MyGeorgetownMDFall 2013

A MedStar Georgetown University Hospital Publication

G Elizabeth Phillips (left) now fully recovered from C. diff, a serious digestive disorder, enjoys a visit from her daughter, Camilla Phillips Schlegel, and Annie, who enjoys Elizabeth’s hugs.

continued on page six

IN THIS ISSUE Page 2Because You Asked: What Do I Need to Know About Osteoporosis?

Page 3Urgent Care Center or the ED: Where Should I Go?

Page 4Hip Procedure Relieves Pain, Postpones Replacement for Some

Back to Normal: Minimally Invasive Spinal Surgery Resolves Pain, Restores Mobility By Leslie A. Whitlinger

Former journalist Mike Feinsilber, 78, could barely walk more than a few blocks; 60-year-old Ray Weil, a University of Maryland professor with an active lifestyle, had trouble covering more than a few feet.

Debilitating Digestive Disorder Cured Using Ancient Chinese Remedy By Norma Babington

Elizabeth Phillips, 92, was reaching the end of her life and her life savings.

But a modification of an ancient Chinese remedy, now performed at MedStar Georgetown University Hospital, restored her health, and she no longer needs the expensive drugs and extra nursing care.

Ms. Phillips, formerly of Silver Spring, Md., and now a resident at Hill Haven Nursing Home in Adelphi, Md., contracted the devastating and sometimes fatal Clostridium difficile infection after a hip replacement in June 2012 at a different hospital.

Also known as C. diff, this bacterium causes debilitating diarrhea that can last for years. C. diff occurs mainly in the elderly and is linked to 14,000 U.S. deaths a year, according to the

Centers for Disease Control and Prevention.

Doctors treat C. diff with antibiotics like Flagyl, or if that fails, the stronger Vancomycin, or an even pricier Dificid. But even the strongest antibiotics didn’t cure Ms. Phillips.

Her daughter, Camilla Schlegal, also of Silver Spring, said, “The infection was debilitating. She ate less, lost weight, became increasingly confused, and was so weak she couldn’t manage her wheelchair. Equally upsetting, I had to use her dwindling funds for extra nursing aides to keep her clean and comfortable. The last medication, which she tried three times, cost $3,500 per course.”

Charlotte Maynard, RN, a Hill Haven unit manager, suggested Camilla call

Photo by Norma Babington

G Mike Feinsilber can swing a shovel again following his successful spinal surgery.

continued on page seven

Photo by Herman Farrer

“Because You Asked” focuses on topics suggested by our readers. If you want to suggest topics for future issues of this newsletter, please email them to torneyd@gunet.georgetown.edu.

MyGeorgetownMD asked MedStar Georgetown Internist Andrea Singer, MD, to answer some questions about osteoporosis. Dr. Singer is the clinical director of the National Osteoporosis Foundation. She splits her practice between general medicine and consultation with patients with osteoporosis, including those who haven’t responded to therapy or have underlying medical conditions that affect bone health.

What is osteoporosis and why does it matter to me?Osteoporosis is a disease that weakens your bones, making them thinner and more likely to break. It primarily affects women older than 50. One in two women over 50 will break a bone due to osteoporosis. For men older than 50 the statistic is one in four.

You may not have thought much about the consequences of a fracture, but consider this: About 24 percent of people die the first year following a hip fracture. Even those who survive a severe fracture may lose their independence, requiring assisted living or a nursing home.

Spine fractures can make it hard to breathe and can cause digestive problems. Some fractures also may result in chronic pain or curvature of the spine. Even a broken wrist can complicate dressing, bathing and eating.

With all the experience I have diagnosing and treating osteoporosis, I cannot stress this to my patients enough: Keeping our bones strong and healthy as we age is really important.

