Tackling challengeshead on

WINTER 2015

JOURNEYS“Destiny is not a matter of chance, it is a matter of choice …” – William Jennings Bryan

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WINTER 2015

ALL ABOUT JOURNEYSStatesman William Jennings Bryan, one of the original benefactors of Bryan Health, said:

“Destiny is not a matter of chance, it is a matter of choice; it is not a thing to be waited for, it is a thing to be achieved.”

Journeys tells our story of how Bryan chooses to achieve. This free publication is mailed quarterly to our employees, physicians, volunteers and the communities we serve.

ON THE COVERSurgeon John Fallick, MD, used an unusual pro-cedure to save patient Steve Winter: See Page 2.

STAY IN TOUCHWe welcome your comments. For more information about Journeys, contact the Advancement team by calling 402-481-8674. To learn more about Bryan programs and services, visit us online at bryanhealth.org.

OPPORTUNITIES TO SUPPORTYour contributions help us care for those who come to Bryan at every stage of life. To find out how you can participate, call the Bryan Foundation at 402-481-8605, or write to us at: Bryan Foundation 1600 S. 48th St. Lincoln, NE 68506

Kimberly RusselPresident & CEO, Bryan Health

John Woodrich President & COO, Bryan Medical Center

Gary “Gus” Hustad, MD Chief of Staff, Bryan Medical Staff

Bob RavenscroftVice President of Advancement & CDO

Edgar BumanisDirector of Public Relations

Paul HadleyEditor

JOURNEYS01 FROM OUR PRESIDENT

02 PATIENT EXPERIENCE Successful surgery brings Steve home for the holidays

05 CONTINUING LEADERSHIP Webenefitfromtheinsightsofpastchiefs’experience

06 NEW AT BRYAN Anklereplacementremediesseverearthritis:Dwight’sactiveagain

08 BRYAN FOUNDATION

09 PULMONARY MEDICINE EmpoweringCOPDpatientstotakeaction

10 PULMONARY REHABILITATION Pacoachievesmanymilestonesonpersonaljourneytobetterhealth

12 BRYAN LUNG CANCER CENTER Highlightingnewestdevelopmentsinthefightagainstlungcancer

14 BRYAN HEART Cardiologiststeamwithpulmonologists:Trialtestssleepapneatreatment

15 MEDICAL STAFF SPOTLIGHT Askthedoctor:Canapulmonologistresolvemysleepissues? 18 MEDICAL STAFF UPDATE Welcome these colleagues to the Bryan medical community

20 NEW AT BRYAN Renaissancesystemguidessuccessfulspineandbrainsurgeries

22 BRYAN LIFEPOINTE ClasshelpsDianedealwithParkinson’s

24 VOLUNTEERS & CUSTOMER CARE Pediatricswelcomesambassadors

26 CRETE AREA MEDICAL CENTER

28 EARLY DETECTION CENTER

29 BRYAN COLLEGE OF HEALTH SCIENCES

31 ACHIEVEMENTS

32 BRYAN STERLING CONNECTION

33 COMMUNITY CALENDAR

New at Bryan

Treatment for migraines, cluster headaches and trigeminal neuralgia

The doctors of Advanced Radiology at Bryan Medical CenterofferSphenoCath,themostadvancedtreatmenttorelieveheadacheandtrigeminalneuralgiapain.

Thissimple,effectiveoutpatienttreatment:• Takesonly15minutes—andthere’snoneedle.• Offersimmediateandongoingpainrelief.• Issafeforchildren,adultsandpregnantwomen.• Isaffordableandcoveredbymostinsurance.

Migraines,clusterheadachesandtrigeminalneuralgiapaincanbedebilitating—takingyouawayfromyourworkanddailyactivities.Thisnewtreatmenteffectivelyblocksthepain,allowingyoutoenjoylife.

I have my life backRebecca,oneofthefirstpatientstoreceivetheSphenoCath

treatmentforhermigraines,sharesherexperience: “I had noideaoftheconstantpainIwascarryingarounddailyinmyheaduntilitwasgone.ThedayIcameinforthetreatment,Ihadamigraine.Aftertheprocedure,mymigrainewasgone.Thetreatmentisnotacure,andwillneedtoberepeatedovertime,butitissoworthit.Ihavemylifeback.”

Thetreatmentcanlastthree-sixmonths,givingpatientslivesfreeofmigraine,clusterheadacheandtrigeminalneuralgiapainandtheabilitytoworkandenjoydailyactivities.Repeattreatments,asneeded,provideongoingpainrelief.n

Learn moreVisitbryanhealth.org/migraine-treatment,orschedulea

consultationtofindoutiftheSphenoCathtreatmentcanhelpyou.CalltheBryanSchedulingCenterat402-481-5121.

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F R O M O U R P R E S I D E N T

“Let us make a special effort to stop communicating with each other so we can have some conversation.” — Mark Twain, writer and humorist

residentsSteveandJanieWinter.We’rehonoredtohavebeenpartofSteve’sjourney,andyoucanreadhisstoryonPage2.

Theartoflistening.It’sahallmarkofateamthatworkstogetherforpositivechange.Fromthemosttrustedandfamiliar,tonewmodelsfordeliveryandaccesstocare,we’reheretomeetyourfamily’shealthcareneeds.Putthepowerofteamworktoworkforyou.

BryanHealth.Forward.Together.

KimberlyA.RusselPresidentandChiefExecutiveOfficerBryan Health

Mr.Twainwasontosomething.Littledidheknowwhatrelevancethesewordswouldhaveintoday’sworld.WhenwasthelasttimeyouputdownyoursmartphoneortabletorswitchedoffSkypejustto

looksomeoneintheeyes,facetoface,andhearabouttheirday?Weanswerasimilarquestioninhealthcare.Whenyoutakethetimetovisitpatients,shakehandsand

haveaconversationabouttheircare,yougainawealthofinformationthatmakesyourhospitalbetter.Safer.Andtrusted.

My colleagues on the senior management team at Bryan Healthhavejoinedmeinmakingsuchvisitsaregularpartofourworkweeks.Withoutexception,wecherishthistimeonourpatientcareunits—itconnectsustoourmissionandremindsuswhywepursuedcareersinhealthcare.Wealsogettomeetincrediblepeople,asIdidthedayIwasintroducedtoBeatrice

Bryan Journeys 1

Bryan Medical Center President John Woodrich (right) joins Leslie Hayes, RN, and orthopedic surgery patient Ronald Johnson of Norfolk on a walk while rounding at Bryan Medical Center on the Bryan East Campus.

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After Steve Winter’s long hospitalization in 2013, he and Janie Winter especially enjoyed the 2014 holiday season.

2 Winter 2015

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astyear,SteveandJanieWinterspenttheholidaysinLincoln—HalloweenandThanksgivingatBryanMedicalCenterontheBryanEastCampus,ChristmasandNewYear’satBryanMedicalCenterontheBryanWestCampus.Butthisyear,theyarehomeinBeatricewiththeirfamily,gratefulfortheBryanteamthatsavedSteve’slifeandbroughttheirfamilycloser.

Sixweeksafterretiringfroma32-yearcareerasaninsuranceagent,Stevewaspreparingtomowthelawnwhenhestartedshakingandsweatingandthenbecameveryweak.Stevecalled911andwastransportedtoBeatriceCommunityHospitalandHealthCenter,whereheunderwenttestingandwasdiagnosedwithadvancedpancreatitis.

Critical situation

AfterbeingcalledtothehospitalfromSouthernPublicSchoolsinWymore,wheresheisasocialstudiesteacher,JaniewenthomeandresearchedSteve’sdiagnosisontheInternet.TheimplicationsofhisconditionworriedherasitdidBeatricesurgeonBlakeButler,MD,whosentStevebyambulancetoBryan.InthetimeJaniegrabbedsomeextraclothes,rantothebankanddrovetoLincoln,Steve’sconditionhadbecomecritical.

“WeknewimmediatelythatStevewasprofoundlyillandrushedhimtosurgery—therewasnotimetosugarcoatthesituation,”sayssurgeonJohnFallick,MD.“Itoldthefamilyupfronttheyshouldbuckleup,asthisisgoingtobethefirstofmanystepsinwhatwillbealongjourneyahead.”

DoctorsbelieveagallstonereleasedandlodgedinSteve’scommonbileduct,causinggallstonepancreatitis,butthenevolvedintonecrotizingpancreatitis,asevereexacerbationofwhatistypicallyamildevent.

“Thisisaveryrareproblem,butwhenithitswiththiskindoffuryyouknowitisgoingtobearoughride,”Dr.Fallicksays.Notmanysurgeonshavehadexperiencewiththisverydifficultsituation;fortunately,Dr.Fallickhadoperatedintheseinstances,thefirsttimeduringhisresidencyattheMayoClinicinRochester,Minn.

Thesurgeryinvolvesdelvingdownverydeepintotherecessesoftheabdomentoremovedamagedtissue.InSteve’s

case,theamountofinflammationandswellingwassoprofoundthattherewasdangerofreachingapointwheretheabdominalcavitycouldnothandlethepressureandwouldbegintodiminishbloodflowtohisheart.

Dr.FallickalleviatedthepressureandleftSteve’sabdomenopensosubsequentsurgeriescouldcontinuetoreducetheinfectionduringthenexttwomonths.Stevewasintheintensivecareunit(ICU)onaventilatorforthreeweeks,duringwhichthephysicianteamgrew,asspecialistsininfectiousdisease,criticalcare,nephrologyandcardiologyjoinedthefighttohelpSteve’slungs,kidneysandheartreturntonormalfunction.

“Bryanisparticularlyadeptatdealingwithverysickpatients—thenursing,anesthesiaandoperatingroomstaffreallyexcelinsuchchallengingsituations,”Dr.Fallicksays.“Ican’temphasizeenoughthatthisisagreatplacetobeifyouarecriticallyill.

“IwasimpressedrightawaythatJanieandherfamilygraspedtheurgencyofthesituation,quicklyrealizingtheroadaheadwasnotgoingtobeeasy.Janiewasarealtrouperasshewasabletoadaptanddealwiththerollercoasterride.”

