. The
group discusses how each hospital uses a relatively conservative criteria.
“Still, I think we need to monitor our own
numbers,” says Dr. Schoenthaler. All agree,
and the session ends, with a few of the physicians staying to continue discussing specific
patients while others head back to Emerson
inpatient units or their offices.
Through their work today, they have helped
assure that women who come to Mass
General Cancer Center at Emerson HospitalBethke—including those with complex, advanced cases of breast cancer—have the best
possible chance of survival, which today is
true for the overwhelming majority of women
who are diagnosed.
8
Despite the American Cancer Society’s new recommendations, David I. Rose, MD, encourages women
to begin having annual mammograms at age 40.
Shedding light on mammography
screening guidelines
Continued from page 7
Moreover, the ACS stated that physicians should no longer perform a breast examination—something that is typically done at an annual physical. “Many women do not
perform regular breast self-exam,” says Dr. Rose. “Why suggest that a primary care physician, who is conducting a physical exam anyway, should not check a patient’s breasts?”
The ACS statement cited the number of false-positives that result from mammography and
the impact on women of being called back for repeat imaging and, in some cases, a biopsy.
“The ACS recommendation doesn’t reflect the fact that tomosynthesis—3D mammograms—has reduced the call-back rate by approximately 20 percent,” says Dr. Rose, adding
that Emerson offers women tomosynthesis in both Concord and Westford. Nationwide,
only 2 percent of screening mammograms require a biopsy.
Professional organizations question the American Cancer Society
The confusion about mammograms began six years ago, when the U.S. Preventive Services
Task Force (USPSTF), a government-sponsored panel of experts, recommended that
women should begin having mammograms at age 50 every other year, instead of annually
beginning at age 40. At the time, the ACS refuted the USPSTF recommendation and endorsed the long-standing mammogram screening guideline.
Since then, the dialogue about health care costs has increased. “I’m all for being judicious
with health care dollars,” says Dr. Rose. “However, given how prevalent breast cancer is, I
believe mammograms should be broadly available.
“It’s a public health quandary. Are we comfortable letting a few more women die of breast
cancer? The American Cancer Society needs to balance the benefits and harms of a treatment or test. With this new recommendation, I do not believe they are doing that.”
Many professional organizations agree. The American College of Radiologists, the
American Congress of Obstetricians and Gynecologists and the Society of Breast Imaging
are among those that have endorsed the original guideline for women to begin having annual mammograms at age 40.
What does Dr. Rose tell patients who are confused about the ACS announcement? “I tell
them that, if they want to decrease their risk of dying of breast cancer, they should begin
having annual mammograms at age 40,” he says.
Emily Welch
‘‘
Tackling heart disease
and diabetes
Getting healthy often begins with coming to a conclusion—that it’s time to do
something. When a routine blood test showed that her cardiac risk factors had
increased, along with her blood sugar level, Emily Welch took action. The
Westford resident, who teaches kindergarten in Lowell, signed up for Emerson’s
Exercise & Weight Loss Prevention Program for Those at Risk for Heart Disease
or Type 2 Diabetes. She hoped the class would motivate her to change behavior—specifically, to commit to exercise. During the 12-week class last winter, she
learned a lot about nutrition, exercise, stress management and behavior modification, and she made a number of healthy changes.
“I saw that my cholesterol had gone up, but what scared me was the triglycerides were much higher, and my blood sugar level was right on the line. My
brother developed type 2 diabetes. Even though I’m on my feet all day teaching school, my weight had crept up, little by little. I knew I needed to get
more exercise.
“For me, the challenge was how to make exercise habitual by fitting it into my
life without it being a big production. I’m not someone who likes to go to a
gym, and when the workday is over, I keep working. Could I make myself—
my health—more important? I hoped that by joining the class, I would begin
a new behavior.
“Right from the beginning, I learned a lot from the staff—especially Julia
Elliott, the program’s registered dietitian. I had dieted before, but Julia
explained how carbohydrates operate in our bodies and why certain ones
are better than others. She measures and weighs you each week and gives
you recommendations on how many calories you should be taking in. It
was very helpful.
“Over the course of the program, I lost 15 pounds. When the class was over,
I signed up for another 12 weeks, and I continued to lose more weight. One
key to my success is that I stopped eating bread. I’ve gone down a size, and
I feel great.
“The class begins with an hour of exercise, which includes a warm-up and
cool-down and is followed by a lecture by one of the staff, including a dietitian, physical therapist and social worker, or watching a video together. I tried
out the various exercise machines and realized that my favorite exercise is
walking. Starting last January, throughout all those snowstorms, I put on my
boots and walked up and down the street. I got it done.
‘‘
In my
OWN
voice
Good things happened
when Emily Welch took
a class at Emerson that
convinced her to make
exercise a priority.
“The class put me in a different frame of mind. At first, my aim was to walk
120 minutes a week. Now I’m walking 45 minutes five days a week; that’s 225
minutes. The American Heart Association recommends that you get 150 minutes of aerobic exercise per week, so I feel good about that. I also got a
tracker, which has motivated me to stay on my program. I know how many
steps I’ve taken, and if I haven’t reached 10,000, I get moving.
“The other thing the class did was to start a conversation at home. My family
loves the dietary changes we’ve made. We do great things with cauliflower
and brussels sprouts!
“One thing leads to another. I think if you put yourself into a structure, and
you’re open to learning and trying things, good things happen. Attending the
class at Emerson made me realize I didn’t have to spend money on equipment or fancy clothes. I just had to make exercise a priority. I had to make
the commitment to changing my behavior; no one could do that for me.
