HealthMatters

Answers to Your Questions about

Diabetes and Back Pain

See page 8

What You Should Know about the

Condition that Affects 37 Million

AmericansFind more on page 4

Pinpointing Health Problems Faster than Ever

Read the details on page 10

winter 2008

AMC

✽two Augusta Medical Center www.augustamed.com

letter from the ceo

two Augusta Medical Center

w i n t e r 2 0 0 8

AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA New Leader for the Future

Dear Friends, It is with very mixed emotions that I say goodbye to Augusta

Medical Center. By the time you read this, I will have retired and your hospital will have a new chief executive officer. I would like to take this opportunity to introduce her to you.

Mary N. Mannix will assume the CEO role here on January 1, 2008. I believe she is an outstanding choice and everyone should be excited about the new perspective she brings to AMC. Mary comes to us from Sayre, Pennsylvania, where she is currently president of the Robert Packer Hospital. This hospital is about the size of AMC and serves a large geographic area in Northern Pennsylvania and Southern New York. Her career of some 18 years is truly a distinguished one. She holds masters degrees in nursing and business and is a Fellow of the American College of Healthcare Executives. Mary, her husband, Frank, and their two children simply cannot say enough about making their new home in the Shenandoah Valley. They will make a wonderful addition to our community.

I simply cannot describe the honor I feel to have been part of AMC, to watch it grow, and serve with distinction since the first day it opened. In my retirement, I do not feel less important here, in fact I am more important to AMC than ever before. Now, I am a member of the community, just like you. We are and will always be the only reason our hospital exists and the most important part of its success.

Best wishes,Richard GrahamChief Executive Officer Augusta Medical Center

and the ANSWER is…

Augusta Medical CenterAMC Health Matters is published by Augusta Medical Center. The articles

in this publication should not be considered specific medical advice, as each

individual circumstance is different. Entire publication ©Augusta Medical

Center 2007. All rights reserved. For more information or to be removed from

this mailing list, please call (540) 332-4969.

Support after

Diversions, the ostomy discussion group at AMC, was created in July when Dianne Moody, RN, BSN, WOCN, director for the surgical unit nursing treatment center and wound ostomy care at AMC, saw a need for a discussion group for patients coping with life after ostomy surgery (a surgery performed to create a fecal or urinary diversion due to disease, trauma, or birth defect).

“Over the years, many patients asked about joining a discussion group to help them through this life-altering change,” says Moody. “Unfortunately, our area did not provide this service for these patients, which is why Diversions is so important.”

AN INSTANT SUCCESS “At the first meeting, you could see a feeling of comfort and relief

in the faces of the patients,” says Moody. “They were so comforted to know that they were not alone in what they had just gone through.”

Jo Cowherd, a resident of Waynesboro, is a participant in Diversions. She says the discussion group finally gave her the answers she had been searching for since her surgery two years ago.

“I felt isolated after my surgery because there was no one I could really talk to,” says Jo. “Now, through Diversions, I have received the answers I needed and the feeling of belonging I had been yearning for.”

For more information about Diversions at AMC, call (540) 332-4346.

✽✽✽

Support afterOstomy Surgery

12

You can only get what condition if you had chickenpox in the past or if you have had the chickenpox vaccine?

What is the name of the bacteria that can survive for up to 56 days on surfaces and can be carried on the hands from person to person?

If you know the answer to either of the above questions, send your answers to Vicki Kirby, Media and Communications Director, at 78 Medical Center Drive, Fishersville, VA, 22939. All correct entries will be entered in a special drawing.

ON THE COVER: As staff radiologist at Augusta Medical Center, Thomas Zumsteg,

MD, uses the latest technology to ensure patients receive the most accurate

diagnoses possible. For more on the latest technology at AMC see page 10.

A new discussion group at Augusta Medical Center helps to improve the lives of patients following ostomy surgery.

Dianne Moody, RN, BSN, WOCN

Support afterOstomy Surgery

You Should Know AboutTHE BACTERIA We count on antibiotics to wipe out harmful bacteria and make us well. But bacteria are master survivors, and some types are becoming resistant to commonly used antibiotics. One strain that has caught the attention of the medical community is Methicillin-resistant Staphylococcus aureus (MRSA).

Randy Robinson, MD, lab pathologist

at Augusta Medical Center

THE BACTERIA

What Can You Do to

Stay Healthy?

4|

3|

2|

1|

Methicillin-resistant Staphylococcus aureus (MRSA) is preventable. Follow this advice to keep you and those you love healthy.

Wash your hands for 15 seconds with soap and hot water (or by using hand sanitizer).

Keep cuts/scrapes clean and covered with a bandage until healed.

Monitor bug bites, boils, pimples, and areas of red, painful skin. If routine treatment doesn’t help, see your doctor.

Avoid sharing personal items like towels, razors, or bar soap.

Avoid unnecessary antibiotics.