What are the risk factors?• Advancedage• Gender—inthefivetosevenyears

after menopause, women can lose up to 20 percent of their bone mass

• Lowbodyweight,smallandthinbody frames

• Familyhistoryoffractures,especially parental hip fractures

• Frequentfalls

• Lifestylehabits,suchassmokingorexcessive alcohol use

• Certainmedicalconditions,suchas diabetes, hyperthyroidism and some gastrointestinal disorders

• Somemedications,suchassteroids.

How is osteoporosis diagnosed?If you have several of the risk factors, talk with your healthcare provider. He or she will take a medical history and do a physical exam and probably order a dual energy X-ray absorptiometry, or DXA scan. These scans are non-invasive, low-dose X-rays of your hip or spine. The procedure takes 10 to 20 minutes and is painless. Blood or urine tests may be ordered to assess for underlying causes.

How can I prevent osteoporosis?You can do a lot on your own to help keep your bones healthy:

• Adequatecalciumintake—gettingyour calcium from the food you eat is better than taking supplements.* The goal is 1,000 milligrams of calcium daily, including diet and supplements for women younger than 50 and men younger than 70. Older seniors should get 1,200 milligrams daily, generally in divided doses.

Photo by Laura Brickley

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*While we all know that dairy products are good for your bones, fish and many vegetables and fruits provide great sources of vitamins D, C, and K, as well as calcium, magnesium and potassium. These nutrients are all important for maintaining healthy bones. Specifically, salmon, greens, peas, cabbage, broccoli, bananas and citrus fruit are just a few of the foods you should include in your regular diet.

Dr. Andrea Singer E explains to a patient how osteoporosis depletes bone strength as we age and she recommends working closely with your doctor to create an individualized treatment plan.

Because You Asked: What Do I Need to Know About Osteoporosis?

Treatment for osteoporosis

starts with a healthy diet and

physical activity.

To schedule an appointment with an osteoporosis specialist, call MedStar Georgetown M.D. at 202-342-2400.

• VitaminD(about1,000unitsdaily)• Weight-bearing,muscle-

strengthening exercises, such as climbing stairs, dancing, hiking or walking help build bones and keep joints healthy.

• Healthydietoverall—avoidtobacco and excessive alcohol.

Treatment optionsTreatment for osteoporosis starts with a healthy diet and physical activity. Some patients supplement their diets with prescription medications. These drugs work primarily by building bone (anabolicdrugs)orbyreducingbonebreakdown(anti-resorptivedrugs).

The most important message I can share is that individualized treatment and working closely with your doctor are really important. Work with your healthcare provider to assess your individual risk and develop an appropriate treatment plan.

G Flexibility and balancing exercises, such as stretching, yoga and tai chi are also good for joints and improve balance to avoid falls.

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Urgent Care Center or the ED: Where Should I Go?By Brendan Furlong, MD, Chief of Service, Emergency Department, MedStar GeorgetownUniversity Hospital

Finding the right type of care provider for your medical needs is always the best medicine. Sometimes, however, it’s not as easy as it sounds.

For instance, if your husband twists his ankle during his weekend pickup soccer game, should you drive him to the emergency room? Or if you wake up in the middle of the night because you’re having an intense pain in your ear, should you call your doctor? Is there another option?

The answer to all the above questions is, “It depends.” If you have an established relationship with a primarycareprovider(PCP),suchasafamily medicine or general practitioner, he or she should be your first call. Your PCP can help you decide the type of medical care you need and how to get it.

If you experience a life-threatening emergency, or simply aren’t sure what todo,don’thesitate—call911orheadto the nearest hospital. The emergencydepartment(ED)iscalledthat for a reason: It’s staffed with physicians and nurses trained to handle a wide range of conditions that are caused by severe trauma or that put your health at serious risk. Best of all, an ED is backed by a hospital full of specialists, including surgeons, who can assist if needed.

However, if your PCP is not available and you need quick medical attention for a non-life-threatening problem, like a sprained ankle or an earache, you can visit an urgent care center instead of the ED.