“My wake-up call was the result of that blood test. I could have waited until
my blood sugar spiked, and I had type 2 diabetes. Instead, I made myself a
priority by attending the class. I believe I’ve made a permanent change.”
For more information or to register for the Exercise & Weight Loss Prevention
Program for Those at Risk for Heart Disease or Type 2 Diabetes, please call
978-287-3732.
9
Back to the birthing center–
this time, with twins
new childbirth features support a happy experience
Giving birth to her twins, Abigail and Benjamin,
says Amy Van de Water, was similar to when
she had Alexandra, shown sitting with her father,
Bill Van de Water.
from Brigham and Women’s Hospital who
are on site at Emerson.
At week 30, an unexpected surprise
She continued her job as an information
technology consultant until around the
sixth month of her pregnancy. “I gained the
target weight—about 45 pounds—which
was good, but I began feeling tired,” she
says. At 30 weeks gestation, an ultrasound
exam revealed that one of the babies was in
a breech position, which would require a
cesarean delivery, something Ms. Van de
Water had hoped to avoid.
Giving birth doesn’t always go as planned. But when Amy Van de Water
gave birth to her daughter, Alexandra, at Emerson two years ago, the experience met all her expectations. When she later became pregnant with twins,
she knew that her pregnancy and giving birth would be different. Still, she
hoped for a similar, positive experience. And that is what happened.
Is it luck, doing all the right things or genetics that leads to a healthy pregnancy and
happy childbirth? Ms. Van de Water had no
morning sickness and felt good throughout
her first pregnancy. “I wanted an unmedicated birth and used the labor tub to achieve
that,” she says. “It was a great birth—really
awesome.”
As soon as she gave birth to Alexandra, who
was delivered by Avra Jordano-Alter, MD, of
Concord OB/GYN Associates, she was able
to have skin-to-skin contact with her newborn. With Alexandra placed on her chest,
Ms. Van de Water began nursing her immediately. Many women request this as it promotes bonding between mother and child
and helps initiate milk production, which
can sometimes take a couple of days.
10
“It was nice to go right into that mode with
Alexandra,” Ms. Van de Water recalls.
“Also, I didn’t want her to be whisked
away—not after 12 hours of labor.”
Two years later, she was surprised to learn
she was having twins. “During the first ultrasound, I heard ‘here’s the heartbeat. . .
and there’s the other heartbeat!’” she recalls.
“I felt great—the same as during the first
pregnancy,” says the Shirley resident, “and
I started reading a lot about having twins.”
It was immediately clear that a twins pregnancy requires more appointments and extra
monitoring. In addition to her regular obstetrician visits, Ms. Van de Water was seen by
Drs. Karen Davidson and Rosemary Reiss,
maternal-fetal medicine specialists
“I tried to get the baby to flip position by
swimming, which exerts a safe gravitational
pull,” she says. “It was summer, and we
were on vacation, so I swam a lot. I even
tried a caffeinated coffee, which is also supposed to help. I knew it was a long shot.”
“There are a number of safe techniques that
are believed to help change a baby’s position,” says Vlassis Travias, MD, an obstetrician who saw Ms. Van de Water throughout
her pregnancy. “There’s no strong evidence
to support these techniques, but we don’t
discourage our patients from trying them.”
However, the baby’s breech position remained unchanged.
Ms. Van de Water’s cesarean delivery was
scheduled for August 10, but her water
broke on July 29. She and her husband, Bill,
headed to Emerson, where Jamie Bond, MD,
delivered Benjamin and Abigail—both a
healthy six pounds. “I had asked the nurses
ahead of time if it would be possible for me
to have skin-to-skin contact with the babies
right after they were born,” she says. “One
of the things that made me sad about having
a cesarean was that few hospitals allow it.
I wanted to give the twins what Alexandra
had right after she was born.”
new birthing center programs receive high marks from parents
During the past year, Emerson’s birthing center has added features
that benefit mothers and babies. Mothers who are seeking new
options for pain relief can now select nitrous oxide, a safe method
that is being selected by many women during labor. The concentration is different from the nitrous oxide used in a dentist’s office;
in labor and delivery, a mixture of 50 percent nitrous/50 percent
oxygen is used.
“Nitrous is non-invasive and offers women full control over its
administration,” explains Sherri Perivolotis, CNM, an Emerson
certified nurse-midwife with AFA Obstetrics and Gynecology. “The
best relief occurs when it is breathed in, through a face mask, just
prior to a contraction. Once the mask is removed, the effects of
the nitrous oxide are gone almost immediately.
“Women in Europe and elsewhere have used it for years. Emerson
is one of the few hospitals in Massachusetts making nitrous oxide
available to patients.”
There is nothing new about skin-to-skin contact between mothers
and babies at Emerson, but giving women this important opportunity to bond with their newborns after a cesarean birth is new.
There are a few good reasons to try to make this happen, says Ms.
Perivolotis. “Babies who receive early skin-to-skin contact are twice
as likely to be exclusively breastfeeding at three to six months.
And their mothers are less likely to have engorged breasts, which
can be uncomfortable.”
This early bonding has an impact on postpartum mood disorders,
such as postpartum depression. “Studies show that mothers who
have early skin-to-skin contact have lower rates of anxiety,” Ms.
Perivolotis notes. “And their babies are 12 times less likely to cry
during the initial newborn period.”