Get a flu shot. The combination of MRSA and the flu is dangerous.

Clean shared sports equipment with an antiseptic solution.

5|

6|

7|

Augusta Medical Center threethree

“MRSA is a variant of a common bacteria that has become resistant to penicillin-like antibiotics,” says Randy Robinson, MD, lab pathologist and chairman of the Infection Control Committee at Augusta Medical Center.

Misuse of antibiotics contributes to the rise in MRSA. But according to Carolyn Palmer, BSN, infection control coordinator at AMC, the ease of transmission is a greater factor.

“MRSA can survive for up to 56 days on surfaces and can be carried on the hands from person to person,” Palmer says.

UNDERSTANDING THE DIFFERENCEThere are two types of MRSA, and both require prompt treatment.“Community-associated MRSA occurs in healthy people who haven’t

been recently hospitalized,” says Dr. Robinson. “This type of MRSA usually causes skin infections, such as boils or lesions that look like spider bites.”

Skilled medical personnel can treat this type of MRSA by draining the infection site. If needed, appropriate antibiotics can be used.

“The other type of MRSA—cal led hospita l-associated MRSA—infects sick patients in hospitals or long-term care settings,” continues Dr.

Robinson. “Urinary tract infections and pneumonia are the most common hospital-associated infections.”

With early diagnosis, more advanced antibiotics can effectively treat MRSA. However, Dr. Robinson cautions that treatment with these antibiotics can be more costly, require a longer hospital stay, and increase a patient’s risk for developing other resistant bacteria.

Because an ounce of prevention is always better, AMC is working to stop the spread of hospital-associated MRSA.

“A recent survey performed by the University of Virginia Department of Epidemiology showed that AMC had the largest number of referrals to their hospital, and yet had the lowest rate of MRSA,” says Palmer.

ENSURING SUCCESSHow does AMC manage to curb the spread of MRSA?Palmer credits AMC’s aggressive MRSA measures. Here is what

AMC is doing to protect its patients:✽ Isolating patients with MRSA so the bacteria won’t spread.✽ Encouraging the strict practice of hand hygiene by staff and visitors.✽ Actively treating patients with MRSA.✽ Rapidly identifying patients at high risk for MRSA through newer and faster testing.✽ Monitoring antibiotic use.

For more on health conditions like MRSA, visit www.augustamed.com.

Dianne Moody, RN, BSN, WOCN

fourfour

Tired of all the coughing, sneezing, and achy bones? Then put down the

tissue and read on to find out more information

about what you can do to prevent sinus infections.

✽.

✽ The Story

Augusta Medical Center www.augustamed.com

.Your SINUSES Want You to Read

Is It Coming?Be familiar with this list of symptoms to help you realize

when a sinus infection is on its way.

❑ ache in your upper jaw and teeth

❑ cheeks are tender when they are touched

❑ cough

❑ decreased sense of smell

❑ earaches

❑ fatigue

❑ fever

❑ headache

❑ neck pain

❑ pain in the forehead over the frontal sinuses when

you are touched

❑ sore throat

❑ swelling of the eyelids or pain between your eyes

Approximately 37 million Americans are affected by sinus infections (sinusitis) each year, causing them to spend more than five billion dollars annually on sinusitis-related healthcare costs. But who really knows what sinuses are?

KNOW YOUR SINUSES The following are the four pairs of sinuses located within the bones

of the head surrounding the nose. • ethmoid sinuses, located behind the bridge of the nose and between the eyes• frontal sinuses, placed over the eyes in the brow area• maxillary sinuses, positioned inside each person’s cheek

• sphenoid sinuses, located behind the ethmoids in the upper region of the nose just behind the eyes

Each of these sinuses is joined by a continuous mucous membrane to an opening in the nose to exchange both mucous and air. Therefore, because each sinus is connected to the nasal passage, anything that causes the nose to swell—such as an allergy—also may affect your sinuses, causing a sinus infection. What is referred to as a “sinus attack” is caused when air is trapped within the sinus, along with other secretions, causing pressure to build on the sinus wall.

STOP THE ATTACKAlthough there is no exact way to stop a sinus infection from occurring,

there are a few tips physicians recommend, such as avoiding dry indoor environments, exposure to anything you may be allergic to, long periods of swimming in pools treated with chlorine, and water diving.

Also, try and keep your nose as moist as possible with any type of saline nose spray.

To find out more information about how you can prevent sinus infections, call an Augusta Medical Center physician. For a complete list of physicians on staff at AMC, visit www.augustamed.com.

Augusta Medical Center

Stephen Keefe, MD

Your SINUSES Want You to Read

Is It Coming?

A new, minimally invasive procedure at Augusta Medical Center is giving sinus patients clearer heads and shorter recovery times.

STEP 1: The ENT surgeon gains access to the target sinus with a flexible Sinus Guidewire. Then a Sinus Balloon Catheter is advanced over the Sinus Guidewire.