Strong bond

JaniehasdifficultytalkingaboutDr.Fallickwithoutbecomingemotional.“ThemanwasaGodsend,”shesays.“AndhewassounconventionalandwillingtotryanythingittooktosaveSteve.AndthecareStevereceivedfromeveryoneatBryanwasexceptionalbeyondwords.”

ICUnursemanagerMonaReynoldssayseveryoneenjoysworkingwithDr.Fallick.“Hetrustsustotakecareofverysickpatientswhohavelong,drawn-outstays.Ournursesheredosuchagoodjobstayingfocusedandgoaldirected,realizingtheyneedtosetshort-termgoalswithinthelong-termgoalofpatientrecovery,”shesays.

Stevedoesn’tremembermuchabouthisordealfromSept.24,whenhebecameill,upuntilThanksgivingwhenhestartedbecoming“Steve”again.

“WhatIremembermostistheclosenessthatJanieestablishedwiththenursingstaff,”hesays.“Monawasamazing,andthenursesintheICU—Sherri,Candy,Lindsey,Kaitlin,

P A T I E N T E X P E R I E N C E

L

Bryan Journeys 3

Successful surgery brings Steve

Home for the holidays

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CourtnieandNatalie—weremyfamily.Theywouldlaughwithme;theywouldcrywithme;theywouldhugme.Idevelopedsuchaclosebondandamstillincontactwithseveralofthem.”

“Whenyouhavepatientswhoarethatsick,youreallygetengagedwiththeirfamilies,andboththepatientsandtheirfamiliesstayembeddedinyourmindsforever,”Monasays.“JaniewasrightthereforSteve,andshehadwonderfulsupportfromherfamily,bothofwhichwereabsolutelycriticalinSteve’srecovery.”

Recovery and appreciation

Inmid-December,StevewasadmittedtoBryanMedicalCenter’sInpatientRehabilitationCenterontheBryanWestCampustobeginworkingonregaininghisstrength.

“Thefacilityiswonderfulandisatruerehabilitationenvironment,”Janiesays.“AndIappreciatedthatthehospitalwasthereifyouneededit,whichwe,infact,didwhenSteveendedupintheICUthedayafterChristmas.”

EventhoughDr.Fallickwasenjoyingtheholidaysathisneighbors,hecameinandstayedwithSteveintheICUthat

nightuntilhefelthewasoutofthewoods.“That’sjustthekindofguyheis,”Janienotes.OnJan.16,StevewasreleasedfromBryanMedicalCenter

andreturnedhometocontinueoutpatienttherapyinBeatrice.HewashospitalizedthreemoretimesbetweenthatdismissalandtheendofMarch2014,buthecontinuestoworkhiswaybacktohispreviouslevelofstamina.

Aftermissingaseasonoffootballandbasketball,Steve,whoisanavidsportsfan,hasbeguntoattendBeatriceHighSchoolandNebraskaHuskerbasketballgames.Butanotherpassion,golfing,willhavetowaituntilSteve’sstrengthiscompletelyback,andhismuch-anticipatedretirementreallybegins.

“WearesothankfulforBryan,“Janiesays.“AndthoughIwouldn’trecommendthatanyonegothroughwhatwedid,itmadeusappreciateeachothersomuchmore.It’slikewehavefalleninlovealloveragain.”n

To learn how you can support the work of Bryan Health, please call the Bryan Foundation at 402-481-8605.

P A T I E N T E X P E R I E N C E

4 Winter 2015

Assistant nursing manager Candy Melcher, RN, (left) and Natalie Schultz, RN, joined Dr. John Fallick in welcoming Steve and Janie Winter (center) to the intensive care unit during a return visit to Bryan.

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There are many challenges that come with leading a health care organization. It’s important to have a network of mentors as part of

your leadership journey.Past Chief of Staff and pulmonologist

John Trapp, MD, believes in leveraging the education and experience of those who have gone before him.

“As a chief of staff, you play an integral role in the way health care is delivered,” he explains. “You’re responsible for multiple modalities of patient care across a wide variety of specialties involving hundreds of staff members. Being able to tap into the wisdom from previous leaders is an amazing opportunity.”

The Past Chief of Staff Advisory Council was introduced in 2011, while Dr. Trapp was serving as chief of staff at Bryan Medical Center. Since each chief returns to a career specialty after a two-year term, the goal of the council is to keep past leaders engaged through events where they discuss current challenges, new procedures/advancements and opportunities at Bryan Health.

“We’ve discussed procedures for treating plantar fasciitis and migraine headaches. We’ve also learned about Transcatheter Aortic Valve Replacement (TAVR), which allows physicians to use a small catheter to replace a diseased aortic valve without open-heart surgery,” says Dr. Trapp.

Hospital leaders are involved, too, seeking to implement relevant suggestions and feedback from the council.

In 2013, a council member presented compelling suggestions to make it easier for referring physicians to directly contact a hospitalized patient and obtain information about laboratory results, consultations and

the ongoing care of hospitalized patients. The Bryan Health leadership team

listened to the council’s feedback and implemented recommendations related to the community affiliate status for physicians. This type of feedback has a direct correlation to a higher level of care at Bryan.

“Many of these leaders are respected in their field of expertise. Their feedback is very valuable,” says Dr. Trapp.

Past Chief of Staff and anesthesiologist Charles Gregorius, MD, also appreciates

the council’s efforts to keep past leaders involved.

“Those who have served as medical chief of staff have typically been leaders in a variety of other settings, both inside and outside the medical environment,” Dr. Gregorius notes.

“They bring a wealth of experience, along with an innate desire to serve, so it’s wise to keep such people in the loop as advisors to both the medical staff and the hospital.” n

Everyone benefits from the insightsof past chiefs’ experience

C O N T I N U I N G L E A D E R S H I P

Bryan Journeys 5

At a recent luncheon meeting, former Chiefs of Staff David Dyke, MD, (standing at left), John Trapp, MD, Glen Lau, MD, Ron Craig, MD, Charles Gregorius, MD, Gene Stohs, MD, Timothy Lieske, MD, and John Baldwin, MD, (seated) and Monte Scott, MD, met with current Chief of Staff Gary Hustad, MD.

Ankle replacement remedies severe arthritis

Dwight’sactiveagain

N E W A T B R Y A N

6 Winter 2015

Likesomanypatientswithsevereanklearthritis,DwightJohnsenofCordovaspentyearstryingvarioussolutionsforhisdebilitating,chronicanklepain.AfterreadingaboutanklefusionsurgeryperformedatBryanMedicalCenter

bysurgeonJoshuaVest,DPM,FACFAS,ofCapitalFootandAnkle,DwightmetwithDr.Vesttoseeifthatprocedurewasrightforhim.

“AnklefusioncertainlywouldhavesolvedMr.Johnsen’spainproblem,”saysDr.Vest,“butIknewwecouldprovidehimwithsomethingevenbetter.

“Althoughhedidhavesevereanklearthritis,hehadalsopreviouslybeenveryphysicallyactiveandevenat79yearsofagewasotherwisequitehealthy.Asanklefusionresultsinarigidlyfixedanklethatlimitsmobility,heandIdecidedthatthenewestgenerationofanklejointreplacementwasidealforhimbecauseit

providedbothextensivepainreliefandfullanklemobility.“Anklereplacementprocedureshavegonethroughalotof

changesinrecentyears.Thefirstfewgenerationshadproblemsandahighfailurerate,soanklefusionwasthegoldstandardforpatientswithsevereanklearthritisatthattime.”

Newerankleimplantshave,however,flippedthatscenario,andreplacementisnowaviableoptionformanypatients.Fusionisstillthemostcommonprocedure—therewere16,000anklereplacementsversus80,000anklefusionsperformedworldwidein2014—butthistrendlikelywillchangeasreplacementproceduresbecomeincreasinglymoresophisticated.

“ThemostsignificantrecentchangeisthatthenewestgenerationofanklereplacementproceduresutilizesCTscanningtogenerateacomputerizedimageofthepatient’sankle,”saysDr.Vest.“Anexactreplicaoftheankleandasurgicaltemplateare

Dwight Johnsen says he’s “110 percent satisfied” with his ankle replacement surgery, which allows him to be active without joint pain.

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N E W A T B R Y A N

Bryan Journeys 7

thencreatedbya3-Dprinter,andweusethereplicaandtemplatetopreparefortheprocedurebeforeenteringthesurgerysuite.

“Themainbenefitofthisnewapproachisthattherearefewersurprises.Thisreducesguessworkandproblem-solvingatthetime of surgery and can decrease surgery and anesthesia time by about50percent,comparedtoprevious-generationreplacements.PatientsalsohavesignificantlylessradiationexposurewiththenewerapproachbecausethereislessneedforintraoperativeX-ray.“

Headds,“Oneadvantageofanklefusionisthatitisperformedonlyonceinapatient’slife,whilereplacementanklejointswearoutovertime.Buttheycanberepaired,oftenbysimplyreplacingaspacerintheimplant.Wetypicallyleaveintherestofthedevice,resultinginamuchshortersecondsurgery.Inthefuture,advancementswillundoubtablybemadeinmaterialsusedintheartificialankle,soreplacementswilllastlongerandlikelycanbecomeaone-timeprocedureformostpatients.

“Asignificantdrawbackofanklefusionisthatpatientsmuststayofftheoperatedanklefor8-12weeks,sotheyrequireconsiderablehelpathomeafterthesurgery.And,upto10percentofpatientsexperiencedelayedbonefusion,sotheyendupwithanunstable,nonfusedanklejointthattypicallyrequiresreoperation.Incontrast,patientswithanklereplacementsareabletomovethejointimmediatelyaftersurgeryandreturntoweight-bearingontheoperatedankleinaslittleastwoweeks.”

Dwightsaysheis“110percentsatisfied”withhisanklereplacement.

“Ihavenopaininthejointnow,andI’mabletoflexitallaround.Istayquiteactive—alwaysmowingordoingsomethinginthesummertime,andIdon’tworryaboutsprainingmyankle,soIdon’thavetobabyit.IfeelmyankleislikewhenIwasyounger—somuchstrongerthanwhenIfirstwenttoseeDr.Vest,”headds.