The donated human breast milk that is delivered regularly to
Emerson is pasteurized and tested to assure its safety. “Many parents are grateful that we have donor milk available, especially when
their baby needs it for medical reasons,” says Ms. Perivolotis, adding
that, in other instances, supplementation with specialty formulas
may be needed.
“Human milk is meant to be perfect for human babies. Providing
donor milk shows Emerson’s strong commitment to supporting
breastfeeding families.”
notes Dr. Travias. “If the baby is doing well,
we can still maintain a sterile environment
and encourage skin-to-skin contact during
and after a cesarean.”
In fact, Emerson encourages skin-to-skin
contact soon after a cesarean as long as the
mother and newborn are stable. Benjamin
and Abigail made a brief trip to the warming
bed—a traditional stop for most newborns—
and, after a quick assessment, returned to
their mother right away. Ms. Van de Water
began breastfeeding both twins, just as she
had hoped.
“The culture in operating rooms has always
been to maintain a sterile environment,”
Benjamin was found to have a low blood
sugar level, which can be corrected with
supplemental milk—typically formula.
Thanks to a program that debuted at
Emerson last year, Benjamin was soon receiving donated human breast milk—something his mother preferred. Mother’s Milk
Bank Northeast provides same-day delivery
for a variety of situations, including when a
mother’s milk has not come in or when
twins require additional milk (see sidebar
above).
“It was wonderful,” says Ms. Van de Water.
“Since the donated milk was already at
Emerson, it was brought to our recovery
room, which was reassuring. Right after my
husband fed Benjamin, his blood sugar level
increased.”
The family was soon home, where Ms. Van
de Water’s attention turned to getting the babies on the same feeding schedule. By the
fall, things were pretty normal. “I’m feeling
great now,” says Ms. Van de Water. “The
weight came off quickly; I’m working out
again. And the twins are sleeping great—six
hours.” They have seen their pediatrician,
Mark Francis, MD, at Pediatrics West in
Groton several times.
“We have family who live close by, and they
love to help out. My mother and grandmother both come over to fold laundry.
Alexandra is a big help; she runs to get baby
wipes or anything I need.”
Healthy twins and a birth experience that
came pretty close to what she hoped for: Ms.
Van de Water appreciates Emerson’s birthing center. “Both times, the care was great,”
she says. “They listened to us—and we
were so well taken care of.”
11
On the road with the
Boston Symphony Orchestra
robert partridge, md, keeps the musicians healthy—and playing
In any concert hall, there is the stage, the
auditorium and, tucked in the back, a doctor’s office. On occasion, in venues that
include La Scala in Milan and the Berlin
Philharmonie, Robert Partridge, MD, an
emergency medicine physician at Emerson,
inhabits that office.
Since 2013, Dr. Partridge has served as the
Boston Symphony Orchestra’s (BSO) physician during their overseas tours. “I’m there
to keep them healthy so that they can play
and do their best,” he explains. “An important goal is to keep the group together. They
don’t want a musician to be in the hospital—
and have to leave them behind—when the
tour is heading to the next city.”
This past summer, the BSO, which is
conducted by Andris Nelsons, traveled on a
highly anticipated two-week European tour:
London, Saltzburg, Vienna, Lucerne, Milan,
Paris, Cologne and Berlin. Dr. Partridge also
accompanied the orchestra on its 2014 tour
in Asia. The orchestra members are his
main focus, but he also cares for the BSO
staff and family members. “We’re like a
small town with a population of about 200
people,” he notes.
He says that emergency medicine expertise
is the right fit when a large group is on the
road, and anything can occur—colds, flu, GI
distress and injuries. “In the Emerson
Emergency Department, we see a wide range
of patients and every situation you can
imagine,” says Dr. Partridge. “We’re used
to making a rapid diagnosis, deciding if a
patient needs to see a specialist and acting
fast when we need to. Also, we can perform
various procedures, such as sutures.”
Applying skin glue and managing fluids
Hand problems are quite common in musicians, and Dr. Partridge is ready. “Musicians
often form calluses on their playing fingers,”
he says. “Those calluses can suddenly crack
open, bleed and cause pain. It’s surprising
how often this comes up.”
Boston Symphony Orchestra musicians rely on Robert Partridge, MD
(right), an Emerson emergency
medicine physician, to keep them
healthy during overseas tours.
He keeps skin glue handy. “A bandage
won’t stay on; it interferes with a musician’s
ability to play,” he says, noting that a carefully applied dab of glue can put someone
back in the orchestra in no time. “The other
category of hand problems are repetitive motion issues. I’m prepared for those as well.”
Upper respiratory infections and viruses
are predictable when a group is traveling
together on planes. “If one person catches
something, it’s difficult to stop the spread.”
But he tries, he says.
While a performance is underway, he sits
with the audience if the BSO has an extra
ticket, but he races back to the doctor’s office
during intermission. “The musicians often
need something in the middle of a concert—
medication for a headache or allergy and
sometimes wound care,” he says.
Touring with the BSO is unpredictable.
“Things can change in a second, just like in
the Emergency Department,” Dr. Partridge
says. “More than once, I’ve been called to
see a musician who is sick and has been
throwing up all night. After they tell me
they don’t think they can get on the flight
later that day, I proceed to fix them up by
giving them medicine and managing their
fluids appropriately, and they’re able to
travel and play that evening.
“I feel fortunate to have this position with
the BSO,” he adds. “I enjoy being a physician, I enjoy traveling, and it’s rewarding to
be useful to a world-class orchestra.”