STEP 2: The Sinus Balloon Catheter is positioned across the blocked ostium and gently inflated.

STEP 3: The Relieva system is removed, leaving an open sinus ostium and restoring normal sinus drainage and function.

2007 Illustration courtesy of Acclarent

1 2 3

fi ve

continues on page 6

Stephen Keefe, MD, otolaryngologist at Augusta Ear, Nose,

and Throat and Facial Plastic Surgery Specialists and on

staff at Augusta Medical Center, is an expert in balloon

sinuplasty, which ensures patients have quicker recovery

times and less pain.

A new, minimally invasive procedure at Augusta Medical Center is giving sinus patients clearer heads and shorter recovery times.Sinuplasty is particularly

good for children,

as their anatomy and their

sinus cavities are smaller.

Using small

instrumentation

and the use of a fl uoroscope

makes the procedure

safer for them.”

—Stephen Keefe, MD, otolaryngologist on

staff at Augusta Medical Center

“

Bringing Relief to SINUS SUFFERERS

First introduced in 2006, balloon sinuplasty is revolutionizing the world of sinus surgery. With quicker recovery times and less post-operative pain for patients, Stephen Keefe, MD, otolaryngologist at Augusta Ear, Nose, and Throat and Facial Plastic Surgery Specialists and on staff at Augusta Medical Center, has been offering the procedure as an alternative to traditional sinus surgery since June of last year.

“The response from patients has been wonderful,” says Dr. Keefe. “Many patients have said if they knew that the pain and aftercare would be so minimal with the new procedure, they would have had their sinus problems treated sooner.”

HOW IT WORKSThe premise behind sinuplasty is the same used in balloon

angioplasties that widen arteries to the heart. The outpatient procedure involves threading a guide wire with a thin balloon attached, up

six

a nostril to the sinus cavity using a fluoroscope for guidance. Using image-guided technology significantly enhances the accuracy of the procedure.

Once in the sinus cavity opening, the balloon is inflated about a quarter of an inch, causing micro-fragmentation of the surrounding bone and expanding the opening to promote better drainage and ventilation. Because the surrounding bone is painlessly and minutely fractured, the opening is more likely to stay clear, reducing the chances of a second procedure later in life.

“The hope is that the procedure would be a permanent fix, but since many sinus problems are precipitated by allergies and other physiological problems, there is always a potential for future swelling that could close the ventilation ports,” says Dr. Keefe. “But so far, studies have shown that the results of the procedure last much longer than traditional surgeries.”

One multi-center study reported that 90 percent of patients who underwent sinuplasty reported significant improvement in their sinus problems after a six-month follow-up period.

THE BENEFITSMany people have heard stories of traditional sinus surgery

recovery involving messy sinus flushing and painful packing in the nose. Sinuplasty, however, is different.

Unlike traditional sinus surgeries, patients of sinuplasty do not have a long recovery period. Most patients are able to return to normal activities within a couple of days. As there are no incisions or cutting during the procedure, there is less bleeding and tissue trauma than with traditional surgeries, practically eliminating the need for packing or washing of the sinuses.

“Patients may feel some discomfort in their nose, have a little swelling, and experience some drainage after the procedure,” says Dr. Keefe. “But compared to traditional procedures, postoperative care is a pleasant alternative.”

Sinuplasty isn’t the answer to all sinus problems. It cannot be used on those who suffer from sinus polyps or isolated ethmoid disease (the sinus cavity located between the eyes). But for those who suffer from chronic sinusitis, it might be the best way to clear your head.

If you suffer from chronic sinusitis, talk to your primary care physician about possible treatment options.

A Safer Option for SINUS SURGERY

Treatment of chronic sinusitis or other sinonasal conditions typically begins with conservative treatments, such as allergy management, antibiotics, and anti-inflammatory medications. When these measures fail or when more serious conditions require treatment, image-guided surgery is a safe and effective option.

“Minimizing the risk of injuries to vital structures, such as the eye, brain, optic nerve, and carotid artery, is paramount to the safe, surgical treatment of sinus disease,” says Michael Plautz, MD, otolaryngologist on staff at Augusta Medical Center. “The bone that separate sinuses from these structures may be less than one millimeter thick. Having all the information available during surgery makes the procedure easier for surgeons and safer for patients.”

STATE-OF-THE-ART TECHNOLOGYNot everyone with chronic sinusitis requires surgery, but patients with

nasal polyps or sinuses altered from birth, disease, or trauma, or those needing revision sinus surgery may benefit from image-guided surgery. The GE InstaTrak system is available at AMC to help your surgeon more precisely navigate through atypical nasal and sinus passages.

Image-guided surgery provides near three-dimensional views of your nasal cavities, allowing your surgeon to operate with safety and precision.

six

Today

1950s

Early 1900s

Sinus Surgery Timeline—Sinus surgeries are performed through external incisions with the goal of removing the sinus tissue to relieve symptoms of chronic sinusitis. This approach occasionally caused facial scarring and possible disfigurement.