“It’sexcitingtohavethisnewgenerationofanklereplacementavailablehere,”Dr.Vestsays.“Beforethat,somepatientsweretravelingoutsideLincolnorevenoutofstatefortheprocedure.ThatthisisuniquetoBryanisonemoreexampleofthequalityofcareofferedbyBryanHealth.”n

To learn how you can support the work of Bryan Health, please call the Bryan Foundation at 402-481-8605.

To watch a video about the new ankle replacement procedure at Bryan, go to www.bryanhealth.org/ankle-replacement-surgery.

Dr. Joshua Vest holds a replacement ankle like the one created for Dwight Johnsen.

VIDEO

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8 Winter 2015

B R Y A N F O U N D A T I O N

Likemanypeople,JeffandAmyBurghadputofftheirestateplanning.Whentheopportunityarose for them to make it a focus

byworkingwithThompsonandAssociates,thecoupletooktheplunge.Now,theysay,itfeelslikeaweighthasbeenlifted.

ThompsonandAssociates’JohniHayeshelpedJeffandAmynarrowdownthethingsthatwereimportanttothemandwhatkindoflegacytheywantedtoleave.Theysayitwasnottakenlightly,butratheritwasaprocessofdiscoveryandreflection.

Designatingsomeoftheirestatetowardhealthcarewasaneasy decision for the Burgs.Notonlyhavethetwoworkedinhospitals—theymetwhileworkingatahospitalinMichigan,wherethey’rebothfrom—butalsobecausetheyhavefamilymemberswhoarenurses,physiciansandaphysicianassistant.JeffnowisBryan’sdirectorofsupplychain.

PartoftheirgifthasbeensetasideasascholarshipforaBryanCollegeofHealthSciencesstudent,andtheotherportionwillgototheBryanEmployeeCaringFund.

“Healthcareisagood,honorableprofession,andweunderstandthestruggles of someone trying to get through

nursingschool,”Amysays.“Wesawfamilymembersgothroughitandwanttohelpothersinthatsituation.”

TheyalsohavegreatregardfortheBryanEmployeeCaringFund,whichwasestablishedtohelpemployeesincrisis.

“Thisfundisreallyimportant,”Jeffsays.“I’veseenitinaction,howitcanimpactsomeone’slife.IfeelthattheEmployeeCaringFundissomethingthat sets our organizationapart.Employeeswhoareinaplacetohelptheirco-workersinneed—thatisverypowerful,andit’spartofwhatmakesBryansospecial.”

TheBurgsencourage others to startplanningtheirownlegacy.

“Wehadafewmedical scares and lossesrecently,andit hit home that life

isunpredictable,”Amysays.“Werealizedweneededtogetouraffairsinorderandmakesureourlegacywashowwewantedittobe.”

AddsJeff:“Thewholeplanningprocesswasagreatexperience,andwewouldrecommendittoanyone.” n

To learn how you can support the work of Bryan Health, call 402-481-8605.

Estate planning bringspeace of mind to Burgs

ThedrivingpurposeoftheBryanFoundation’sworkistopartnerwithindividuals,foundationsandorganizationstohelpBryanHealthadvancetheexceptionalcareitprovidespeoplethroughoutNebraskaandinsurroundingstates.

Inthepastyear,morethan2,600generous donors made gifts and commitmentstotaling$6.3milliontoenhancehowBryanimpactspeople’slives.WatchforfulldetailsinourannualreportongivingthatwillbepartofthesummereditionofJourneys magazine.

LeadingthewaywereBryanHealthemployees.In2014,theseco-workersgave$500,000totheBryanFoundationto be reinvested into the care of our patients.

Intheaccompanyingstory,you’llreadaboutoursupplychaindirector,JeffBurg,andhiswife,Amy.It’sinspirationaltoseehowsomeonewhodaily shares his skills and materials managementexperiencetomakeBryanbetter,takeshiscommitmentastepfurther to ensure future generations willbenefitfromBryanprogramsandservices.

Employeedonors,likeJeff,whohave embraced our vision for Bryan trulyareourgreatestambassadors.

— BobRavenscroft, BryanVicePresident andChiefDevelopmentOfficer

Bryan staff members are among our best ambassadors

Amy and Jeff Burg have included Bryan College of Health Sciences and the Employee Caring Fund in their estate planning.

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P U L M O N A R Y M E D I C I N E

Bryan Journeys 9

Chronicobstructivepulmonarydisease(COPD)isaserious,increasinglywidespreadrespiratoryproblem—andit’sthethird-most

commoncauseofdeathintheU.S.,behindheartdiseaseandcancer.Theterm“COPD”encompasseslungdiseasesthatmakebreathingdifficult,oftencausingshortnessofbreathandfatigue,whichlimitdailyactivitiessuchasexercising,yardworkandshopping.

Emphysema,chronicbronchitisandasthmaarethemostcommoncausesofCOPD.Inemphysema,airsacs(alveoli)attheendofmanyofthesmallestairwaysinthelungsaredestroyed,oftenbyexposuretotobaccosmoke.Inchronicbronchitis,inflammationandnarrowingofthelargeairways(bronchi)causedifficultyin moving air into and out ofthelungs.Inaddition,patientswithsevere asthma candevelopCOPDwhenlong-standinginflammationoftheairwaysresults in permanentnarrowing.Inall of these diseases,airwaynarrowinganddamage to lung tissue lead to decreased blood oxygenation,causing a sense of“airhunger,”shortness of breathandfatigue.

“AlthoughCOPDcan’tbereversed,therightmedicaltherapycanreducesymptoms,

improvequalityoflifeandpreventfurtherdamagetolungtissue,”saysDouglasFiedler,MD,apulmonologistandcriticalcarespecialistatNebraskaPulmonarySpecialties.“Optimaltreatmentcombinessteroidmedication,bronchodilatorsandoxygentherapyasappropriate,smokingcessationandpulmonaryrehabilitationtherapy.

“Patientslearnexercisesduringrehabili-tationthathelpthememptyairmorefullyfromtheirlungs,becauseairtrappingisaverysignificantproblemwithCOPD.Ourprogramhelpspatientsplantheirfuturemedicalcare—theytakeactiveroles—andwesupportthemastheytransitiontousingsupplementaloxygen.Someworrythataportableoxygentankwillbeinconvenient,butnearlyallof

ourpatientsfeelimprovementafterthis,because good blood oxygenationhelpsthemfeelbetter,reducestheir shortness of breath and allowsthemtomore easily do whattheywantand need to do inlife.”

“AtBryan,wetakeacomprehensiveapproachtoCOPDtreatmentto reduce complicationsand enhance qualityoflife,”adds clinical

servicesdirectorMarcyWyrens,RRT.“ThekeytothisapproachisinvolvementofCOPDcasemanagerChrisPlies,RRT,CPFT,whomakes

regularphonecontactwithpatientstocheckontheirsymptomsandconfirmthey’retakingtheirprescribedmedications.

“Wealsoverystronglyencourageourpatientstobeginpulmonaryrehabilitation.ThistherapyisareallifesaverforpeoplewithCOPDbecauseitreducestheirriskforreadmissiontothehospital,increasestheirenergylevel,reducesshortnessofbreathandteachesthemtobreathemoreefficientlyandtocontroltheircoughing.

“Inshort,pulmonaryrehabilitationkeepsourpatientswithCOPDhealthierandhelpsthemlivelonger,betterlives.” n

For more information about pulmonary rehabilitation and other services provided by Bryan Health for patients with COPD, contact COPD case manager Chris Plies, RRT, CPFT, at 402-481-5627 or Janis Howlett, RRT, at 402-481-6387.

Pulmonologist Douglas Fiedler, MD

Empowering COPD patients to take action

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10 Winter 2015

P U L M O N A R Y R E H A B I L I T A T I O N

IfyouhaveaconversationwithPacoMartinez,you’llquicklydiscoverthat“journey”isoneofhisfavoritewords.

“Ispentmorethan25yearsinthetravelindustry,”heexplains.“Itonlyseemsnaturaltotalkaboutchangeasajourney.”

Witheyesthattwinklewhenhesmiles,youmightthinkPacoisanaturaloptimist,withhisglasshalffull;buthe’lltellyouthathissunnydispositionhasn’talwaysbeensoapparent.Hispasthidesadarkshadow.

“I’vestruggledwithdepressionandhaveeventriedtotakemyownlife,”hesays,softly.“It’sdifficulttotalkabout,butthat’swhatmakesmyjourneyevenmoreamazing.”

Manyyearsago,asdepressiontookitsholdonPaco,thestressofhiscareerbeganaddingpoundstohissmallframe,aswell.Withthesefactors,plusa25-yearhistoryofsmoking,itwasonlyamatteroftimebeforehebeganhavingpulmonaryissueswithdifficultybreathing,lowenergyandsleepapnea.

“Iwenttoseemypulmonologist,Dr.SeanBarry,whotoldmeIneededtobeonaCPAPmachine,”saysPaco.“Thatwasnoteasyformetouse,sotheymovedmetooxygen.Ididnotwanttouseit—itwasamajorinconvenienceforme.”

Dr.BarrytoldPacothathecouldconsidermovingoffoftheoxygenifhebeganexercisingtoimprovehisfunctionalstatusandloseweight.

Asaresult,PacostartedthepulmonaryrehabilitationprogramatBryanLifePointe,butonlylastedafewsessionsbeforegivingup.Hesaidhewasn’treadyforthatjourney.

However,in2010,hereturnedtogiveitonemorego-round.

ThroughthepulmonaryrehabilitationprogramatBryanLifePointe,patientslikePacogothroughaseriesofeducationandexerciseclasseswheretheylearnabouttheirlungs,howtoexerciseandhowtolivebetterwiththeirlungcondition.Thegoalistohavethesepatientsgraduateintoalong-termexerciseandstrength-trainingprogramthatcanbemaintainedfortherestoftheirlives.

Dr.JohnTrapp,medicaldirectorforthepulmonaryrehabilitationprogram,emphasizesthemultidisciplinaryapproachoftheprogram.

“Patientsworkwithmultiplespecialtiestobettermanagetheirrespiratorydisease.Thesemayincludepulmonologists,respiratorytherapists,physicaltherapists,

pharmacists,exercisespecialistsandothers,”hesays.“Researchhasproventhateducationandexercisetherapyleadtoabetterqualityoflifeanddecreasedhospitalizations.”