Dr. Partridge says he loves all kinds of
music, including classical music. “I’ve
developed an appreciation for how the maestro and musicians interpret the nuances of
a piece to bring out what the composer
intended people to hear.”
Next up: a May tour with stops in Austria
and Germany. “It’s a fantastic group of people,” says Dr. Partridge. “I’m in awe of what
they do.”
12
The doctor is in
Useful information from the Emerson medical staff
Jessica Rubinstein, MD, pediatrician, on why teenagers are not getting enough sleep—and what to do
Many of your patients are teenagers. Do they mention having a
problem with sleep?
Sleep has become a major complaint. When one of my teenage
patients complains about headaches, fatigue, stomachaches, depression or anxiety, I ask them about their sleep habits. Do they have
trouble falling asleep? Do they nap in the afternoon? Are they waking up in the middle of the night? Kids have told me they wake up
in the middle of the night to text their friends. As I tell their parents, it is not a good idea for their children to have phones, laptops
or TVs in their bedrooms—partly because they should know what
the child is doing on the internet and partly for sleep hygiene.
However, there is also a biological reason why teenagers have
problems with sleep.
What is the biological reason?
During adolescence, the circadian rhythm or sleep-wake cycle
changes. The brain produces melatonin, the hormone that makes us
sleepy, later in the evening. As a result, teenagers aren’t feeling
sleepy at 9:00-10:00 pm, eight to nine hours before they have to
wake up and go to school. So they’re sleepy during the day, which
causes some of them to take a nap—and also interrupts their sleep
cycle. On weekends, teenagers typically go to bed later and then
sleep late. Patients often tell me they have the most difficult time
falling asleep on Sunday and Monday nights. All of this is totally
biologic.
“When one of my teenage patients complains about
headaches, fatigue, stomachaches, depression or
anxiety, I ask them about their sleep habits.”
– j essica rubinstein, md
Pediatrician
Do environmental factors also play a role?
Yes, beginning with electronic devices. We know that the blue light
from a computer screen suppresses the secretion of melatonin. Kids
often tell me their phone is in the bedroom because they use it as an
alarm clock. What’s surprising is that parents typically go along
with this. Other factors include caffeinated drinks, which are
widely available today; academic pressures, which now begin during middle school; and jam-packed schedules, including extracurricular activities and homework. We know about the increasing
stress levels among area teenagers from Emerson’s 2014 Youth Risk
Behavior Survey, which also revealed that 71 percent of high school
students are getting seven hours of sleep or less. It’s not enough for
healthy growth and development; the American Association of
Pediatrics recommends they get between 8.5 and 9.5 hours.
Do you have suggestions for parents?
I encourage parents to consider if their kids have too much going on;
take a look at their activities and the impact of, for example, taking
multiple honors and advanced placement classes. You can only
take so many classes when you have an hour of homework for each
one every night. I suggest that parents take on one factor at a time—
maybe getting their teenager to stop napping and perhaps get some
exercise instead. Then take on their caffeine intake. Finally, I
would ask parents if they are modeling good behavior themselves.
How much do they work? Do they allow themselves enough
downtime?
What if parents have a hard time disciplining their teenagers
about sleep?
If that’s the case, I would ask that they look at the health implications of sleep deprivation. People who get inadequate sleep are
more likely to be overweight, partly because they have more hours
in the day to consume calories. And when you’re tired, you don’t
have good impulse control, so you can easily overeat. Those who
are fatigued are prone to get in car accidents, which is dangerous
and a clear public health issue. Being a nuisance to your child—
making them change behavior so that they get enough sleep—could
be a lifesaver in the long run.
13
ON-SITE PHYSICAL THERAPY GETS ATHLETE
back in the game
Gabrielle Reuter, a senior at
Lawrence Academy in Groton,
returned to competitive play
soon after re-spraining her
ankle thanks to regular physical
therapy at school.
Emerson-Lawrence
Academy program is a
successful partnership
A sprained ankle can take anyone out
of action. Re-spraining that ankle further
stretches the ligament, which leads to a wobbly
ankle joint and instability—a nightmare for a
young athlete, especially when the fall sports
season is about to begin. Lawrence Academy in
Groton has partnered with Emerson on an innovative rehabilitation program that provides students with regular, on-site physical therapy. It
is an approach that gets them healthy and back
to team sports and other activities more quickly.
Mountain Day is a Lawrence Academy tradition
dating back almost 100 years. As the school
year begins, students ride buses to Jaffrey, New
Hampshire, where they hike Mount Monadnock
together. “I really like Mountain Day,” says
Gabrielle Reuter, a senior. But the late
September day trip ended with Gabby nursing a
painful, swollen ankle.
“I came down the mountain pretty fast,” she recalls. “At one point, I jumped and twisted my
ankle—the same ankle that I sprained last year.
I could walk, but it was painful.” The winter
before, Gabby sprained her right ankle during a
basketball game and had to leave the game. The
new sprain meant she couldn’t participate in
volleyball practice, which had already started.
Frank Mastrangelo, LAT, ATC, the school’s
head athletic trainer, made an appointment for
Gabby to have an x-ray, which ruled out a fracture. “With the second ankle sprain, I knew
there was potential for it to become a chronic
injury,” says Mr. Mastrangelo. “Gabby needed
to be out of her sport and get into physical therapy.” Once volleyball season ended, Gabby
14
Faster outcomes thanks to regular
physical therapy
Frank Mastrangelo, LAT, ATC, head athletic trainer,
wanted Lawrence Academy to be a satellite for Emerson
rehabilitation.
would go directly into basketball practice.