—Nasal endoscopy revolutionizes sinus surgery by providing visual examination of nasal cavities, allowing surgeons to remove any obstructions.

—Image-guided surgery integrates information from computed tomography (CT) scans with standard sinus endoscopes and instruments, allowing surgeons to navigate complex nasal structures and limit the risk of damage to

surrounding structures.

Early Early 1900s1900s

1950s1950s

TodayToday

Augusta Medical Center www.augustamed.com

continued from page 5

✽✽✽sevenAugusta Medical Center

What Are Nasal Polyps?

Polyps may form in response to viral or bacterial infections, allergies, or an immune system response to fungus.Symptoms of nasal polyps include:• runny nose• persistent stuffiness• chronic sinus infections• loss or diminished sense of smell• dull headaches• snoring

Diagnosis and Treatment Nasal polyps occur more frequently in people age 40 and older or in children with asthma, cystic fibrosis, chronic sinusitis, or allergic rhinitis. Talk to your doctor if symptoms of a common cold last longer than a week, as nasal polyps will not go away on their own.

Small polyps can often be treated with medications that will reduce the inflammation in the lining of the nose and sinuses: Nasal steroids and antihistamines will reduce inflammation, while antibiotics will combat any infection.

If symptoms persist, a computed tomography (CT) scan can show your doctor the location and size of nasal polyps. Isolated polyps can be removed in an outpatient procedure using a microdebrider—a small suction device that cuts and extracts soft tissue.

Minimally invasive surgery may be required for larger polyps, and medications are used to manage symptoms after surgery. Polyps often return, and may require additional surgery in the future.

✽A Safer Option for SINUS SURGERY

First developed for use in neurosurgery, image-guided surgery uses a computerized model of the patient’s sinuses taken from their computed tomography (CT) scan to indicate the exact position of the surgeon’s instruments during a procedure. The use of image-guided sinus surgery in more complicated surgeries potentially reduces complications and the need for subsequent sinus surgeries in the future.

“Image-guided surgery is a major innovation not typically available at community hospitals,” says Dr. Plautz. “AMC is committed to providing the latest technology to ensure our community members receive the best care available.”

For more information about image-guided surgery or to make an appointment with Dr. Plautz, call (540) 245-7010.

Michael Plautz, MD, otolaryngologist on staff at Augusta Medical Center, uses image-

guided surgery to treat chronic sinusitis.

You may attribute your constant runny nose or a loss of smell to allergies or sinus infections, but in some cases the problem might be small growths on the lining of your nose and sinuses.

Q:

eighteight Augusta Medical Center www.augustamed.com

In this special feature, three doctors on staff at Augusta Medical Center answer your questions about diabetes,

chronic back pain, and the excruciating condition known as shingles.

✽.

DOCTORS ANSWER Your QUESTIONSQ: My doctor just told me that I have been diagnosed with prediabetes. What does this mean?

(T. Deepa Kirk, MD, with Augusta Diabetes & Endocrinology, cares for patients with diabetes, thyroid disorders, osteoporosis, and other hormonal problems.)

A diagnosis of pre-diabetes means that your blood sugar is higher than is healthy, yet not quite high enough for you to be diagnosed with Type II diabetes. This diagnosis should serve as a warning sign to you, because it means you might still have time to delay—or even prevent—the onset of full-blown Type II diabetes.

Prediabetes i s an indicator that your body is on its way to developing Type II diabetes—a chronic health condition that occurs when the body either doesn’t produce enough insulin (a hormone that allows the body to convert sugar in the blood to energy) or doesn’t use it correctly. When this happens, the high sugar levels in the blood gradually build up, destroying the cells and leading to a myriad of health complications that can affect the entire body—especially the eyes, nerves, kidneys, and heart.

There are lifestyle changes you can make to prevent or delay the onset of Type II diabetes. The Centers for Disease Control and Prevention says that those with prediabetes can reduce their chance of developing diabetes by 58 percent within a three-year period by changing their diet and adding two-and-a-half hours of exercise each week. Medication—particularly one called Metformin—can also cut your risk of diabetes by 31 percent during a three-year period.

Begin a dialogue now with your physician to learn how to change your diet, incorporate exercise into your life, and if you need to take any medications to stay healthy. Lifestyle changes you make now can create a dramatic improvement on your health later.

Q:

nineAugusta Medical Center

Q: I’ve suffered from chronic back pain for years, and over-the-counter medications aren’t working for me anymore. Is there anything else that can be done to help me relieve the pain?

(Victor C. Lee, MD, is the medical director of Augusta Pain Management Center.)