JanisHowlett,pulmonaryrehabspecialistatBryanLifePointe,saysmanypeopleenrolledinthepulmonaryrehabilitationprogramaresmokers,butherteamalsoworkswithindividualswhoarenon-smokersorformersmokerswhohaveCOPD,asthma,interstitiallungdiseaseorpulmonaryhyper-tension.Followinganinitialintakeprocess,Janisconfirmsthepulmonaryrehabilitationpatientunderstandswhatheorshewantstoachieveasaresultoftheprogram.

“Youhavetoknowwhatyourgoalsare,”shesays.“Formanypeople,theysimplywanttobeabletoexperiencelessshortnessofbreath.Theywanttobestronger,abletodomorewithoutgettingfatigued.”

Pacoknewwhathewantedtoaccomplish—toincreasehisstrengthandendurance,walk/runamilewithoutbeingshortofbreath,andgethisbloodsugarundercontrol.

JanissaystheBryanLifePointeteamcanhelppatientsbuildstrengthandenduranceduringtheprogram,butdiseasemanagementisalifelongcommitment.

“WhenIfirstcametotheprogram,Iwasverydepressed,”saysPaco.“Janishelpedmepushthrough,andafteracoupleofmonthsIstartedtoseeresults.Yes,Iwasabouttobetakenoffmyoxygen,butIalsowasfeelingbetter about myself and started to be much happier.”

BattlingTypeIIDiabetesaswell,theBryanLifePointestaffhelpedPacomanagehisbloodsugar,providingaccesstojuiceor

Pacoachievesmanymilestonesonpersonaljourneytobetterhealth

Paco Martinez (center) appreciates the structure that Jon Cook and Janis Howlett provide at Bryan LifePointe.

W11997.indd 10 1/13/15 11:51 AM

Bryan Journeys 11

P U L M O N A R Y R E H A B I L I T A T I O N

other high glycemic foods if he started to feel faintduringhisworkout.

Thepulmonaryrehabilitationprogramtypicallyruns18weeks,andattheendoftheprogram,participantsareencouragedtocontinuewiththeirexerciseplan.PacochosetocontinueatBryanLifePointe,expandinghishorizonsintofitnessclasses,cardioandweightmachines,evenjoggingaroundthetrack.

“BeforeIcametoBryanLifePointe,Ihadneverevenusedatreadmill!”heexclaims.“WhenIfinishedrehab,Ihadlost10pounds.Iwassohappy.ItoldJanisthatIneededtobuyherabouquetofrosesforhelpingmegetbetter—Ihadtokeepgoing.”

ThisisthepointofthejourneywherePacomeetstheindividualhedeemsresponsibleforthemajorityofhisrecenttransformation—JonCook.

Jon is a health coach and trainer at Bryan LifePointeandregularlyworkswithclientslikePacowhohavetransitionedoutofamedicallysupervisedrehabilitationprogramintoastructuredfitnessprogram.

“I’vebeenprivilegedtowitnessPaco’sentiretransformationfromrehabpatientandfitnessclient,toastrongandcenteredindividualinchargeofhisownhealth,”saysJon.“He’sacompletelydifferentperson!”

PacosingsJon’spraisestoeveryone.“Jonpushedmetobebetter,”saysPaco.

“Hemakesprogramsforme,andIjustdowhathesays.I’m54yearsold,andIjuststartedexercisingfouryearsago!”

He’sevenaregularparticipantinJon’sbootcampclasses. “WhenIfinishworkingout,I’m

exhausted,butI’mgettingstronger.Myspiritfeelsgood,”Pacosays.

Hecontinuesaddingtohisgoallist.Theneweststepinhisjourney?Learninghowtoswim.

“IgotothepoolnowonceaweekorwhenI’mhavingabadday,”saysPaco.“Ilovetokickwiththekickboardaroundthepool.Butyouknow,Iwilllearnhowtoswimwithoutitoneday!”

Othergoalsonhislistincluderidingabikeandlearningtotango.

Basedonhistrackrecordofsuccess,he’ssuretoaccomplishboth.

Andsoon. n

To learn how you can support the work of Bryan Health, please call the Bryan Foundation at 402-481-8605.

Pulmonologist Sean Barry, MD, and Michelle Tyser, PA, helped Paco on his journey.

Better health brings a smile to Paco.

Exercising is a big part of Paco’s new life, as hetransitions from former rehab patient to being in charge of his own health.

W11997.indd 11 1/13/15 11:51 AM

12 Winter 2015

B R Y A N L U N G C A N C E R C E N T E R

In2014,lungcanceraccountedfor27percentofallcancerdeaths—morethancolon,breastandpancreaticcancerscombined.EachNovember,patients,physicians,andfamiliesgatherfortheShine a Light on Lung Cancer event to share stories of thosewhohavebeenaffectedbythedisease,whilehighlightingmedicaladvancementsandnew

proceduresdesignedtoimprovethedetectionandtreatmentoflungcancer.

Herearesomeoftherecentdevelopmentsdiscussedatthatevent.

Safety net program for incidental lung nodulesCardiothoracicsurgeonRichardThompson,MD,

directoroftheBryanLungCancerCenter,saysthatlatedetectionremainsthebiggestchallenge.

A study conducted at Bryan earlier this year discoveredthatasignificantnumberofpatientshavingCTscansforconditionsunrelatedtolungcancerorfollow-upofknownlungnodulespossessedincidentallungfindings—pulmonarynodules,massesorlesions.

ThestudywaspromptedbythecaseofapatientwhohadaCTscanforabdominalpaininwhichalungnodulewasnotedontheradiologyreport.Sincethenodulewasunrelatedtothepatient’spresentcondition,follow-upwasnotordered.Ayearlater,thepatientwasfoundtohavelungcancerthathadalreadyspread.

Basedontheresultsofthisstudyandexperienceinthediagnosesoflatestagelungcancer,theBryanIntegratedThoracicProgramhasdevelopedasystematicreviewprocesstomoreeffectivelydetectcancerinitsearlystages,givingpatientsabetterchanceforsurvival.

ThroughapartnershipwithpulmonologistsfromNebraskaPulmonarySpecialtiesandLincolnPulmonaryandCriticalCare,allreportsofCTscansinvolvingthehead,neck,chestand/orabdomenwithincidentallungnodulesorotherfindingsarereviewedweekly.

“Upto300scansarereviewedeachweek,andabout18percentofthosewarrantfurtherreviewduetoincidentalfindings.Wealsodiscoveredthepatient’sprimarycareproviderisoftenunawaretheCTscanwasdoneorofthefindingsandpatientsmightnothavebeeninformedoftheincidentalnodules,”saysRuthVanGerpen,RN,APRN-CNS,nursenavigatorattheBryanLungCancerCenter.“It’stoo

Highlightingnewestdevelopmentsinthefightagainstlungcancer

Medical oncologist Nathan Green, DO, summarized current studies and treatments during the Shine a Light on Lung Cancer event at Bryan last fall.

Richard Thompson, MD, says the Bryan Integrated Thoracic Program helps physicians detect cancers earlier, so treatments can begin sooner.

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Bryan Journeys 13

B R Y A N L U N G C A N C E R C E N T E R

earlytomeasurethetrueimpactofthisapproach,butwe’vealreadyobtainedasignificantamountofpositivefeedbackfrompatientsandproviders.”

TheCTscanreportissenttotheprimarycareprovider,alongwithrecommendationsforfollow-upofthenodules,massesorlesionsbasedonevidence-basedguidelines.Patientsreceivealetterabouttheabnormalfindingsthatencouragesthemtofollow-upwiththeirprimarycareprovider.Alsoincludedisinformationaboutlungnodules,whatthatmeans,andwhatnextstepsneedtobetaken.

AccordingtoDr.Thompson,thisprocessservesasanawarenesstoolthatmaytriggeradditionalactionssuchasavisittoapulmonologist,abiopsyoraregularCTscaneverysixto12months.

Video-assisted thoracic surgeryFarlessinvasivethantraditionalthoracicsurgery,patients

typicallyexperiencelesspainandshorterrecoverytimeswithvideo-assistedthoracicsurgery(VATS).Thisprocedureenablesdoctorstoviewtheinsideofthechestcavitywithouthavingtocutthroughthemajormusclegroups,theribsorsternum.Duringtheprocedure,atinycameraandsurgicalinstrumentsareinsertedintothechestthroughseveralsmallincisions.Thecamera transmits internal images onto a video monitor to guide thesurgeonperformingtheprocedure.Surgeonsarethenableto remove masses close to the outside edges of the lung to test themforcancer.

Stereotactic radiosurgeryForpatientswhoseconditionistooriskyforsurgerydueto

ageorotherhealthproblems,anewformofradiationcalledstereotacticradiosurgerymaybetheanswer.

AccordingtomedicaloncologistNathanGreen,DO,stereotactic radiosurgery can be used to target and treat an abnormalareabyfocusinghigh-powerenergyonasmallareaofthebodywithoutdamagingnearbyhealthytissue.

Advances in molecular diagnosticsThereisagrowingimportanceofgeneticbiomarkersinthe

diagnosisandtreatmentoflungcancer.Biomarkerscanhelpwithcancertreatmentinmanyways,includingthediagnosis,aggressivenessofthecancerandhowwellapatientwillrespondtotreatment.Throughmoleculartesting,oncologistsareabletoguidetreatmentforasignificantportionofpatientsinawaythattheynevercouldbefore.Whilethismethodologycontinuestoevolve,itcouldcertainlytransformthewayoncologistsapproachtherapyforyearstocome.

Electromagnetic navigation bronchoscopyElectromagneticnavigationbronchoscopy(ENB)isan

excitingnewoutpatientproceduredrivenbyatechnologysimilartoacar’sGPSsystem.NebraskaPulmonarySpecialtieswasamongthefirstintheregiontoutilizethistechnology,notespulmonaryandcriticalcarespecialistBillJohnson,MD.

ENBcombinesaCTscan,patientmarkers,anelectromagneticfieldandcomputer-generatedsoftwaretonavigateasmallsetofcathetersdeepintothelungs.Thesoftwareguidesthephysicianthroughthelungswiththehelpofmarkerstodistinguishthepathtothelesionornodule.