She will play on her college basketball team
next winter.
Thanks to the presence of Crystal Fontas, DPT,
from Emerson, Gabby had physical therapy
sessions in the Lawrence Academy training
room two afternoons per week. “Crystal measured my range of motion, which wasn’t very
good, and started me on simple stretches that
improved it,” says Gabby. “Then we began
using bands and specific exercises to build
strength in my ankle.”
“When the ligaments have loosened due to a
re-sprain, we build stability by working the
adjacent muscles,” Ms. Fontas explains. “We
also concentrate on increasing balance and
proprioception—awareness of the relative
position of one’s body. I had Gabby work on
an unstable surface, sometimes with her eyes
closed, which forced her to rely on
proprioception.”
During the final week or so, Ms. Fontas gave
Gabby sports-specific training that would prepare her for the remaining volleyball season
and the basketball season to come. “Before
she returned to competitive play, I had Gabby
do a lot of jumping, landing and cutting to
make sure she tolerated those activities,” she
says. “Within a month of her injury, after consulting with Frank, the decision was made to
clear Gabby to rejoin her volleyball team.
“That’s pretty quick, but we see outcomes like
this because of the readily accessible care this
relationship has provided to the students.
Gabby is a motivated young athlete; she did
everything I asked her to do, including exercises on her own. She was eager to get back
into competition.” One-third of the season remained; Gabby was careful to wear a brace
during practice and games.
It is a model that works well, says Mr.
Mastrangelo. “It’s what they do in the top
collegiate settings: physical therapy services
come to the school,” he notes. “I wanted
Lawrence Academy to be a satellite for
Emerson because I know the quality of care the
hospital provides. We have everything
we need to be effective—top-notch physical
therapists, ultrasound, electrical stimulation,
hydroculators for pain management and
hydrotherapy pools.”
The program launched last year and has
steadily grown to where Ms. Fontas is periodically joined by Laura Nejame, PT, chief
physical therapist at the Emerson Health
Center in Westford. “We see a range of sportsrelated conditions, from overuse sprains and
strains to students who are in rehab after ACL
reconstruction or shoulder surgery,” says Ms.
Fontas. “It’s a forward-thinking model,
and there’s no question our being on-site to
work with the students is leading to faster
outcomes—something everyone wants.”
Given the volume of activities available at
Lawrence Academy, Mr. Mastrangelo depends
on having experienced physical therapists at
the school. “We offer our students 50 different
athletic options,” he says, noting that they include soccer, tennis, squash and cross-country,
as well as dance and yoga. “I need to focus on
as many as eight games going on every afternoon. But every day, kids need to have quick
evaluations or need to be taped, wrapped or
have heat applied.
“I can’t find the time to give a student the
one-on-one care and attention they need if, for
example, they have a torn meniscus,” he says.
“With this program, when one of our students
needs high-quality, formal physical therapy,
that’s what they get. Crystal has been absolutely wonderful.
”We wanted Gabby to make progress, and she
did. When Crystal felt she was ready, that’s
when a decision was made about her return to
competition.”
“Crystal taught me about keeping my ankle
healthy,” says Gabby. “Having regular physical therapy gave me confidence, because my
ankle needs to be strong if I’m going to play
basketball. So far, so good.”
the total athlete:
performance assessment
program
What if you could spend 90 minutes with a physical therapist who
is completely focused on your
goals—to play a sport, to increase
your running or participate in another activity—and assesses you to
identify problem areas and develop
corrective strategies?
That’s what Emerson’s The Total
Athlete: Performance Assessment
Program delivers, says Christopher
Iby, PT, DPT, the certified strength
and conditioning specialist who
provides student and adult athletes,
runners and weekend warriors with
a one-on-one session aimed at injury prevention, as well as success
on the field, the court or the road.
“We do a complete head-to-toe
evaluation,” he explains. The assessment includes a comprehensive
mobility screen, functional movement assessment and peak output
muscle strength and balance testing.
The program was designed for runners, as well as athletes who play
basketball, soccer, lacrosse and
football. “We’re interested in preventing injury in healthy athletes,”
Mr. Iby says.
Runners should ideally be aware of
mobility deficits, Mr. Iby notes.
“Someone in his or her 40s who has
an office job and likes to run could
easily have a hip mobility deficit,
which we can address before they
‘up the volume’ on their running in
advance of training for an event.”
To schedule an assessment, please
call 978-589-6850 or email Mr. Iby
at CIby@emersonhosp.org. The
fee is $250. Participants receive
a detailed report aimed at injury
prevention and a customized
exercise program with corrective
strategies.