Growing in popularity in most major metropolitan areas, urgent care centers provide episodic medical

services on a walk-in basis, often with little or no wait time and extended hours. Some offer additional services, such as routine immunizations and school physicals, and can even help manage chronic health conditions. An urgent care center should not be a replacement for your PCP, however.

Know before you goPerhaps the best way to determine if an urgent care center is right for you is to understand what one is ahead of time. If there is one in your area, and MedStar has several PromptCare centers in the Baltimore-Washington region(seesidebar,page5),gocheckitout—beforeanurgenthealth issue arises. Here are some factors to consider when visiting an urgent care center:

• Careproviders:Askwhothecareproviders are. Many urgent care centers are staffed with at least one board certified physician. Some are run by nurse practitioners, who are certified to

G Brendan Furlong, MD, helps us figure out where to go for our aches, pains and medical emergencies.

Photo by Laura Brickley

continued on page five

Because You Asked: What Do I Need to Know About Osteoporosis?

After the red-eye from LA to Dulles, 34-year-old Eric Olson expected to be a little stiff. But as he rose from his seat, a sudden, stabbing pain in his groin nearly took his breath away.

“I’ve never felt anything like it,” he said. “I could barely stand and was struggling to walk. I actually wondered whether my first stop on the way home should be the hospital.”

Instead, he decided to give it some time. Three days later, still stiff but in less pain, Eric went to his doctor for help. But he wouldn’t find relief until he landed in the hands of MedStar Georgetown Orthopaedic Institute’s William Postma, MD, months later.

That’s not unusual for people suffering from femoroacetabular impingement (FAI),theconditionEricdidn’tknowhehad.

“Its symptoms mimic those of other disorders,” explained Dr. Postma, who specializes in sports medicine. “The pain and discomfort from FAI are often misdiagnosed and treated as a muscular problem or a groin pull. The only way to get an accurate diagnosis is through a combination of imaging, a detailed physical exam and listening carefully to a patient’s complaints.”

FAI is caused by structural abnormalities in the hip’s ball-and-socket joint. Either the surface of the ball(theheadofthethighbone)orthe cup-like socket that surrounds it is slightly misshapen, so that the two parts don’t form a smooth, tight fit. In many cases, both parts of the joint are affected. Over the years, the resulting

friction wears away and sometimes tears the protective cartilage, often causing stiffness, pain in the groin, limping and, eventually, arthritis. If more conservative approaches fail, the only other option is surgery to reshape the joint. Left alone, the damage can progress until hip replacement is needed.

ForEric,theconservativeoptions—including cortisone shots, anti-inflammatories and weeks of extensivephysicaltherapy—weresimply not working. So his savvy therapist recommended he seek another opinion and knew just the doctorforthejob:Dr.Postma—oneofonly a handful of orthopaedic surgeons in the metropolitan area to tackle FAI minimally invasively with hip arthroscopy.

“The hip is technically more difficult to approach arthroscopically than either the knee or shoulder, because of the depth of the soft tissue separating the

surgeon from the target,” said Dr. Postma. “Yet arthroscopy is better for eligible patients than open surgery, with a faster recovery time and return to full function.”

Last spring, Dr. Postma made three small incisions in Eric’s thigh to reach the damaged joint with miniaturized cameras and tools. He then resculpted Eric’s femur, rounding it to fit more smoothly in the cup and repaired a tear in the connective tissues lining the pelvic socket. Altogether, the outpatient procedure took less than three hours, after which Eric went home on crutches and used them for about a month.

Aggressive physical therapy followed for the avid golfer and softball player. While he’s not yet back to his sports, he is walking, running and pain-free for the first time in six months, and should remain so for a long time to come.Studiesshowthat80to90percent of patients undergoing minimally invasive arthroscopy for FAI continue to do well three to five years out. Longer-term results are not yet available.