“Manytimes,atraditionalbronchoscopycannotreachthedistantregionsofthelung,wheremanylunglesionsarefound,”Dr.Johnsonsays.“ENBallowsustodiagnoseandtreatlesionsusingamuchsaferprocedure,withalowerriskofpneumothorax.”n

To learn how you can support the work of Bryan Health, please call the Bryan Foundation at 402-481-8605.

Interested in current treatments for lung cancer? Go to www.bryanhealth.org/lung-cancer. A video related to the Bryan Lung Cancer Center also is planned.

Cancer survivor Teresa Fitzgerald of Malcolm says cooperation among her primary care physician, pulmonologist, surgeon and the Bryan Lung Cancer Center has been instrumental to her continuing recovery.

VIDEO

W11997.indd 13 1/13/15 11:51 AM

14 Winter 2015

Cardiologists team with pulmonary specialists

Trial tests sleep apnea treatment

B R Y A N H E A R T

In brief: Sleep apnea occurs commonly among patients with cardiovascular disease (CVD) and is associated with a striking increase in mortality among those with heart failure. Respiratory rhythm management, which

involves electrical stimulation of the phrenic nerve resulting in a diaphragmatic response, is an innovative treatment for central sleep apnea that is associated with normalized breathing patterns among patients in early clinical trials. Cardiologist Steven Krueger, MD, of Bryan Heart provides information about this new treatment.

Q: You have said that sleep apnea is a commonplace, often deadly, and highly treatable condition among patients with heart disease.

That’sright.Sleepapneaisstronglyassociatedwithcardiovasculardisease—ithappensin30percentofCVDpatientsandupto75percentofpatientswithheartfailure.Ithasseriousadverseeffectson morbidity and mortality andiscloselycorrelatedwithhospitalreadmissionandreoccurrences of cardiovascular events.Fortunately,sleepapnea(stoppingbreathing)alsoisquitetreatable.Currenttreatmentincludespositiveairwaypressuretherapy,mandibularsplintingandsurgery.

Q: Bryan Heart is part of an international study pioneering a new treatment for patients who have central sleep apnea, with or without heart failure. What does this study involve?

About40percentofpeoplewithheartfailurehavecentralsleepapnea,inwhich

temporarysuppressionofthecentralrespiratorydrivecausesbreathingtostopforsecondstominutes.BryanHeartcurrently is a clinical site for testingtheremedeSystem,aninnovativerespiratoryrhythmmanagement device that monitorspatients’breathing,thenprovideselectricalpulsestothephrenicnervetostimulatethediaphragmasnecessarytonormalizebreathing.

Q: Safety and efficacy results from preliminary trials of the remede System have been promising. What is the goal of the current trial?

Thegoalistoreplicatethepromisingfindingsofpreliminarystudies in a larger trial involving 320patients,andwehavetheopportunitytoincludepatientsfromLincolnandsurroundingcommunities.Thislargertrial,called the remede System PivotalTrial,isenrollingqualifiedpatientsforevaluationandtreatmentforcentralsleepapneausingtheremedeSystem.

So,theremedeSystemisapromisingnewtreatmentthatmaybeakeynewdevelopmentforloweringmorbidity,mortalityand readmissions among our patients.n

W11997.indd 14 1/13/15 11:51 AM

Bryan Journeys 15

M E D I C A L S T A F F S P O T L I G H T

Ask thedoctor:Can a pulmonologist resolve my sleep issues?

Q: How did you decide to become a pulmonologist? Whileinmedicalschoolandresidency,Ibecameveryinterestedinthephysiologyofthelungsandfounditveryfascinating.That,andthefactthatpulmonologistsareinvolvedinthecareofcriticallyillpatients,aretheprimaryreasonswhyIwentintothisfield.Theintensivecareunit(ICU)isaveryintenseatmospherewheredecisionsaremadequicklythatimpactthelivesofpatients.Ienjoythischallengeagreatdeal.

Q: What do pulmonologists do? Inadditiontoourworkintheintensivecareunit,wealsotakecareofpatientswithasthma,emphysema,chronicbronchitis,lungcancerandsleepissuessuchasapnea(wherebreathingisshallowortemporarilystops).Weareinvolvedintheevaluationandtreatmentofthesepatients.Wedodiagnosticproceduressuchasbronchoscopytohelpdiagnosevariouslungconditions,andweevaluatepatientsinthesleeplabatBryanWestCampus.Thisisthesideofpulmonologythatisnotasacuteandstressful,butitiscertainlyveryenjoyable,aswell.

Q: How prevalent are sleep issues today? Statisticsonsleepissues,suchassleepapnea,varyquiteabit.Asfarassleepapneainpatientswhoreceivemedicalevaluation,somestudiessayitisabout10to15percent.Isuspectthatitisactuallyquiteabithigherthanthat.Weareallverywellawareoftheepidemicofobesityinthiscountry,andcertainlythisisgreatlyimpactingissuessuchassleepapnea.Ourlifestyleplaysanimportantroleinsleepapnea.

Q: How many hours of sleep do we really need? Theactualnumbervariesfromindividualtoindividual,buttheoverallaverageisbetween7.5to8hoursofsleep.However,thereareinstanceswherepeoplerequiremuchless,aswellassomeinstanceswherepeoplerequiremuchmorethanthis.Itisimportantthatsleepbeundisturbedthroughoutthesleepcycles,aswell.

Q: What happens to the body and mind when we do not get enough sleep?Manypeoplethinkthatyoucanbecomephysicallyillifyoudonotgetenoughsleep.Thoseofuswhoworkinthesleepfielddonotnecessarilyagreewiththatstatement.Whilewemaynotfeelwellorevenfeelillwhensleepdeprived,thereisverylittleevidencetosupporttheideathatyoucandevelopanupperrespiratoryinfectionoraheartattackoranyotherkindofmedicalproblemjustbecauseoflackofsleep.Certainly,ourabilitytofunctionduringthedayisimpairedifwedonotgetenoughsleeporenoughoftherightkindsofsleep,butthephysicalillnessdoesnotusuallyoccur.Toexpandmoreonthefunctionalityaspectofsleep,ourabilitytofunctionintermsofdoingcomplexcognitiveactivitiesduringthedaysuchasmathematics,criticalthinking,andthesekindsofthingsaregreatlyimpactedbythequalityandquantityofoursleep.

Inadditiontothat,reactiontimesareslowedsomewhatifwedonotgetenoughsleepsimilartohowreactiontimesareaffectedifweconsumealcoholandthentrytodosomeoftheseactivities.Thisincludesdrivingoroperatingheavymachineryandsoforth.Infact,somestudieshaveconcludedthatchronicsleepdeprivationmayimpaircognitiveabilityalmostasmuchasalcohol.

Q: Why is getting a good night’s rest so important?Inadditiontotheaboveanswer,oursenseofwell-beingisaffectedbyhowmuchsleepwegetandthequalityofthatsleep.Certainlythereisnosubstituteforgettingagoodnight’ssleep.

Q: Is it possible to catch up on one’s sleep?Inasensewecancatchuponsleepjustaswecanacquireasleepdebt.Ifwegetonelesshourofsleeppernightthanweshould,bytheendofsevenoreightdaysthecumulativeaffectisequivalenttobeingawakeforasolid24hourswithoutanysleep.Oftenwetryto“catchup”onsleepovertheweekends,andwhilesleepingindoesfeelgoodanddoestendtorepaythesleepdebt,itdoestendtoalsoaffectoursleephygieneinawaythatitmakesitmoredifficulttostayonschedule.Keepingasleepscheduleisimportant,

Timothy Lieske, MD, discusses the role of sleep in maintaining good health.

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16 Winter 2015

M E D I C A L S T A F F S P O T L I G H T

so probably the best way to “catch up” on sleep is to keep that schedule and allow enough time each night for an adequate amount of sleep.

Q: What are the trends in sleep problems for children and youth as regards to school schedules affecting sleep? One of the most important trends for sleep problems in children and youth is the epidemic of obesity, the result being that we are seeing obstructive sleep apnea at much earlier ages. This is not a good trend. Healthy eating, exercise and maintaining an ideal body weight are some of the ways parents can prevent this.

Early school schedules can greatly affect the ability of students to learn and be alert in school. Children and even high school-aged individuals, by nature, tend to have a different type of sleep schedule than adults. They are what we call “phase-delayed,” meaning they like to stay up longer and wake up later. This is at odds with the way school schedules are set up. Many activities are very early in the morning, with school days ending earlier. As you can see, this is the direct opposite of the way most school-aged individuals sleep.

My advice to parents is to try to maintain a set sleep schedule for their children. Make sure children getenough time in bed to at least try to get the amount of sleep that they need.

Q: What is the difference between over-the-counter and prescription medications to aid in sleeping? Most of the over-the-counter medications are a form of antihistamine. One that is commonly known is Benadryl; they are used because of their sedative aspects. As far as taking such medications for the long term, it usually is not helpful.

These medications can lose their effect over time, with the end result that more will be needed to get the same effect.These medicines also can cause a “hangover” the next day. I feel pretty much the same about prescription sleeping medicines. While they have a more direct affect on the sleep/wake centers in the brain, there is still the question of the person’s ability to tolerate the drug. Plus, some of these drugs can be habit-forming. My personal recommendation is to not use sleeping aides very often or for long periods.

Q: Can anyone use them if they are not sleeping well?People commonly think: “I will just go get an over-the-counter medication or ask my physician about getting a sleep aid.” But if sleep problems have been going on for longer than one to

Tim Lieske, MD, of Lincoln Pulmonary and Critical Care Associates, says cardiovascular health has a big impact on whether patients develop conditions such as sleep apnea. Dr. Lieske has practiced in Lincoln since 1984. He is a former Bryan Health Board of Trustees member and chief of the Medical Staff and currently serves as a trustee at Crete Area Medical Center.

W11997.indd 16 1/15/15 7:12 AM

Bryan Journeys 17

M E D I C A L S T A F F S P O T L I G H T

two months, a physician evaluation could really help to determine if the person has apnea, insomnia for a number of reasons, or whether this is a short-term issue associated with stress, for example. Continued use of sleep medications without a definitive diagnosis or an evaluation is not recommended.