15
emerson hospital
Support Groups & Special Services
support groups
special services
Alcohol and Substance Abuse Support 978-287-3520
Alzheimer’s Information 800-272-3900
Nutritional Counseling 978-287-3782
Cancer Caregivers Support Group
978-287-3428
Aphasia Conversation Group
978-287-8238
Pediatric Intervention Team 978-287-3422
Grief Support Group
978-287-3428
CPR 978-287-3050
Pelvic Health/Bladder Control 978-287-8200
Loss Due to Illness
855-774-5100
Cardiac Rehabilitation 978-287-3732
Physician Referral
877-9-EMERSON or 877-936-3776
Melanoma Support
800-557-6352
Care Dimensions
888-283-1722
Pulmonary – Better Breathers Club 978-287-3715
New Mothers Group 978-429-8284
Chronic Lung Disease Program 978-287-8300
REACH (hotline for domestic violence)
800-899-4000
Oral, Head and Neck Cancer Support 978-287-3428
Gambling Problems 978-287-3520
Speech and Language Screening for Preschoolers
978-287-8200
Parkinson’s Support 978-369-0419
Heart Failure Program 978-287-8300
Sports Rehabilitation
978-287-8200
Surgical Weight Loss Support
978-287-3532
Home Health Service 978-287-8300
Volunteer Program 978-287-3200
National Alliance on Mental Illness 978-692-2908
Wound Care Center 978-287-8550
Outstanding care through all the stages of life
charles and katharine denault have new appreciation for emerson
Emerson, where they cared for me—the
whole me—with gentleness,” she recalls.
“The staff was thoughtful in handling a
young mother.”
Charles and Katharine Denault agree: area residents
cannot take Emerson for granted.
Many area residents receive their first impression of Emerson through an emergency—often an injured child. Charles and
Katharine Denault have those memories,
dating to the early 1980s when they moved
to Acton and were raising a family.
For Mrs. Denault, the introduction came
when she was pregnant and suddenly
became sick. “The ambulance brought me to
16
The Denaults’ four children were in and out
of that same Emergency Department with
broken legs and injured fingers and eyes,
and the couple continued to see that having
a high-quality hospital nearby is important.
They began giving to Emerson’s Annual
Appeal and have remained steady supporters, including to the hospital’s fundraising
campaigns that have upgraded the Critical
Care Unit and the pediatric and cardiac inpatient units.
“I feel strongly that you can’t take Emerson
for granted,” says Mr. Denault. “If you or
someone you love is going to walk through
the doors of Emerson to receive care, what
do you want for them? You want the place
to be the best.”
The Denaults understand the need for philanthropic support. “Health care technology
changes quickly,” says Mr. Denault, who
oversees Davidson Holdings Inc., which
owns and operates commercial real estate
properties throughout New England.
“Equipment and facilities need to be upgraded regularly; that’s where Annual
Appeal funds come in.”
As their children have grown, the Denaults
have turned to Emerson as they care for another generation in the family, namely Mrs.
Denault’s parents. “I’ve come to realize that,
for those of us who are taking care of aging
parents, Emerson is an important part of that
puzzle,” says Mr. Denault. “They may be
able to have all their care at Emerson, or
they may need to be stabilized at Emerson
before receiving care elsewhere. As we’ve
seen ourselves, the care at Emerson is
spectacular.”
“When life happens, you’re going to
Emerson,” says Mrs. Denault. “And when
you get there, you want the best community
hospital possible.”
Advisor
emerson
Q
your health questions answered by our experts.
I’ve dieted on and off for years with limited success. Should I try just one more diet?
Q
If you can lose weight by dieting—without having surgery—that is the best possible scenario. What is the
likelihood you can keep the weight off? You need to
consider the risks of remaining obese, if you are, and
the impact on your health. There are risks associated
with any surgical procedure, but the field of weight
loss surgery has dedicated itself to safety over the past
several decades. Current statistics show that bariatric
surgery is safer than a hip replacement or having your
gallbladder removed.
we don’t want someone becoming complacent about
their weight, especially if they have been obese for many
years. I encourage young, healthy patients to commit
to a diet and exercise program. However, if someone
has longstanding obesity, has dieted numerous times
and failed to keep the weight off, the dialogue turns to
surgery. And I tell that patient they’re not alone; only
a small percentage of obese individuals can lose the
weight and keep it off with just diet and exercise.
We feel it is a medical necessity that you avoid the conditions associated with obesity, which include diabetes,
high blood pressure, stroke and cancer. For that reason,
laura doyon, md
Bariatric Surgeon – Emerson Surgical Weight Loss
Program
My father had a heart attack at 52. I’m turning 50; should I be worried?
Because you inherit your genes, there is a possibility you
inherited the genes that predispose you to cardiovascular disease. However, that doesn’t mean you will suffer
a heart attack at a relatively young age, similar to your
father. We’re finding out that family history is a piece of
the puzzle—not the whole story.
Q
That’s good news, because it means you largely control
your own destiny, although there are rare situations
where whole families develop cardiovascular disease.
A combination of daily exercise, a healthy diet and
taking your medications—if any are needed—goes
a long way in preventing cardiovascular disease.
This is why heart attacks are occurring less frequently
today and, for the unlucky few who do experience a
heart attack, patients are surviving much longer today
compared to the past. The reasons for this include
the widespread use of statins (the cholesterol-lowering
medications) and more effective and better-tolerated
blood pressure medications. Thanks to these and other
medications, combined with diet and exercise, many
people are avoiding the development of cardiovascular
disease.
jonathan greene, md
Cardiologist – Emerson Cardiovascular Associates
I am aware that cancer treatment is becoming more personalized.
Does that include cancer surgery?
Yes. In the case of breast cancer, oncotyping is often
performed along with the pathology evaluation to
assess the likelihood that the cancer will recur. We
perform genetic testing to look for BRCA and other
high-risk genes in patients with a strong family history.
Someone found to be at low risk for recurrence requires
less extensive surgery, and less intensive chemotherapy
and radiation.