Absolutely! If you have chronic pain, pain manage-ment specialists have numerous options for relief that aren’t typically available in your primary care physician’s office. From medication management to implantable spinal cord stimulators, there are a lot of pain management tools that can help:• Medication manage- ment. With medication

management, a pain management specialist can oversee your medication usage and recommend alternatives to help you avoid narcotics. He or she might recommend you try other alternatives, such as neuropathic agents and muscle relaxers.• Injection therapy. Injection therapy often involves anti-inflammatory medication. While injection therapy—such as an epidural or spinal analgesia—can last for up to a few months, it sometimes provides long-term relief.• Implanted pain devices. With implantable pumps, a pump and catheter are surgically placed in the body so that small doses of medication can be regularly delivered to pain receptors in the spinal cord. With a spinal cord stimulator—which has both internal and external parts—a small stimulator sends electrical impulses that block pain signals from reaching the brain.• Complementary and alternative medicine. Acupuncture, massage therapy, and relaxation therapy and stress management can also make a difference in the level of pain you experience. Acupuncture is available at AMC in the pain clinic by Dr. Victor C.

Lee, who is certified to perform medical acupuncture. While it might be unrealistic to expect a 100 percent reduction in pain, it’s reasonable to say that a pain management specialist can help to better manage your pain.

DOCTORS ANSWER Your QUESTIONSQUESTIONS?

Q: My mother-in-law says she’s in a lot of pain because she has shingles. Isn’t shingles just the grown-up version of chickenpox?

(Kimberly M. Cheek, MD, with AMC Skyline Internal Medicine, is currently accepting new patients ages 18 and older.)

Yes and no. While shingles is caused by a dormant chickenpox virus called Herpes Zoster, the virus can cause tre-mendous pain in adults when flare-ups occur.

You can only get shingles if you had chickenpox in the past or if you have had the chickenpox vaccine. After you have chickenpox, the virus stays in your body in certain nerve cells. Most of

the time, the virus simply stays inactive in those cells. But as you get older, or if the immune system weakens due to illness, the virus can escape from the nerve cells and cause shingles. The reactivated virus then travels along the nerve paths to the skin’s surface.

At the skin’s surface, shingles cause a painful, blistering rash. What begins as reddish bumps turns into blisters, which generally crust over and fall off after about a week to 10 days. Even though the rash gets better after a few days, the pain can last much longer.

About one in five people with shingles will get postherpetic neuralgia, which is where nerve pain from the virus lingers. The postherpetic neuralgia causes a burning pain that can make the skin extremely sensitive to temperature change or even light touch.

To reduce the pain of shingles, you can take over-the-counter pain medications such as acetaminophen or ibuprofen, as well as apply topical lotions or creams to the rash. If the pain is severe, the doctor can prescribe stronger prescription medications, including numbing patches. In addition, shingles is often treated with an anti-viral medication to shorten the length of the outbreak. A shingles vaccine is available at the Nursing Treatment Center at Augusta Medical Center, although your physician must write an order for you to receive the vaccine.

Shingles is not contagious. But people who haven’t had chickenpox can contract the condition after contact with a person with shingles. Anyone who hasn’t had chickenpox or the vaccine should avoid coming in contact with the shingles rash.

For a list of physicians on staff at AMC, visit www.augustamed.com.

tenten Augusta Medical Center www.augustamed.com

For those who are injured or ill, the journey to better health starts with a proper diagnosis. In the Shenandoah Valley, the first step on that journey is often through Augusta Medical Center’s back door—the entrance to AMC’s new computed tomography (CT)/magnetic resonance imaging (MRI)/positron emission tomography (PET) suite, where doctors and technologists can pinpoint health problems more rapidly and accurately than before.

Like the radiology suite itself,which is open and airy, the diagnostic imaging equipment there was designed with the patient in mind. MRIs are less confining and CTs significantly faster than they were just a few years ago. And a new PET/CT scanner makes diagnosing serious illness, including potentially cancerous tumors, both more efficient and accurate.

Doctors use these noninvasive tests to identify a remarkable range of conditions—from strokes to spinal tumors, from degenerated disks to dementia. The key is prescribing the right scan for the right situation—usually not a “black and white” decision for referring physicians, says Rick Grounds, AMC’s director of cardiology and radiology services.

MRI, CT, PET— What ’s the Difference?

Rick Grounds, director of cardiology and radiology services at AMC

elevenAugusta Medical Center

MRI, CT, PET— What ’s the Difference? “I was told years ago that the CT was better for analyzing bones, and MRIs were better for soft tissue,” he says. “Sometimes that’s true, but the choice of testing really depends on the clinical indications, meaning what the patient is presenting for, and what the doctor is trying to rule out or diagnose.”

Even time can be a factor, adds staff radiologist Thomas Zumsteg, MD. An emergency-room doctor often opts for a readily available CT scan over an MRI, which can take much longer to obtain.

Most scans, however, are done on an outpatient basis—scheduled by a referring physician, whose staff works with AMC

to ensure the process goes smoothly. The physician’s office provides the hospital with required preauthorization and the patient’s medical history, as well as providing the patient with pre-test instructions.