Q: If I snore does this mean I have apnea? Not necessarily. There are people who snore and do not have apnea just as well as there are people who do not snore and do have apnea. There are many signs and symptoms of apnea, such as loud snoring, unrefreshed sleep, or spouse or significant other recognizing interrupted breathing at night. Severe daytime sleepiness is usually a symptom, but that can be a symptom of other disorders, too. However, if there is loud snoring, restless sleep, and the witnessed interrupted breathing at night, this is a pretty good indicator of apnea.

A full evaluation is the best way to know for sure.

Q: What are the main causes of sleep apnea? The tendency for sleep apnea increases as we get older. Weight plays a significant role in the development and continuation of sleep apnea. However, there are other developmental and anatomical factors that are causes of sleep apnea.

Q: Does sleep apnea affect cardiovascular health? It may not be very well known, but obstructive sleep apnea is now the No. 1 cause of hypertension in this country, especially in males. It plays a significant role in hypertension in females, too, but seems to be a larger concern in males. Rhythm disturbances in the heart, such as atrial fibrillation, also are very closely associated with obstructive sleep apnea. Congestive heart failure interestingly enough can be both a cause and an effect, meaning that in some cases congestive heart failure can cause or worsen obstructive sleep apnea just as obstructive sleep apnea can cause congestive heart failure, so we are working very closely with colleagues at Bryan Heart to sort out more of these issues and try to come up

with some very good therapies.

(Please refer to the related article on Page 14.)

Q: If I need a nasal CPAP machine, will I always have to use it? A continuous positive airway pressure (CPAP) machine is basically a compressor that blows air into the posterior portion of the oral cavity and helps splint open the airway so that air can flow freely into the lungs. At this point, nasal CPAP is the best therapy we have for obstructive sleep apnea. Surgery is effective in only very limited and isolated instances. In rare instances, patients who have significant weight loss can come off the nasal CPAP machine. I take the approach that CPAP is not forever, but it is indefinite.

Q: What are some healthy habits that will help me sleep better and avoid the need for a nasal CPAP machine? First of all, you must maintain an ideal body weight by getting enough exercise and eating right. Again, it is always good to maintain a set sleep schedule. We are creatures of habit, and our sleep falls into fairly rigid categories in terms of how much we need, when we should go to bed, when we should get up and so forth. We should maintain these habits, as this will help make our sleep more efficient and more restful.

Q: How will I know if it is time to ask a sleep specialist?If sleep problems, whether they are insomnia, loud snoring, fatigue, sleepiness, etc., do not have a well-defined end, you should see a sleep specialist or contact your physician to see if a referral to a sleep specialist is in order. Things like family stress, a death in the family and other life-changing events can cause short-term sleep issues. However, if the sleep disturbance associated with these types of events persists, then you should see a sleep specialist. If issues such as loud snoring or excessive daytime sleepiness continue or do not resolve with weight loss, then a sleep referral would be indicated. There are many other sleep disorders, such as narcolepsy, restless leg syndrome and periodic limb movements, that may require evaluation by a sleep specialist.

No matter the sleep problem, if it persists for more than a month or two and there is no obvious inciting event or resolution, consider a sleep referral.

To find out if you would benefit from a sleep evaluation, take our free online Sleep Aware screening. Go to www.bryanhealth.com/SleepMedicine and get started today.

If you have questions about pulmonary conditions, contact your physician.

W11997.indd 17 1/15/15 7:12 AM

New faces at

Bryan

Jennifer Ahlers, MD, anesthesiology, hasjoinedAssociatedAnesthesiologists,402-489-4186.

Dr.AhlersreceivedanundergraduatedegreefromCornellCollegeofMountVernon,Iowa,andin2006earnedamedicaldegreefromUniversityofNebraskaMedicalCenterCollegeofMedicine,Omaha.Shecompletedher

residencyatUniversityofSouthDakotaSanfordSchoolofMedicine,SiouxFalls,SouthDakota,andUniversityofNebraskaMedicalCenter,Omaha.

Abhijeet Basoor, MD, cardiology, has joinedBryanHeartandpracticesatBryanHeartMaryLanningCardiologyinHastings,402-460-5555.

Dr.BasoorearnedhismedicaldegreefromNSCBMedicalCollegeandHospitalinJabalpur,MadhyaPradesh,India,in2004.Heservedasastaffmemberingeneralsurgeryatthecollegeuntil2006.Dr.Basoor

completedresidenciesatSt.JosephMercyOaklandinPontiac,Michigan,inpreliminarysurgeryandinternalmedicineandalso

Welcome these colleagues to the Bryan medical community

servedaschieffellowincardiovascularmedicine.In2013hecompletedafellowshipininterventionalcardiologyatSt.JohnHospitalandMedicalCenterinDetroit.

Jonathan Cramer, MD, pediatric and adult congenital cardiology,isassociatedwithChildren’sHospital,Omaha,402-955-4350.

Dr.Cramerisaninternalmedicineandpediatrics-trainedcardiologistwhospecializesinthecareofchildrenandadultswithcongenitalheartdisease.Hisinterestsincludesimpleandcomplexcongenitalheartdisease(singleventricle),congenitalvalvularheartdiseaseandthetransitionfrompediatrictoadult

cardiology.He received his Bachelor of Science

fromCreightonUniversity,Omaha,andin2006earnedamedicaldegreefromtheUniversityofNebraskaMedicalCenterCollegeofMedicine,Omaha.Hecompletedhis residency in internal medicine and pediatricsattheUniversityofLouisville,Louisville,Kentucky.

BeforejoiningChildren’sHospital,Dr.CramerwasaninstructorinpediatriccardiologyatChildren’sHospitalofWisconsinandMedicalCollegeofWisconsin,Milwaukee.

Robert Dugas, MD, orthopedics,isassociatedwithNebraskaOrthopaedicandSportsMedicine,402-488-3322.

Heearnedabachelor’sdegreefromLouisianaStateUniversity,BatonRouge.Dr.Dugascompletedhismedicaldegreein1983atLouisianaStateUniversity,NewOrleans,

wherehealsocompletedanorthopedicresidency.HehaspracticedinAlabama,NebraskaandLouisiana.Dr.DugasalsoservedinsportsmedicineinBatonRougeandNewOrleansandwastheresidentdirectoroforthopedicsurgeryatLafayetteGeneralMedicalCenterinLafayette,Louisiana.

HereturnstohispracticewithNebraskaOrthopaedicandSportsMedicineafterservingasdirectorofOrthopaedicResidentEducationwiththeLouisianaStateUniversityOrthopaedicDepartment.HealsowilldirectOrthopaedicSportsMedicinecareattheUniversityofNebraska-Lincoln.

18 Winter 2015

M E D I C A L S T A F F U P D A T E

W11997.indd 18 1/13/15 11:51 AM

Michael Gartner, MD, emergency medicine, istheprincipalinvestigatorforCelerion,402-476-2811.

Dr.GartnercompletedhisundergraduatedegreeattheUniversityofNebraska-Lincoln;in1987,heearnedhismedicaldegreefromtheUniversityofNebraskaMedicalCenterSchoolofMedicineinOmaha.

HefulfilledaresidencyinemergencymedicineatMichiganStateUniversityCollegeofHumanMedicineinGrandRapids,Michigan.

Dr.GartnerservedasanemergencystaffphysicianinMichiganandKansas.HeisaninstructorfortheUnitedStatesDepartmentofHomelandSecurity.

Prathima Jasti, MD, endocrinology, hasjoinedNebraskaEndocrinologySpecialists,402-484-3440.

Dr.Jasticompletedhermedicaldegreein medicine and surgery at Rangaraya MedicalCollegeinKakinada,AndhraPradesh,India,in2004.Shecompletedan internal medicine residency at Saint JosephHospital,whichisaffiliatedwiththeUniversityofChicago.

BeforejoiningNebraskaEndocrinology,Dr.Jastiwasonthemedicalstaffat

ClevelandClinic,LakewoodDiabetesandEndocrineCenter,Lakewood,Ohio.

Kara Krejci, DPM, podiatry,hasjoinedPrairieShoulder,ElbowandHandCenter,402-489-4700.

Dr.Krejciearnedabachelor’sdegreeatMidlandLutheranCollegeinFremont.Shereceivedhermedicaldegreein2010fromtheDesMoinesUniversityCollegeofPodiatricMedicineandSurgery,DesMoines,Iowa.

HermedicalandsurgicalresidencywasatCommunityMedicalCenterinScranton,Pennsylvania.In2014,shecompletedthePennsylvaniaIntensiveLowerExtremityFellowshipatPennsylvaniaOrthopaedicCenterinMalvern,Pennsylvania.

Bryan Journeys 19

Derek Miller, DPM, podiatry,hasjoinedCapitalFootandAnkle,402-483-4485.

Dr.MillercompletedhisundergraduatedegreeatNebraskaWesleyanUniversity,Lincoln.Heearnedhismedicaldegreein2011fromtheDesMoinesUniversityCollegeofPodiatricMedicineandSurgery,DesMoines,Iowa.

BeforemovingbacktoLincoln,Dr.MillercompletedhisresidencyatDePaulHealthCenterinSt.Louis.

Darren Splonskowski, MD, internal medicine, hasjoinedNebraskaHospitalistsatSelectSpecialtiesHospital,402-917-5489.

Dr.SplonskowskireceivedhisBachelorofSciencefromCreightonUniversityinOmahaandearnedhismedicaldegreein2003fromtheCreightonUniversitySchoolofMedicine.

Hecompletedafour-yearresidencyininternalmedicineatCreighton;duringhisfourthyearhewasthechiefresident.BeforejoiningNebraskaHospitalists,hepracticedinOmaha.

Rachel Swim, MD, obstetrics and gynecology, hasjoinedWomen’sClinicofLincoln,402-434-3370.

She received her undergraduate degree fromtheUniversityofNebraska-Lincoln.

Dr.SwimearnedhermedicaldegreefromtheUniversityofNebraskaMedicalCenterCollegeofMedicine,Omaha,in2010.

ShecompletedanobstetricsandgynecologyresidencyattheUniversityofMissouriinKansasCity,Missouri.