Our melanoma patients benefit from sentinel node
biopsy, which is performed during surgery. If fewer than
three lymph nodes are found to be positive, the treatment can be less aggressive. For advanced melanoma,
we perform BRAF gene testing to see if the patient is
a candidate for targeted chemotherapy. Similarly, if a
patient has colorectal cancer, we consider their family
history, we may perform genetic testing and will evaluate the tumor for high-risk characteristics. Where appropriate, we perform minimally invasive surgery so that
patients have a quicker recovery.
Each new patient’s case is discussed at our regular
multidisciplinary conference, where we develop a personalized cancer care plan. It includes a variety of cancer specialists and our colleagues from Mass General
Cancer Center at Emerson Hospital-Bethke.
elizaveta ragulin-coyne, md
General Surgeon – Walden Surgical Associates
For more information on care at Emerson Hospital, call the toll-free Physician Referral Line: 877-9-EMERSON (877-936-3776) or visit the hospital’s web
site at www.emersonhospital.org.
17
OnCall
Emerson Hospital is pleased to introduce the following new clinicians.
FAMILY MEDICINE
OTOLARYNGOLOGY
Daniel Perl, MD
Terry Jay Garfinkle, MD, MBA
Bedford-Lexington Internal Medicine, P.C.
450 Bedford Street, 1st floor
Lexington, 781-274-6274
3 Accepting new patients
Massachusetts Eye and Ear - Concord
54 Baker Avenue, Suite 303
Concord, 978-369-8780
masseyeandear.org/concord
3 Accepting new patients
Dr. Perl received his medical degree from Robert Wood
Johnson Medical School. He completed his residency
in family medicine at the University of Connecticut in
Hartford and is board-certified in family medicine.
Clinical interests: Chronic disease management, diabetes, hypertension, obesity and anticoagulation
Dr. Perl sees adult patients only.
Dr. Garfinkle earned his medical degree from George
Washington University School of Medicine and completed his residency at University of Pennsylvania
School of Medicine. Dr. Garfinkle is board-certified in
otolaryngology and serves as chief medical officer for
Partners Community Physicians Organization.
Clinical interests: General and pediatric conditions of
the ear, nose and throat
MIDWIFERY
Yasmeen Bruckner, CNM, MSN
AFA Obstetrics and Gynecology
131 Old Road to Nine Acre Corner, Suite 830
Concord, 978-371-1396
afaobgyn.com
3 Accepting new patients
PEDIATRICS
Eliza Jones, MD
Pediatrics West
100 Boston Road
Groton, 978-577-0437
pediatricswest.com
3 Accepting new patients
Ms. Bruckner is a certified nurse-midwife. She received
her master’s degree in nursing from Yale University
School of Nursing and completed her training at YaleNew Haven Hospital and Mount Auburn Hospital.
Ms. Bruckner is board-certified as a midwife.
Clinical interests: obstetrics, well woman care, adolescent gynecology, family planning
Dr. Jones received her medical degree from Yale
University School of Medicine and completed her residency at Columbia University Medical Center. She is
board-certified in pediatrics.
Clinical interests: Well child care, developmental delays
and children with special needs
OPHTHALMOLOGY
Balaji Perumal, MD
D’Ambrosio Eye Care
479 Old Union Turnpike
Lancaster, 978-537-3900
dambrosioeyecare.com
3 Accepting new patients
Dr. Perumal earned his medical degree from Duke
University School of Medicine and completed his
residency at Kresge Eye Institute. He then completed
a fellowship at the Lions Eye Institute. Dr. Perumal is
board-certified in ophthalmology.
Clinical interests: Eyelid malpositions, thyroid eye disease, tearing disorders and cosmetic eyelid surgery
18
UROLOGY
Octavia N. Devon, MD
Lahey Urology Program at Emerson Hospital
131 Old Road to Nine Acre Corner, Suite 740
Concord, 978-369-5551
emersonhospital.org
3 Accepting new patients
Dr. Devon earned her medical degree from Drexel
University College of Medicine and completed her residency at University of Wisconsin Hospitals and Clinics.
She is board-eligible in urology.
Clinical interests: Urologic cancer, stone disease and
voiding disorders
The Emerson Wellness Center
for Mind and Body
there are classes for all ages
The Emerson Wellness Center for Mind and Body is home to a wide range of classes and programs designed to keep you and your family healthy. For
complete class descriptions or to register, visit EmersonWellness.org. There is something for everyone, whether you’re looking to get fit, neutralize stress
or gain new skills. Check out these categories:
EXERCISE/MOVEMENT
SPECIAL EXERCISE PROGRAMS
HEALTHY EATING/COOKING
INFANT AND CHILD CARE
KIDS AND TEENS
NATURAL THERAPIES
PREGNANCY AND CHILDBIRTH
SELF-HELP/LEARNING
SPORTS PERFORMANCE
STRESS MANAGEMENT
WEIGHT LOSS/NUTRITION
Some classes are ongoing; you can join at any time. Before attending a drop-in session, please call 978-287-3777 to check if the class is being held. If you wish
to receive a copy of the calendar, please call 978-287-3777.
News from Emerson
Emerson earns two impressive national rankings from
The Leapfrog Group
The Leapfrog Group, a respected health care quality rating organization,
recently named Emerson a 2015 Leapfrog Top Urban Hospital for meeting
the nation’s toughest standards for safety and quality. For the 2015 reporting
year, more than 1,600 hospitals willingly disclosed their safety information
to the public through the Leapfrog survey. Patricia Wheeler, senior director
for quality and patient safety, accepted the award in Washington, D.C., on
December 2.