Today, Eric can’t say enough good things about Dr. Postma and MedStar Georgetown. “The difference between Dr. Postma and my first two physicians was like night and day,” Eric said. “He listened attentively, knew what I needed and how to do it.”

Dr. Postma added, “Our immediate goal is to relieve pain, return people to their activities and delay the onset of hip arthritis. Our ultimate hope is to postpone or possibly even prevent hip replacements by intervening early in patients with FAI pain.”

Hip Procedure Relieves Pain, Postpones Replacement for Some By Leslie A. Whitlinger

To schedule an appointment with an orthopaedic specialist, call MedStar Georgetown M.D. at 202-342-2400.

G Eric Olson enjoys going through his physical therapy routine following hip surgery that resolved femoroacetabular impingement (FAI) — a deformation of the hip ball-and-socket joint.

Photo courtesy of Eric Olson

4

Eric Olson is walking, running

and pain-free for the first time

in six months.

35

treat certain ailments, and physician assistants, who work in tandem with an MD. You should also find out if the center will report your visit to your PCP for follow-up care.

• Serviceofferings:Dotheyhavethe ability to do lab work, run diagnostic tests or take X-rays, and is there a pharmacy on-site? Knowing that information ahead of time may save you from making an additional trip to another facility.

• Insurancecoverage:Determineifyour insurance will be accepted or, if not, how you can pay for services. Some urgent care centers offer a discount for patients paying with cash.

The bottom line is: If you are experiencing a serious medical condition, such as chest pain or severe bleeding, go to the ED. If your condition is not life-threatening, a visit to an urgent care center may save you time and money, and free your local ED to handle more serious situations for others.

Urgent Care Center or the ED continued from page three

Welcome New PhysiciansWe are pleased to introduce doctors who have recently joined the MedStar Georgetown team.

General Internal Medicine and PediatricsErin Farrish, MD

Hematology-OncologyStephen Liu, MDPaula Pohlmann, MDBrandon Smaglo, MD

NephrologyJudit Gordon-Cappitelli, MDUsman Rahmat, MDWen Shen, MD, PhD

NeurologyKaren Anderson, MDCarrie Dougherty, MDIshita Gambhir, MDAndrew Stemer, MD

NeurosurgeryAmjad Anaizi, MD

To schedule an appointment with one of our physicians, call MedStar Georgetown M.D. at 202-342-2400.

Walk-ins WelcomeThese are some of the non-life-threatening illnesses and injuries treated at PromptCare locations:

• Mild allergies/allergic reactions • Asthma/bronchitis/other upper

respiratory conditions • Minor burns • Cold and flu symptoms • Cough/congestion/runny nose/

sore throat • Ear pain/infection • Eye irritation/pain/infection

• Gastrointestinal disorders and stomach aches

• Migraines • Nausea • Sprains/strains • Urinary tract infections • Skin rashes and bug bites • Minor trauma, possible concussions • Neck and back pain

Locations: Wheaton11915 Georgia Avenue Wheaton, MD 20902301-942-4505 Gaithersburg12111 Darnestown RoadGaithersburg, MD 20878301-926-3020 Adams Morgan1805 Columbia Road N.W.Washington, DC 20009202-797-4960

Services:Should you need further treatment or evaluation, PromptCare staff will help you get to the nearest MedStar Health facility, where the team will be ready for your arrival. And with an integrated, electronic medical record, your complete medical history will be accessible to the physicians and nurses who will provide your care.

Visit MedStarHealth.org/PromptCare for details about hours, a listing of providers, and more.

