Pulse of UTMC

As I was driving into work this morning, I heard on the radio news that the U.S. Preventative Services Task Force  is now recommending routine mammograms begin for most women at the age of 50, not 40, which has been the standard since at least 2002.

As someone who has spent the last six months undergoing breast cancer treatment, my immediate reaction was frustration – I was 38 when diagnosed, no family history. 

But I found a lump myself, which was then further investigated with a mammogram. But it happened to be in an easy spot to notice, close to the surface. What if the location had been different? I can’t help but wonder what that tumor could have become in another dozen years, when I turned 50 and finally had my first mammogram.

And the Department of Health and Human Services says that breast self exams are “optional.” I can’t remember exactly when this recommendation changed from monthly self exams, but I think it was a couple of years ago.

So what do you think about this change? It’s not like the recommendation was made in a vacuum without consideration of data.  But are they just looking at lives saved, or are they considering other quality-of-life issues, too?

I haven’t come to any conclusions yet. What are your thoughts?

Nov. 8 through 14 is Nurse Practitioner Week. According to the Academy of Nurse Practitioners,  nurse practitioners play a vital role “in bringing high-quality, cost-effective, comprehensive, patient centered, personalized primary care to all populations of the United States. (I love their alliteration, by the way!)

Nurse practitioners, or NPs, much like physician assistants, which I wrote about in a past journal entry, provide care under the supervision of a physician. They can provide a ton of services for patients, including ordering/interpreting diagnostic tests, diagnose and treat, prescribe medications, and, I think one of the greatest things they can do – they can take the time to explain, counsel and educate patients.

Most recently, my personal experience with an NP has been with Pam Snyder, who works with Dr. Anita Leininger who ordered my biopsy and performed my lumpectomy.

Pam explained the biopsy process to me in a way I could understand. Later she would explain my cancer and the treatments options that would work for me. She also gave me a ton of reading material.

Most importantly, Pam took the time to answer my questions. She obviously knew her stuff, and by that I don’t just mean the facts about disease and treatment, but she knew what questions to ask me. She know how to look at me, how to talk to me. She knew how to make a newly diagnosed cancer patient feel a little more at ease after receiving some pretty heavy news.

And by the time I saw Dr. Leininger at these appointments, many of my questions had been answered, some information I already had forgotten (all of this can be a blur when you’re in mental shock over news) and was able to ask again, and new questions popped into my head in the few minutes since I had seen Pam. It made my appointment with the physician more efficient, and, in many ways, more effective.

In a few days, I’ll share with you more about Pam and about her life as a nurse practitioner.

Thinking about making a career change? Check out UT’s College of Nursing.

It’s been about an hour since my last radiation treatment for breast cancer. It’s something I’ve been looking forward to since I began treatment in August.

Beating breast cancer

I won’t miss the daily trips to the basement of the hospital every weekday morning, the burning armpit and the not being able to wear deodorant.  

I will miss Ken’s wonderful laugh and the rest of the friendly radiation techs who greeted me every day.

When you’re sitting in the waiting room for treatment (which was never very long for me), you get to know others going through treatment at the same time. I’ll miss watching another patient working on a puzzle down there each morning. A patient who travels an hour each way (passing a number of other reputable hospitals to come to UTMC, by the way) for his treatment.  I’m sure he’ll be thrilled when he gets those hours back!

And I think about how lucky I am. No chemo. No horrible side effects from radiation. And most of all, the incredible outpouring of support from friends, family, co-workers, and people I’ve never even met!

Not everybody has all of that.

Connie Nofziger, Manager of Patient Support Services

And for those individuals – the people who are facing much pain, suffering, confusion and more, there’s help at the hospital from the folks in pastoral care. Pastoral Care Week happens to be Oct. 26 through 30 this year.

They provide the obvious services for patients and families, such as spiritual support, sacramental ministries, Holy Communion and other religious services, but they provide much more, too: grief and loss support, trauma/crisis support, assistance with advanced directives and support in ethical decision making. They even loan out CD players with CDs with soothing music and art supplies.

So if you’re reading this as a member of the general public, keep this in the back of your mind, should your family or friends ever need it (and, of course, I hope you never do).

If you provide care in our hospital, remember that these services are there for the patients you help, and how important they can be.

Jan Tipton

It doesn’t take a person working in health care to know that northwest Ohio is an extremely competitive hospital environment.