M E D I C A L S T A F F U P D A T E

W11997.indd 19 1/13/15 11:51 AM

N E W A T B R Y A N

Precisionin surgery

20 Winter 2015

Neurosurgeon Benjamin Gelber, MD, and orthopedic surgeon Robert Vande Guchte, MD, recently began using Mazor’s Renaissance System, a new, FDA-approved, robotic surgical guidance system, for procedures on the spine and brain.

ForPhyllisSticeofLincoln,makingtheacquaintanceofasurgicalrobotwasunexpected,butverygoodnewsindeed.Lastwinter,Mrs.Stice,a

veryactive76yearold,fellontheiceinherdriveway,fracturingthreebonesinherspineandleavinghernearlyunabletowalkbecauseofconstantbackpain.

“I’vedoneJazzercisefor28yearsandwasalwaysoutdoingsomething,soIwasn’tusedtobeingthatlaid-up,”shesays.“Mydoctor—pulmonaryspecialistLisaMansur—referredmetoDr.BenjaminGelber,andsincephysicaltherapyandeverythingelsehadalreadybeentried,hedecidedthatsurgerytoplacescrewsintotheinjuredpartofmyspinewasthebesttreatmentforme.”

Mrs.Sticelaughsandadds,“Thethingthatsurprisedmewasthattherewasgoingtobearobotinvolvedinthesurgery.Itallmadeperfectsense,though,whenDr.Gelberexplainedthattherobotisatoolheusestoplacethesurgicalscrewsexactlywheretheyneedtobe.”

Afterhersurgery,Mrs.Sticeexperiencedcompletereliefofherbackpain.“I’mquitehappywithmysurgery,”shesays,“andI’drecommendDr.Gelbertotheworld.Heknowsexactlywhattodo,caresabouthispatients,andpaysindividualattentiontoeachofus,whichisimportantbecausenoneofusarealike.”

“IusetheRenaissanceroboticsystemmostoftenforplacingscrewsinthespineduringtreatmentofpatientswho’veexperiencedspinetraumaordegenerativespinedisease,”explainsDr.Gelber.“We’vesofaruseditvery

Benjamin Gelber, MD, was instrumental in bringing Mazor’s Renaissance System to Bryan.

W11997.indd 20 1/13/15 11:51 AM

successfullyduringspinesurgeryonaboutadozenpatients,anditperformedquitewellduringarecentbrainbiopsy,aswell.I’llalsouseitsoontotargetplacementofelectrodesthatwillprovidedeepbrainstimulationfortreatingpatientswhohaveessentialtremororParkinson’sdisease.

“BryanisthefirsthospitalintheUnitedStates outside of research sites to use the Renaissancesystemtotreatbraindisease.ThesystemishighlyinnovativebecauseitusesCTandMRIimagingandcomputermodelingtocreatethree-dimensionalviewsofpatients’spineandbrainanatomythatallowextremeprecisionintheuseofsurgicalinstruments.”

Aswithallrobot-assistedsurgeries,surgeons using the Renaissance system aretotallyincontroloftheoperationsatalltimes;thepurposeoftherobotis

simplytoactasatargetingtool,akindof“computerizedpointer”tocalculatehowtomostpreciselygettothesurgicaltarget.

“OnethingthatmakestheRenaissancesystem so distinctive is its high level of precision,asit’saccuratetolessthan1.5millimeters,”Dr.Gelbernotes.“Asaresult,allthescrewplacementswe’veuseditforhavebeenperfectlyon-target.

“Renaissanceisaverysophisticated,high-techtoolthatIbelievewe’llusemorewidelytoenhanceprecisionofmanytypesofsurgicalprocedures.Asfarasfuturedevelopmentsofthistechnologygo,roboticsurgicalguidancesystemslikeRenaissance might one day be used to

preciselydelivermedicationstospecificareas of the brain to treat localized problemssuchasinfectionorstroke.”

RobertVandeGuchte,MD,thefirstLincolnorthopedicsurgeontoworkwiththeRenaissancesystem,shareshisexperience.

“I’veusedRenaissancetosuccessfullyplacesurgicalscrewstostabilizethoracicandlumbarspinesofpatientswithtraumaticinjuryordegenerativespinedisease,andI’llsoonuseitforcervicalspineprocedures,”hesays.“Theuniqueelement of Renaissance is that it lets us plantheplacementofsurgicalscrewstoexactlyfiteachpatient’sindividualspinalanatomy,whichletsusachievethemostaccuratespinesurgeryinstrumentationthat’scurrentlypossible.”

Dr.VandeGuchteadds,“IthinktheRenaissancesystemwillbeusefulforalmostallpatientswhorequiresurgicalstabilizationofthespinebecauseofinjuryordegenerativeconditions,includingbothlong-incision(open)andpercutaneoussurgicalprocedures.I’mpleasedtosaythat Bryan Health has been committed foralongtimetoprovidingspineand neurologic surgery at the highest technologiclevelpossible.

“ThefactthatBryanhasintroducedthecutting-edgeRenaissancesystemtoNebraskaandtherestoftheU.S.isnosurprise,asit’srightinkeepingwiththatphilosophy.” n

To learn how you can support Bryan Health, please contact the Bryan Foundation at 402-481-8605.

Bryan Journeys 21

Renaissance system guidessuccessfulspineandbrainsurgeries

N E W A T B R Y A N

Phyllis Stice says surgery with the Renaissance guidance system at Bryan helped eliminate her back pain.

Robert Vande Guchte, MD, is the first orthopedic surgeon in Lincoln to use the Renaissance system.

W11997.indd 21 1/13/15 11:51 AM

ClasshelpsDianedealwithParkinson’s

Luckyarethosewhogetthroughlifewithouthavingat least one curve ball throwntheirway.Butwhenyou’renotsolucky,andfatethrowsacoupleofthematyouthatarecompletelylife

altering,youhavechoicestomake.DianeKacvinskychosetotakeapositiveroad,andfightforabalanceinherlife.

In2011,shesufferedasevereconcussionwhileonamissiontripinTanzania.TheconcussionleftDiane,aformeraccountant,withextensivememorylossanda5th-grade-levelmathcomprehension.Itchangedeverythingthatshewas,andmadeherfeellikeacompletelydifferentperson.

“Ibattledwhattheconcussionwasdoingtome,”recallsDiane,whocurrentlyworksparttimeinthelaundryandlockerroomsatBryanLifePointeandvolunteersforBryanMedicalCenter.“Notonlymymemory,butmydancingwasaffected.Iusedtodancefivedaysaweekbeforetheconcussion,doingballet,jazz,tapandpointe.Itwasalifelongdreamofmineasayounggirltolearntodance.”

Despiteintensiveoutpatienttherapytoimprovehermemoryandmovement—andtheloveandsupportofherhusbandBobandtheirtwochildren—thingswerenotgettingbetterandbySeptember2012,Dianestartedhavingsuicidalthoughts.

“Thedepressionwasoverwhelming,”shesays.“Becauseoftheconcussion,Iwasn’treallycapableofacceptingthatthatwaswhatmylifewasgoingtobe—thatithadchangedthatmuch.”

Butthatwasn’ttheendofthelife-alteringchangestocomeherway.In2013,cameadiagnosisofParkinson’s

disease.Thiswasn’tatotalshocktoDianebecauseshehadfeltsymptomsforsometime—15yearstobeexact—buthadnotreceivedadiagnosis.

Giventhesehurdles,Dianenowconsiders her regular sessions at the BryanCounselingCenteralifeline.ShealsofeelsthatwayabouttheFitness

Thanks to Bryan LifePointe’s Fitness Counts, Diane Kacvinsky improved her health and outlook on life.

B R Y A N L I F E P O I N T E

22 Winter 2015

W11997.indd 22 1/13/15 11:51 AM

ClasshelpsDianedealwithParkinson’s

B R Y A N L I F E P O I N T E

Bryan Journeys 23

CountsclassesatBryanLifePointe,whichareexclusiveforthosewithParkinson’sdiseaseandmultiplesclerosis.

Still,whenshewasapproachedaboutthisclassoffering,shequestionedwhetheritwouldbebeneficialsinceshewasstilldancingacoupleofdaysaweek,andherParkinson’swasnotterriblyadvanced.

“ItalkedwiththeinstructorsquiteabitbeforeIsignedup—theypromisedthey’dworkwithmeatmylevelandothersattheirlevel.Wedidstrengthtraining and endurance and balance exercises,anditturnedouttobeagoodthingforme,”shesays.“Iwasflexiblefromallofmyyearsofdance,butIreallynoticedanimprovementinmyendurance.FitnessCountsgavemeconfidence,such that I felt like I had control over the disease.Itdidnothavecontroloverme.”

Friendshipsdevelopedamongtheclassparticipants.Somuchsothatmanyplantotaketheclassagainwhenit’s

offeredagaininFebruary.Dianeisoneofthem,althoughthatwasn’ttheplaninitially.Dianethoughtshecoulddotheexercisesonherown,butfoundthatnottobethecase.

“IlearnedthatI’mnotcapableofkeepingupthatpatternonmyown.

“Theclassisalongcommitment.It’s12weeks,threedaysaweek,butIdon’tthinkyouwouldgetthesamebenefitifitwasshorter.Theclasswastoobeneficialtomenottodoit.IalmostfeellikeIdon’thaveachoice,”shesayswithasmile.

She also needed the camaraderie of herclassmates.“Havingthegrouptherewasimportant,”Dianesays.“Wedidalotoflaughing.IlearnedIreallyneededthesocialaspect.Wewereallthereforeachother.Weunderstoodthatweallhavegoodandbaddays.Onepersonmightfallduringclass,butyoulearnthatit’sOKto

fall;we’llhelpyougetbackup,andlifegoeson.

“Keepmovingandstaypositive—that’sthekey.” n

The next 12-week Fitness Counts class begins Feb. 10. This class provides tools and training to improve the quality of life for those with Parkinson’s disease or multiple sclerosis.

Activities include balance training, resistance training, gait and coordination exercises, and endurance activities. Participants must be cognitively alert with minimal mental dysfunction and must be able to walk independently or with a cane. A physician’s clearance and preassessment are required before the first class. (See Page 33 for details.)

To learn more, call 402-481-6300.

Yoga and meditation are important parts of Diane’s wellness plan.

Clinical exercise physiologist Kristi Beyer helps Diane improve balance and endurance.