Ob/GynMaria Eguiguren, MDDimitry Zilberman, DO

Plastic SurgeryKatherine Raspovic, DPM

Pediatric EndocrinologyEvgenia Gourgari, MD

Pediatric PsychiatryColin Stewart, MD

PediatricsElizabeth Chowla, MDHilary Wolf, MD

PulmonologyDaniel Jamieson, MD

Radiation MedicineSonali Rudra, MD

RadiologyFaisil Budhani, MDTheresa Caridi, MDJanice Jeon, MDGeorge Lynskey, MD

Rehabilitation MedicineEdwin Numsuwan, MD

Transplant MedicineAurn Jesuidian, MD

Transplant SurgeryAmol Rangnekar, MDPhilip Weems, MD

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Back to Normal: Minimally Invasive Spinal Surgery Resolves Pain, Restores Mobility continued from page one

The culprit in both cases was years in the making: severe leg pain stemming from a bad back, the cause of misery for so many. At various times, both men tried to stave off pain and disability through a combination of traditional and complementary approaches, including physical therapy, chiropractic and acupuncture. Nothing really worked, or brought relief for very long.

Finally,MikeandRayfoundrelief—beyondtheirexpectations—atMedStar Georgetown University Hospital at the hands of two of its experts in minimally invasive spinal surgery: Drs. Faheem Sandhu and Jean-Marc Voyadzis. The two lead the

area in performing minimally invasive spine surgery.

“We use minimally invasive approaches whenever we can get equal or better results than in open surgery,” said Dr. Sandhu, director of spine surgery. “In our experience, that’s 80 percent of the time. Thanks to these procedures, we’ve even successfully relieved pain and restored mobility to patients in their 80sand90swhocouldneverundergoa major open surgery.”

Nationwide, less than 20 percent of spinal surgeries are performed using minimally invasive techniques. However, the procedure is gaining acceptance, as more physicians become acquainted with its benefits.

Minimally invasive spinal surgery preserves as much of the body’s original architecture as possible by splitting muscles and ligaments, rather than detaching or stripping them from the bone. That technique results in smaller incisions, less blood loss and improved recovery overall. In addition, the approach can decrease potential long-term problems or complications that can occur after open procedures.

Equally important are the results, according to Dr. Voyadzis. “Minimally invasive spinal surgery really only came into its own a decade ago,” he said. “A growing number of studies are demonstrating that these techniques are safe and effective when compared to traditional

approaches, with patients returning to normal activities faster.”

That certainly appealed to Ray, whose severe back pain was a constant companion for 30 years. When it started affecting his legs, Ray reluctantly looked into surgery. The newshefirstreceived—fromanothertop-ratedinstitution—wasunsettling.

“The other surgeon told me that he’d have to cut muscle, tendon and bone, and fuse three vertebrae,” said the soil scientist. “He also cautioned I could only expect to reduce the pain by about 40 percent in my back and 80 percent in my legs. And that my days of jogging, yoga and digging were probably over.”

So Ray searched for a better alternative and soon had an appointment with Dr. Voyadzis, with great results. Shortly after minimally invasive surgery to stabilize his vertebrae and decompress his spinal nerves, Ray’s pain disappeared. Within two weeks, he was walking a mile or two a day. Now, he does 80 crunches each morning, rides his bike to work, prunes trees and chops wood —justabouteverythinghedidbeforehis back pain started.

For his part, Mike Feinsilber already knew about MedStar Georgetown after the “big success” of his quadruple bypass surgery years earlier. After exploring other options for his spinal stenosis, he asked Dr. Sandhu to tackle it. Through a solitary incision less than 1 inch long, Dr. Sandhu removed the bone and ligaments that were compressing the nerves at two levels in Mike’s lumbar area.

“I found relief right away,” he said. “Recovery was pretty painless: I was on my feet within a few hours and went home the next day.”

Within two weeks, I was

walking a mile or two a day.

~ Ray Weil, minimally invasive spine surgery patient

G An avid hiker, Ray Weil sets out for a trek on the streets of New York City. His successful minimally invasive surgery fixed the severe back pain that kept him from going for hikes and carrying heavy packs.

Photo by Diana Sierra

Debilitating Digestive Disorder Cured continued from page one

MedStar Georgetown, where gastroenterologist Mark Mattar, MD, was offering a new procedure, albeit one that may sound off-putting.