And that’s why I want to call out an event that’s being held on Thursday, Oct. 22 called About Healing.

The program is a true partnership of cancer services from around the area, including cancer support agencies like the American Cancer Society, the Victory Center and Komen; as well as UTMC, Mercy Cancer Centers and the Waterford at Levis Commons, where the event is to be held.

It’s funny – well, “funny” might not be the right word, but you get what I mean. Cancer is something nobody wants to go through, but it invokes some awesome (and I mean “awesome” in a literal sense) dynamics. It brings people together who might not have thought they have anything in common. And it can provide a forum for which folks who deliver health care can pitch in and make a difference – no matter where they work.

I have to share with you that Caren Goldman will be there as the keynote speaker. Caren wrote Healing Words for the Body, Mind and Spirit: 101 Words to Aspire and Affirm.
I met Caren years ago. She is a breast cancer survivor, and she used to write a column in a publication MCO produced called Balance that covered topics related to cancer, including research, treatment and prevention. She’s an incredible woman.

And About Healing promises to be an incredible event for those who attend. In addition to Caren, UT oncology nurse Jan Tipton will speak, as will Iman Mohamed, MD, my medical oncologist.
For more information about the event, contact UT’s Cancer Center at 419.383.5170.

In a recent journal entry I attempted to provide a glimpse of Anna Chlebowski, one star of our UT Medical Center “alumni” television spot that salutes some inspiring survivors of medical conditions.

Another one of those “alumni” (patients who were treated at UTMC and now have “graduated” to a healthy, happy life), is Michael Jones, who appears having a pillow fight with his wife in the spot.

Michael received a kidney transplant in 2006. His wife was his donor. Both of them have received a precious gift as a result – each other.

I could write more about Michael, but I don’t need to. His message to Sandra Flick, transplant coordinator, and me lets his incredible spirit shine through:

“Hello ladies, I trust all is well with both of you. I am sure you each are busy doing what you do, which is having positive impacts on the lives of the people you come in contact with.

I just wanted to take a moment to thank you for presenting me with an opportunity to perhaps be of some type of help for someone in the future.

When I was going through dialysis, I would always ask God, ‘why me?’ Then I would proceed to have my pity party. For a while, that got to be a daily ritual. One day, as I was asking that question, I heard, ‘Have you ever thought that this just isn’t about you?’ It was then that I realized that I was going through what I was dealing with to help someone else.

Although I don’t say a word in the commercial… if someone can see that I was able to make, then maybe they will get the hope to know they can make it as well.Sandy, you keep doing what you do in that clinic. Whether you realize it or not, your smile helps countless people every time they go through those doors at the clinic. I will never forget how calming you were, and still are, when I come there.

Esther, thanks for your hard work in getting the word out about the great things that take place at the medical center. I don’t think people realize how important it is to have people like you who love what they do working behind the scenes.

When we think of hospitals, doctors seem to get all of the attention. However… I’m reminded of something I used to hear my grandfather say, ‘Everyone wants to be a king, but no one really wants to be a king maker.’

I would often think, ‘What in the heck does that mean?’ Now I know. King makers work behind the scenes to make the king look good. You are truly two of the best king makers I have ever had the privilege of knowing.”

Take care,

Michael [Jones]

For the record: Michael thinks the world of our physicians, particularly Drs. Michael Rees and Matthew Rutter. I don’t want anyone to think by the preceding comments that he doesn’t. It’s nice, though, to see someone really look at all aspects of his experience with an institution and to see the value in each.

I share Michael’s thoughts with his permission because it defines, for me, a survivor, an ambassador, the type of person I strive to be.

By the way, you can hear Michael “playing himself” in UTMC’s radio spot.

According to the Association for Professionals in Infection Control and Epidemiology, this week is International Infection Prevention Week. No doubt we’ll be hearing a lot about hand washing, covering our mouths when we cough and other disease prevention measures, all of which are important, especially in the times of H1N1.

One of the more interesting – and debated – prevention measures is to have physicians put away the traditional neck tie. It’s been shown that, since those uncomfortable pieces of clothing hang down and touch all kinds of things and don’t get washed after each wear, they can end up full of germs.

The theory is that opting for a bow tie (or no tie at all) is a more sanitary option.