Prior to that announcement, Leapfrog gave Emerson an “A” for its Leapfrog
Hospital Safety Score. The survey assigns quality and safety grades of A, B, C,
D and F to more than 2,500 U.S. hospitals based on their prevention of medical errors, accidents, injuries and infections. Only 35 Massachusetts hospitals
received the impressive “A” grade. To see the Leapfrog Hospital Safety Score
rankings, please visit hospitalsafetyscore.org.
Changes for the Auxiliary
The Emerson Hospital Auxiliary, a tradition at Emerson since 1924, has a new
twist on their name—the Auxiliary of Emerson Hospital—and a new mission:
to support the community by enhancing the patient experience, increasing
awareness of the hospital’s services and providing educational programs.
Betty Ann Killian, a long-time supporter and friend of Emerson, recently was
named president of the vibrant organization, which has more than 250 members. Last year alone, auxiliary initiatives resulted in a gift of $120,000 that
supported a range of hospital programs to enhance the patient experience.
For more information or to join, please visit emersonhospital.org/support/
auxiliary.
Physician moves and announcements
The practice of Eric Mahoney, MD, general surgeon, has a new website:
concordsurgicalassociates.com.
James A. Street, PhD, MD, chair, department of anesthesia, and Paul Sikka,
MD, edited a new textbook, “Basic Clinical Anesthesia.”
Ira Skolnik, MD, PhD, of Family Dermatology, PC, was elected to a three-year
term as president of the Massachusetts Academy of Dermatology.
Toby Nathan, MD, an Emerson pediatrician, has moved her practice from
Bedford to Walden Pond Pediatrics in Concord, 978-369-9401.
Arthur Lee, DO, and James Spinelli, DO, have changed their practice name to
the Emerson Spine Program, still at 54 Baker Avenue, Concord, 978-287-3194.
19
133 ORNAC, Concord, MA 01742
978-369-1400
www.emersonhospital.org
Emerson Hospital is an acute care medical center
located
in Concord
with health
centers
in Bedford,
HealthWorks,
published
by Emerson
Hospital,
is
Groton,
Sudbury
and
Westford.
It
is
well
known
mailed to residents in the hospital’s service
area for
its medical
and surgical
specialists,and
outstanding
nursand
is distributed
to the employees
physicians’
ing
care
and
patient-centered
services,
including
the
offices affiliated with Emerson Hospital.
Clough Birthing Center, the Mass General Cancer
If you would prefer not to receive such mailings in the
Center at Emerson Hospital-Bethke, the Polo Emerfuture, please let us know by calling 978-287-3458 or
gency Center and the Clough Surgical Center.
send an email to pr@emersonhosp.org.
www.emersonhospital.org
Emerson Hospital President and CEO
Christine
C. Schuster
HealthWorks
, published by Emerson Hospital, is
Save these spring dates
mailed to residents
in the hospital’s
service area
HealthWorks
Magazine
editorial staff
and is distributed
to the employees
physicians’
Christine
Gallery, Bonnie
Goldsmith,and
Leah
Lesser offices affiliated with Emerson Hospital.
Writer
If you would prefer not to receive such mailings in
Laura Duffy
the future, please let us know by calling 978-2873458 or send an email to pr@emersonhosp.org.
Photography
Tony Rinaldo
Emerson Hospital President and CEO
Design
and
Christine
C. Printing
Schuster
Fassino/Design and Signature Printing & Consulting
HealthWorks
Magazine editorial staff
The information included here is intended to educate
Christine Gallery, Bonnie Goldsmith
readers about health issues, but it is not a substitute for
consultation with a personal physician.
Writers
The
mission
of Ralph
Emerson
Hospital is to deliver
Laura
Duffy,
Fuller
high-quality care to our community that is safe,
Photography
compassionate, accessible, appropriate, efficient
Tony
Rinaldo
and
coordinated.
These two events will be here in no time. Please save the dates for Emerson’s Annual Family Health
Expo on Saturday, May 14, and the 16th annual 5K Run~Walk for Cancer on Saturday, June 4.
This popular event features free screenings, cancer
and general health information, conversations with
health and wellness experts, children’s activities
and more. Registration is required for skin cancer,
Saturday, May 14
lipid profile/cholesterol (a 12-hour fast is required),
prostate-specific antigen (PSA) and thyroid function.
Please call 1-877-936-3776 to register after March 15. No registration is required for chair message,
body fat analysis or screenings for blood pressure, bone density, diabetes, oral cancer, respiratory or
postural problems. For more information, please visit Emerson’s website (emersonhospital.org),
Facebook page or watch the local media.
Design and Printing
Join
our online community
at Printing & Consulting
Fassino/Design
and Signature
The information included here is intended to educate
readers about health issues, but it is not a substitute
and
for www.emersonhospital.org
consultation with a personal physician.
The mission of Emerson Hospital is to deliver
high-quality care to our community that is safe,
compassionate, accessible, appropriate, efficient
and coordinated.
Join us for another great day of running, walking and events,
including music, family activities and swimming. Teams of runners
or walkers are encouraged to participate. This event, which
raises funds to support cancer services at Emerson, drew more
Saturday, June 4
than 500 participants last year. Cambridge Savings Bank is the presenting sponsor. See you at the Thoreau Club, 275 Forest
Ridge Road in Concord, between 8:30 am and 1:00 pm. To register or make a donation, please visit
emersonhospital.org/5K.
Front cover: Gabrielle Reuter, a senior at Lawrence Academy in Groton, got back to competitive
volleyball and basketball quickly, thanks to on-site physical therapy at the school.