While many people consider the procedure new, Chinese doctors have used it successfully since the fourth century.Ithasabetterthan90percent success rate in curing C. diff.

The procedure is called fecal microbiota transplant, or FMT. Dr. Mattar uses colonoscopy to transplant donor feces into the gastrointestinal tract of the recipient, where the donor feces help restore the normal flora to the gastrointestinal system. “It’s not hi-tech or glamorous,” said Dr. Mattar, “but we’re transplanting feces, and within a day or two, the diarrhea is gone.”

After Camilla met with Dr. Mattar, she agreed to become her mother’s donor. “At first it sounded off the wall,” Camilla said, “but it cured my mother.”

“I was amazed how quickly it worked. She was feeling better the same day. I know people might feel squeamish about the procedure,” said Camilla. “But the oddness and inconvenience are minimal in comparison to watching someone you love be so sick and contagious to others.”

The Food and Drug Administration is interested in FMT for treating recurring C. diff. Dr. Mattar said, “The FDA supports our efforts as we collaborate with them in providing the best care to our patients.”

In Dr. Mattar’s capacity at MedStar Georgetown’s Center for InflammatoryBowelDisease(IBD),he also is interested in the possible role of FMT to combat IBD. “We’re not there yet, but small trials reveal FMT may be helpful in treating IBD. It’s exciting to take old medicine and apply it to the here and now. East meets West; a prime example of how integrative medicine is saving lives,” said Dr. Mattar.

At Hill Haven, Charlotte said that Ms. Phillips is eating well, managing her wheelchair and is all smiles again. She said, “MedStar Georgetown was thorough and efficient, and I would not hesitate to refer C. diff patients to them again.”

FMT cured my mother. She was

feeling better the same day.

~ Camilla Phillips Schlegel, daughter of 92-year-old Elizabeth Phillips

Center for Inflammatory Bowel Disease (IBD)

MedStar Georgetown’s IBD program offers patients a comprehensive, multidisciplinary approach by involving gastroenterologists and surgeons with expertise in managing and treating IBD. The team of specialists involved in treating the complex and challenging aspects of IBD often include:

• Radiologists• Interventional radiologists• Obstetricians and gynecologists• General medicine clinicians

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To schedule an appointment with a spine surgeon, call MedStar Georgetown M.D. at 202-342-2400.

G Dr. Sandhu’s minimally invasive surgery techniques help spine surgery patients recover faster and go home sooner after surgery.

With their training, experience and track record, Drs. Sandhu and Voyadzis are writing the book on minimallyinvasivespinesurgery—literally. The MedStar Georgetown specialists have one textbook on the topic to their credit with another in the works. They’ve also co-authored numerous peer-reviewed articles and regularly train physicians in the U.S., Europe and Latin America on the special techniques involved.

“The patient benefits are just so great,” said Dr. Sandhu. “We’re absolutely dedicated to resolving the maximum number of problems with the most minimally invasive techniques.”

“My ‘before’ experience was a bad situation only getting worse,” said Mike.“My‘after’situation—anditcameimmediatelyaftersurgery—wasgreat: blessed normality. No pain, no difficulty walking. My back hasn’t felt this good in 20 years.”

My back hasn’t felt this good

in 20 years.

~ Mike Feinsilber, minimally invasive spine surgery patient

To learn more about IBD treatment,visit MedStarGeorgetown.org/IBDor call MedStar Georgetown M.D. at 202-342-2400.

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WritersNorma BabingtonBrendan Furlong, MDHenry MortimerLeslie A. Whitlinger

A symposium focusing on the emerging role of molecular profiling in cancer diagnosis, treatment planning, the transition to personalized medicine, and the latest therapy for hepatocellular carcinoma

RueschCenter.org/symposium2013 for more information and to register.

December 6 andDecember 7, 2013

Fighting a Smarter War Against CancerA Three-Part Symposium