Makes sense in my mind, but I haven’t been able to find any references to research that actually confirm this theory.

What do you think? Is the bow tie in hospitals and clinics a way to keep people healthier? I’d love to hear your thoughts!

Regardless of your opinion on the bow tie, I do want to leave you with an enormous request, regardless of who you are or what you do: Wash your hands. Often.

Dr. Ishmael Parsai

I recently celebrated passing the halfway point of my 33 days of radiation for breast cancer, so I thought this would be a good opportunity to share with you the process of radiation treatment planning.

Dr. Ishmael Parsai is professor and chief of medical physics and director of UT’s graduate medical physics program. I asked him to be a guest writer on my journal about the process:

Before patients actually begin their radiation treatment, they come to our clinic to start what is affectionately called the “patient simulation day”, where imaging data is acquired and patient’s skin is carefully marked to map out the area being treated. With the patient secured in treatment position, CT images are acquired and transferred to our treatment planning computers for target identification and treatment plan analysis. The section of the anatomy imaged is reconstructed in 3D space, and through careful measurements the best angles for aiming the radiation beams to treat the target while sparing healthy tissue are determined. If additional imaging (MRI, SPECT, or PET) is deemed necessary, those are also sent to treatment planning computers for image fusion, and further analysis to make certain that the affected area is delineated. Beam ports are also identified with tiny marks on skin (like a tattoo), to help the radiation therapist precisely position the patient for daily treatments. The patient is asked to come back a few days later where work is done to generate an optimized treatment plan. A final treatment plan is then reviewed and approved by a radiation oncologist. We may go through a few iterations to achieve that final plan which gets transferred to the treatment machines and quality checked to get it ready for treatment day. Quality assurance is a major part of radiation treatment performed by the medical physicists on every patient to assure high level of accuracy. In most of the breast treatment cases, we deliver a daily fraction (up to five weeks) to a larger area encompassing the affected site and some related lymphatics. This is followed by 14 to 17 additional days of daily radiation concentrated on the area where the tumor was found. When delivering the boost radiation, the radiation oncologist focuses the radiation field on the tumor bed to assure that all the microscopic cancer cells are sterilized. The daily treatment takes about 15 minutes from beginning to end.

It is interesting to note that based on 2008 statistics from the American Cancer Society’s Facts and Figures publication, breast cancer is the most common type of cancer in American women. This year alone, 182,000 women and 2,000 men will learn they have breast cancer. Another 68,000 women will learn they have noninvasive (also called in situ) breast cancer. What most people do not realize is that breast cancer can often be cured. About 80 percent of all patients with breast cancer live 10 years after their diagnosis.

Oct. 6 through 12 is National Physician Assistant week. Over the years, I’ve had the privilege to get to know a number of PAs who have taught in UT’s PA program, graduated from that program and treat our patients at UT Medical Center. I’ve also been the beneficiary of their care. When I’ve got something nasty happening in my lungs and can’t get in to see a physician, I’m thrilled to have access to a PA.

Amy Biedenbach, PA-C

I’m a big fan of the profession, but I’ve encountered laypeople who are apprehensive, so I’ve asked Amy Biedenbach, PA-C, a surgical physician assistant, to share some information on her profession.

Q: What is a physician assistant? What can a PA do?

A: A physician assistant (PA) is a licensed health professional who practices medicine under the supervision of a physician. What a physician assistant does.

In general, PA’s can provide approximately 80 percent of the services typically provided by a family physician. They perform physical exams, diagnose illnesses, develop and carry out treatment plans, order and interpret lab tests, suture wounds, assist in surgery, provide preventive health care counseling, and in 39 states, including Ohio, can write prescriptions.

A physician assistant can do whatever is delegated to him/her by the supervising physician and allowed by law.

The scope of the PA’s practice corresponds to the supervising physician’s practice. For example, the PA working with a surgeon would be skilled in surgical techniques in the operating room, perform pre- and post-operative care, and be able to perform special tests and procedures.

Q: What is the difference between a PA and a physician?

A: One of the main differences between physician assistant education and physician education is not the core content of the curriculum but the amount of time spent in school. The length of a PA program is about two thirds that of medical school. Physicians also are required to do an internship, and the majority also complete a residency in a specialty; PA’s do not have to undertake an internship or residency. Doctors are independent practitioners; PA’s practice medicine under the supervision of a physician.