Whichever test you are prescribed—MRI, CT, or PET—some basic rules apply:• Dress comfortably. • Show up on time. • Take advantage of designated parking behind the hospital, near the entrance to the new wing.

And relax—a little test can be a big investment in better health.

Understanding MRIsUnderstanding MRIsUnderstanding MRIsUnderstanding MRIs

Magnetic Resonance Imaging at Augusta Medical Center

Unlike most scans, magnetic resonance imaging (MRI) does not involve the use of radiation. As its name suggests, the equipment contains a powerful magnet. During the scan a patient lies on a table, which slides into a bore; the MRI then sends radio waves into the patient’s magnetized body, which modifies those waves and sends them back out to a receiver (computer). That signal becomes the “picture” (diagnostic image) that a radiologist then interprets.

“Most people correctly associate MRIs with orthopedic and neurologic diagnoses—degenerative disc disease or sports injuries, for example,” says AMC staff radiologist Thomas Zumsteg, MD. “It gives us an excellent way to look at joints.”

But the test is also used to diagnose blockages in blood vessels, hip fractures, and many other diagnoses, and it’s the surest way to detect tumors in the brain and spine, which can be difficult to view by other means.

While MRIs can detect an abnormality almost anywhere in the body, Dr. Zumsteg says, “it doesn’t always tell you necessarily what that is—whether it’s an infection, a tumor, or something else. For cancer detection in most areas, you’d probably do another test first. Neurology and orthopedics are going to be 90 to 95 percent of what we do with MRI.”

What to ExpectPatients should show up at least 30 minutes before an MRI to allow for thorough prescreening questioning, which is essential.

Though an MRI poses very little risk of side effects, the magnet can dislodge certain metals in

the body, so it’s important to identify patients with pacemakers or staples from newer surgeries—and, possibly, those who have worked with sheet metal—who may not be good candidates for the test.

“We screen them several times,” says Rick Grounds, AMC’s director of cardiology and radiology services. “It’s all about doing things right the first time and for the utmost safety of the patient.

Before the scan begins, the patient changes into scrubs and may be given an intravenous needle in case contrast solution is needed to enhance the resulting image. While technologists administer MRIs like most scans, there are doctors close by in the very rare event that the dye causes an adverse reaction.

Historically, a more common side effect of an MRI has been anxiety—a problem now greatly relieved, Grounds says, by the combination of less confining equipment and a patient-friendly process. As MRI technology has advanced, the magnet is shorter and the bore opening is wider than with the older generation of scanners, lessening the “tunnel” effect.

Typically an MRI takes 30 to 45 minutes, during which patients can use headphones to listen to music; they also can speak with the technologist through a two-way intercom. If necessary, the patient can push a button signaling the technologist to stop the scan. Most MRI procedures are problem-free, but patients who are anxious might wish to discuss any concerns ahead of time with their referring physician.

A final note: Unlike radiological tests, MRIs can be noisy. During the scan a patient will hear thumping and hammering noises—the mechanical sound of the actual high-strength magnet, doing its job.

Getting Test Results

The results of any scan performed will usually be available within about a week from the physician who referred the patient for routine testing.

It’s common (and understandable) for patients anxious about their results to question the technologist who administers the test. But while technologists are experts at imaging, only a radiologist—as a medical doctor—can make a diagnosis based on that image and patient history.

If a magnetic resonance imaging (MRI) or computed tomography (CT) scan indicates a very serious problem requiring prompt treatment, the radiologist will get in touch with the referring physician immediately. Otherwise the radiologist will render a report that is sent to the referring physician within a week, at which point the physician contacts the patient. Patients receiving positron emission tomography (PET) scans, which are ordered for ongoing or complex medical cases, typically will have scheduled an appointment in advance to discuss their test results with their physician.

Whatever the test, an outpatient at AMC’s newest imaging wing can be confident in both the process and the result. Using the combined tools of good communication and state-of-the-art technology, AMC’s radiologists and technologists are key players on the patient’s healthcare team.

twelvetwelve Augusta Medical Center www.augustamed.com

Your Guide to CT Scans

Think of computerized tomography—a CT scan—as a 3-D X-ray, says AMC staff radiologist Thomas Zumsteg, MD.

Like an MRI, a CT is a cylinder through which the patient passes on a slowly moving table. A CT is significantly shorter, though—like a great big doughnut—and it scans the patient from all sides. Patients may receive an oral or intravenous solution, or both, which helps enhance certain organs or body systems in the resulting image obtained.

The beauty of the CT scan is its quickness. “The test that used to take 20 minutes back in 1990 now takes two

minutes,” says Dr. Zumsteg. “Plus, it gives us the ability to take pictures of things that move, like a beating heart. That’s just happened over the last three or four years.”