Q: How did the physician assistant profession begin?

A: Dr. Eugene Stead of the Duke University Medical Center in North Carolina put together the first class of PA’s in 1965. He selected Navy corpsmen who had received considerable medical training during the war in Vietnam but who had no comparable civilian employment. He based the curriculum of the PA program in part on his knowledge of the fast-track training of doctors during World War II.

Q: How much education and training does a PA receive?

A: Most physician assistant education programs require applicants to have previous health care experience and some college education. The typical applicant already has a bachelor’s degree and more than four years of health care experience. Nurses, EMTs, and paramedics often apply to PA programs. On average, an accredited PA program lasts 25 months. PA programs are accredited by an independent organization sponsored in part by the American Medical Association. All PA programs must meet the same standard curriculum essentials.

A PA’s education doesn’t stop after graduation. PA’s are required to take ongoing continuing medical education classes and to be retested on their clinical skills every six years.

Q: What does PA-C. stand for? What does the C mean?

A: Physician assistant-certified — the person who holds the title has met the defined course of study and has undergone testing by the National Commission on Certification of Physician Assistants (NCCPA). To maintain the C after PA, a physician assistant must log 100 hours of continuing medical education every two years and take the recertification exam every six years.

Thinking about a career change? Learn about UT’s PA program.

For more information, visit the Physician Assistant History Center.

I’d like to introduce you to somebody I met this morning.

This morning I was heading from my daily radiation treatment to my office and coming up a stairwell. A custodian stepped aside and said something I couldn’t quite understand. I stopped, asked him to repeat himself, and he told me that he always stops to let a woman pass. I joked that the two of us had plenty of room to pass each other, but he said his gesture was made out of respect.

Now I’m not exactly a “traditional” woman in the stereotypical sense, but I found this man’s manners to be refreshing. What was even more refreshing is that his kind gesture was a catalyst for a short conversation. Noticing an unfamiliar accent, I asked where he was originally from. I learned that Rudolph (who, I found out from two of his co-workers later goes by “Rudy) came to the United States from Ghana in West Africa (he’s got a great accent, by the way).  He asked what department I work in and where my office was.

John Nance, author of Why Hospitals Should Fly, visited our campus this summer and made numerous presentations to students, faculty and staff. He talked about the importance of mutual respect and personal connections in a hospital setting, and how it ultimately can result in safer care for patients.

Rudolph and I aren’t treating the sick or injured, necessarily, but we engaged.  That may not seem like a very big deal, but it was to me. You see, now I will always make eye contact and say hello to Rudolph when I see him. If there’s a piece of trash on the floor, I will think, “Maybe I ought to help Rudolph out and pick this up.”

So, I ask those of you reading this – would you be willing to share ways – however small – that you engage with the folks with whom you work? Or maybe share a new habit you’ve decided to make in order to be more engaging with the folks around you.

I’d love to hear your thoughts!

From left to right: Ryan Pakulski, Erin Severance, Sheila Foster, Amy Lett and Diane Bouillon

Last year at this time, Sheila Foster, staff nurse in the UT Medical Center operating room, contacted me about loading a screen saver on the hospital computers that would recognize Surgical Tech Week.

She supplied all of the information, and put a good amount of time and effort into it. A few weeks ago, she contacted me again to do the same thing this year.

Surgical techs may never be seen or heard by a patient, but it’s one of the fastest-growing professions in the Unites States. These specially trained professionals are responsible for ensuring safe and effective surgery by making sure that the operating room is safe, that all equipment is functioning properly and that operative procedures are conducted under the safest conditions.

I contacted Sheila to ask if I could highlight her and what she likes about being a surgical tech. Much to my surprise, she informed me that she’s not a tech, she’s a staff nurse. After talking a little more, I learned that she contacted me simply because she wanted to do something to recognize the hard work of her colleagues.

So I write this to salute UT Medical Center’s surgical techs and also to recognize Sheila, who takes an attitude toward her co-workers that is an excellent example for the rest of us. When we appreciate each other, we provide safer, more patient-centered care, we enjoy work, we help each other out, and we’re happier in general.

To be happy or miserable. It’s hard to believe that this is a choice, and even harder to believe that we sometimes choose to be miserable. But it is a choice, and Sheila’s chosen to foster a work environment that helps her (and those around her) to be happy.