A CT is usually the first test used to find problems in the brain, he says, and it’s especially helpful for pinpointing abnormalities in the chest, abdomen, or pelvis. It’s also the alternative scan for patients who aren’t good candidates for an MRI.

As with MRIs, side effects from CT scans are limited to rare reaction to contrast dye.

What to ExpectMost CT patients will be asked to fast before the scan, and some are

given a barium-type solution (provided by the ordering doctor or hospital) to drink ahead of time. Street clothes are fine for a CT, though patients may be asked to push clothing aside or to remove bras with metal fasteners.

Patients should arrive 30 minutes early to answer questions and receive an intravenous needle in case they will need contrast solution. As with

an MRI, the technologist who operates the CT scanner first explains the procedure and what the patient will experience.

The scan itself often takes five minutes or less. “For CTs it takes longer to get the IV started and to do the little bit of

screening that we do than it does to actually scan the patient,” says Grounds.

Prod

uct p

hoto

s co

urte

sy o

f Siem

ens

Corp

orat

ion

CT scan of a healthy lung

screening that we do than it does to actually scan the patient,” says Grounds.

thirteenAugusta Medical Center

How PET Scans Can Save Your Life

Positron emission tomography, or PET scanning, is a particularly safe and powerful diagnostic tool. It allows radiologists to identify diseases like cancer and even dementia, which before could have been confirmed only surgically—or not at all.

PET scans rely on a radioactive chemical that, administered intravenously, is absorbed to varying degrees throughout the body. The body emits radiation captured by the scanner.

“Instead of putting X-rays from outside into the body, you put the material in and the radiation come out of the body,” explains Augusta Medical Center staff radiologist Thomas Zumsteg, MD.

Sheila Brown, supervisor of nuclear medicine and PET services at AMC, describes the test as a “function study”: The radiologist interpreting a PET scan looks not only at the size and shape of any abnormal area, but at the degree to which it has metabolized the radioactive chemical. A cancerous tumor will absorb the solution in greater amounts than surrounding organs, for example, while a poorly functioning lobe of the brain will absorb less.

Because of cost and insurance limitations, a PET scan usually isn’t used for an initial diagnosis in most situations, Brown says. But for cancer patients—the majority of those who get the scan—it is an invaluable way to track the extent of the disease, recurrent malignancies or monitor the results of cancer treatment. The PET’s effectiveness is further enhanced by its integrated connection to a CT scan, which maps the resulting image.

Side effects are almost unheard of with PET; the radioactive chemical quickly expires and is flushed from the body. Because of the chemical’s short shelf life—less than 24 hours—it must be special-ordered the day before the test, so if a patient must cancel, it’s important that he or she do so well in advance.

What to Expect Patients scheduled for a PET scan should wear comfortable clothing without metal fasteners, and they should not eat or drink after midnight before their scan, as a blood glucose level over 200 will cloud test results. A technologist always checks the glucose level before administering a PET drug.

A crucial step in the procedure happens prior to the scan, when the patient relaxes under a blanket in a dimly lit room for up to an hour while receiving the IV; in a non-stimulating environment, the brain absorbs less of the injected chemical, which is taken up instead by problem areas.

Before the test, the IV is disconnected and the patient lies on a table with the head and knees supported. Because the PET and CT equipment are joined, the table moves through the equipment twice, both times scanning the patient from the base of the skull to the mid-thigh. The total test time is about 25 minutes.

Thomas Zumsteg, MD, radiologist at Augusta Medical Center, explains how positron

emission tomography (PET) scans can save your life.

Patients at Augusta Medical Center can receive positron emission tomography (PET)

scans that accurately diagnose diseases like cancer.

fourteenfourteen Augusta Medical Center www.augustamed.comAugusta Medical Center

“Pelvic pain and incontinence are not a natural part of aging, and there are things that physical

therapy can do to help. It’s really rewarding work because we’re about to change patients’ quality of life so they can get out and start having fun

again without having to worry.”— Lara Young, MPT at Augusta Medical Center

Helping YOU Live without Embarrassment

Pelvic pain often refers to intermittent pain in the region of a woman’s internal reproductive organs; however, this pain can be present in either men or women and can stem from multiple causes. This pain may be a symptom of infection or the result of inflammation of the internal organs.

Incontinence refers to an involuntary leakage of urine caused by weak pelvic floor muscles. This may happen when you sneeze, laugh, or cough, or it may cause you to have to take frequent trips to the bathroom. Incontinence is commonly caused by pregnancy and childbirth. However, it may also be the result of neurological conditions, genetic weaknesses, diseases, or radiation treatment for cancer.

TELL YOUR DOCTORPelvic pain and incontinence can significantly disrupt a normal lifestyle.

With the right treatment and exercises, however, these problems can be overcome. That’s where AMC’s physical therapy program comes in.

“Many people think that these problems are just a natural part of aging,

but they’re really not,” says Gretchen Cassell, physical therapist at AMC. “It’s important to tell your doctor about the problem because he or she can refer you to physical therapy, and there’s a lot that we can do to help.”

HOW WE CAN HELP To begin, AMC therapists review a patient’s history and use

biofeedback to determine possible causes of the pelvic pain or incontinence. Using this information, the therapists are able to create a treatment plan and pelvic floor exercises for patients. Following these guidelines, exercises, and in some cases counseling on fluid intake, patients often see impressive results.

“This is one of the most rewarding areas of physical therapy because pelvic pain and incontinence are quality-of-life issues,” says Ashley Kane, MSPT on staff at AMC. “So often people are limiting their activities because they always need to be near a bathroom. With a little bit of work with a physical therapist, however, pelvic pain and incontinence can get better, and people can truly start living again.”

For more information on treatment for pelvic pain or incontinence, call (540) 332-5935.

Although they’re not fun to talk about, pelvic pain and incontinence are real problems for many people. The good news? Treatment is available, and Augusta Medical Center’s physical therapy program can help.

Gretchen Cassell, PT, Andy Poole, PT, and Lele Sims, administrative assistant, are

on staff at Augusta Medical Center to offer help for those dealing with pelvic pain

and incontinence.

✽.

fi fteenAugusta Medical Center

New Year’s Resolution SolutionsLet’s face it: Traditional New Year’s resolutions often don’t work. Knowing why they fall short is the first step to learning how to make changes that stick.

ACROSS1 The premise behind sinuplasty is the same as established heart procedure

balloon______________________4 To find out the odor of something with your nose. If this is bad, you might feel sick!5 A long flexible tube with a camera at one end6 The amount of mucus sinuses can produce in one day

7 Sinus located behind the ethmoids in the upper region of the nose just behind the eyes 11 The number of days MRSA can survive on surfaces and be carried on the

hands from person to person14 Sinus placed over the eyes in the brow area15 Before a PET scan, the radioactive chemical is administered in a non-stimulating

environment to ensure absorption by cancerous tissue and not this organ16 Sinus positioned inside each person’s cheek18 If your blood sugar is higher than is healthy, yet not quite high enough for you to be

diagnosed with Type II diabetes, you have this condition

DOWN2 A common cause of incontinence3 Small and pearl colored growths that appear singly or in clusters like grapes on a stem8 Sinus located behind the bridge of the nose and between the eyes9 Instruments indicate their exact position on a computerized model during surgery using

these signals10 The test used to diagnose brain problems like strokes and hemorrhages as well as the

surest way to detect tumors in the brain and spine 12 Virus caused by a dormant chickenpox virus called Herpes Zoster

13 The ostomy discussion group at AMC17 A period of seven consecutive days, such as from Sunday to Saturday

ANSWERS: Please visit www.augustamed.com for this puzzle’s solution.

“Most resolutions are essentially fancy sounding ‘shoulds,’” says Pat Clough, LCSW, licensed clinical social worker at Augusta Behavioral Health and coordinator of AMC’s employee assistance program. “Good intentions alone rarely result in lasting change—they’re simply signals that we are trying to be further along in our motivation level than we currently are.”

Many people get trapped wanting the end (the goal) but not the means (the work it takes to achieve it). So how can you attain your goals? For a new you in the New Year, consider these secrets to success:

1| Be honest. Honestly evaluate whether you are ready to commit to a given change or need to

identify and work on roadblocks first.

2| Commit yourself. Be ready, willing, and motivated to make healthy changes in your everyday life.

3| Get prepared. Support your commitment by carving out time and allotting resources to help

you follow through.

4| Stay anchored. Be consistent so your new habits become resistant to backsliding and increase your

accountability by taking others under your wing to coach.

Pat Clough, LCSW, recognizes the importance of sticking to healthy New

Year’s resolutions.

Name Date(Key # 1 - 642132)

Play Smarter Winter 2008Try your hand at the Health Matters crossword puzzle and have fun while you add to your healthknowledge. Help with the clues can be found throughout the issue.

12

9

11

13

2

8

3

10

17

16

18

7

14 15

1

4

5

6

18

Try your hand at the AMC Health Matters crossword puzzle and have fun while you add to your health knowledge. Help with the clues can be found throughout the issue.

Play Smarter

Augusta Health Care, Inc.78 Medical Center DrivePO Box 1000Fishersville, VA 22939

www.augustamed.com

Nonprofit OrganizationUS Postage

Lynchburg, VAPermit No. 830

PAID

You deserve the latest...in medical technology and equipment, specialists who actually specialize, and physicians and staff working right here at home everyday...

taking care of our friends and neighbors with the focus always on quality healthcare. The kind of care youʼve come to expect...with a personal touch.

Augusta Medical Center is here to take care of you...

Your health. Your home. Your hospital.Augusta Medical Center • 78 Medical Center Drive • Fishersville, VA 22939 (932) 332-4000

www.augustamed.com