W11997.indd 23 1/13/15 11:51 AM

V O L U N T E E R S & C U S T O M E R C A R E

Imaginethatyou’revisitingachildinpediatricsontheBryanEastCampus.YoufollowalonghallwaywhereaseriesofsilhouettesofsilverstorkskeepdirectingyoutotheWomen’sandChildren’sHealth

unit.Youenteranopenareawherelargebeautifulblackandwhitephotosofbabiescoverthewalls.Thenyouseethesignforpediatricsandarebuzzedin.Someonegreetsyouimmediately—that’sanewposition,thevolunteerunitambassador.

“Wehadanidentifiedneedforavolunteer,”saysKimDierks,nursemanagerofPediatricsandWomen’sHealth.“TheRNswouldbechartingandsharingreportsinpatients’rooms,sothephoneonthedeskwouldbeleftunattendedattimes.Evengreetingvisitorswasaneedbecauseit’simportanttogreeteveryonewhocomestoanursingunit.Wethoughtifwebroughtinvolunteers,itwouldbeawin-win.”

“We’vealwayshadvolunteersinpatientcare,”saysEllenBeans,directorofVolunteersandCustomerCare.“Butthevolunteerswereworkingindependently.”

Kimsays,“Ellenhadavision:Shewantedaplacewhereteamworkcouldhappen,andshehadthestafftodoit.”

VolunteercoordinatorAnnBaueradds,“Kimgotherstafftocommittotheidea.”

Sothetwodepartments,pediatricsandVolunteersandCustomerCare,embarkedonajourneytocreateavolunteerpositionthatwouldmeetneedsinthepediatricunit.

Forthefirsttime,VolunteersandCustomerCarestaffmembersworkedasunitambassadorswhilecreatinga

Pediatricswelcomesambassadors

University of Nebraska student Megan Mihulka is among the first volunteer pediatric unit ambassadors at Bryan.

24 Winter 2015

W11997.indd 24 1/13/15 11:51 AM

Bryan Journeys 25

V O L U N T E E R S & C U S T O M E R C A R E

job description from scratch. Volunteer coordinators Ann Bauer and MaryBeth McWilliams worked at the nurses’ desk in pediatrics and watched for tasks that volunteers could do. Besides answering phones and greeting guests, they found ambassadors could greet physicians, organize DVDs for the patients, stock supplies, answer patient’s requests for water or a blanket and pick up meal trays.

Kim, Ann and MaryBeth met weekly with Ellen and customer care supervisor Sarah Carter to talk about what worked well. Gradually a job description developed. They determined that the busy times needing a volunteer were 7-9 a.m. when physicians do rounds and from 6-8 p.m.

After the pilot program, the group polished the job description, interviewed candidates and trained the new pediatric unit ambassadors.

Many college students are unit ambassadors, and the job helps them learn what goes on in a nursing unit.

One such student is Megan Mihulka, who’s a junior at the University of Nebraska-Lincoln. She works around classes and homework to volunteer on Mondays. She plans to go into nursing or sonography (medical imaging).

“It’s definitely a great way to be exposed to what it’s like on a nursing unit,” Megan says. “I’ve had more opportunities

to learn.”Kim points out that another college

student “had a final exam at 9 a.m. Yet she drove to Bryan to work at 7 a.m., then drove all the way back in time for her final. They’re so motivated.”

Another volunteer tabulated patient safety statistics from rounding records that helped pediatrics improve its pain scores. A physician liked the unit ambassador position so much he wanted to recruit more volunteers.

We have successfully moved from performing independent tasks on the

patient units to being part of the team, working collaboratively with the nursing unit staff, Ellen notes.

“Because of our success with pediatrics, we’re adding the unit ambassador position to mother/baby (postpartum) and to the NICU (neonatal intensive care unit). It’s our hope through this collaborative model to build a solid base for the departments in Women’s and Children’s Health,” she says.

Those involved see various reasons why the collaboration was a success. “It’s because Kim stepped up,” MaryBeth says. “And it was her being willing to work with us.”

“It was the right time and the right people,” Ellen agrees.

Sarah adds, “This was a whole new approach to working with a unit.”

“Now we feel confident that this process could be used throughout Bryan Medical Center.

We’re counting on Kim to introduce this new collaborative model to other managers and support them through the process,” Ellen says.

“When volunteers have had a wonderful experience, and they come back to Bryan to begin their career in the health care field, that’s a great reward.” n

If serving as a volunteer unit ambassador appeals to you, please contact Bryan Volunteers and Customer Care by calling 402-481-3032.

Pediatrics welcomes ambassadors

Colleagues who created the role of volunteer pediatric unit ambassador are (standing, from left) nursing managers Kim Dierks, Wendy Muir and Laurie Ketterl; Volunteers and Customer Care director Ellen Beans, customer care supervisor Sarah Carter, volunteer coordinator MaryBeth McWilliams; and (seated) nursing manager April Deis and volunteer coordinator Ann Bauer.

W11997.indd 25 1/15/15 7:22 AM

26 Winter 2015

Mary Krupicka credits preventative care, including health fair screenings and regular visits with her physician and the staff at Crete Area Medical Center, with saving her life.

W11997.indd 26 1/13/15 11:52 AM

Bryan Journeys 27

MaryKrupickaneverdidgettoask about those triglyceride results that November morning.

That’swhatshehadmadetheappointmentforattheCreteAreaMedicalCenter.TheresultsofherbloodworkfromanearlierCAMChealthfairhadjustarrivedinthemail,andshefeltatleastoneofthereadingswarrantedadiscussionwithherdoctor,JasonHesser,MD.

Justroutine,the74-year-oldMarythought.Whenshearrived,clinicnurseStacyPflanzgreetedher,andtheymadesmalltalkwhileStacycheckedMary’sweightandbloodpressure.Thenthevisitbecamedecidedlyabnormal.

Mary’spulsewas30beatsperminute.Thirty.Dr.HesserwouldlatertellMarythat

whenrenownedathleteLanceArmstrongwasinthebestshapeofhislife,hispulsewasintheupper30s.Mostadultsintheir60sand70scanexpectarestingheartraterangingfrom60-to-100beatsperminute.

CAMCpersonnelshiftedsmoothlyintoemergencymedicalmodewithoutalarmingMary.Itwasaserioussituation.Dr.HessersaysMarywasathighriskofgoingintoventricularfibrillation—themostseriouscardiacrhythmdisturbance—whichoccurswhenthelowerheartchambersquiverandtheheartcannolongerpumpblood.Anyonewhohaswatchedatelevisionmedicaldramaknowshowthescenecanplayout,withdoctorsshouting“V-Fib,”and“Clear!”whilegrabbingthepaddlesofadefibrillator.Inreallife,doctorsalsoworryifthepatient’sbrainisreceivingenoughblood.

ButMarywastalkingtoherdoctorand

nurse,andherbloodpressureremainedstable.Medicalstaffexplainedthatherheartwasnotpumpingproperly;thatanambulancewouldtakehertoBryanHeart inLincolnandthatshewouldlikelybereceivingapacemakersoon.

Marytoldthemhowcoldshewas.Sheaskedifshecouldcallherpart-timeemployertosayshecouldn’tmakehershiftthatday.(Don’tworryaboutthatrightnow,theyadvised,astheybroughtherblankets.)

Couldn’therhusband,Melvin,drivehertoLincoln,Maryasked?(No,theyanswerednicely,butfirmly.)

MaryleftCreteinanambulanceshortlyafter11a.m.,withatemporaryexternalpacemakerinplaceforthetrip.Hersurgeryforapermanentdual-chamberpacemakertoregulateherheartbeatwascompletedthesameafternoon.

“Ican’tbelievehowgoodIfelt,considering.They(CAMCstaff)deservealotofcredit,”Marynotes,atherhomeinCreteafewweeksintoherrecovery.“Dr.Hesser,Stacy—everyonewassocalm.Thatkeptmecalmandthat’sprobablywhyeverythingwentsowell.”

Shesays,“Ifnotforthemandtheiractions,Iprobablywouldn’tbeheretodayandthat’snotevenwhatIwentinfor.”

Thesurgeryalsotookcareofsomeproblemsshehadn’trealizedwererelated.Lookingback,thefatigueshehadfeltthepreviousmonthhasliftedandthedizzinessattributed tovertigo—nowthoughttobeasymptomofherheartproblem—hasnotreturned.

Maryisanexampleofthepowerofpreventativemedicine,acorecomponentofthepatient-centeredMedicalHomeapproachCAMCisknownfor.Physicians

personallyknowtheirpatientsandadvisethemonpreventativecare.InMary’scase,itdoesn’ttakemuchconvincing.SheandMelvinalwaysgotoCAMC’shealthfairs.“Ithink the health fairs are the most valuable thingwe’vegot.It’svaluablemedicalinformationeverysixmonths,”shesays.WhentheymissedthelocalfairinOctoberwhiletraveling,theymadesuretoattendoneinWilberwhentheyreturnedhome.

Maryishealthy,walksforexercisefaithfully,followsahealthydiet,andwellnessguidelinesandscreenings,Dr.Hesserpointsout.Evenso,anextradoctor’sappointmentmayhaveinadvertentlysavedherlife.“Withpreventativemedicine,wecansometimesfindissuesthataregoingon,onesthatdon’thavealotofsymptoms,whichcanbesignificant,”hesays.

Marywillhaveapacemakertherestofherlife,butknowshowluckysheis.

Shehasalottobehealthyfor:Melvin,herhusbandof57yearsandtheotherhalfofthecouplepeoplerefertoas“M&M”;theirthreechildren,Marilynn,MichaelandMark(whomakethem“TheFiveM’s”);theirfivegrandchildren;traveling,campingandenjoyingretirement.

Fromnowon,Marywillcarryanidentificationcardforherpacemaker,haveregularcheckupstomakesurethedeviceisworkingproperlyandtakeafewprecautions,likestandingbackfromtheinductioncookstovewhentheycamp,justtobesafe.

“Soundslikeaprettygoodtrade,”shesays,laughing.

Andhertriglycerideresults?“Turnsoutitwasnothingtoworry

about.”n

A life savedThrough the power of preventative care

C R E T E A R E A M E D I C A L C E N T E R

W11997.indd 27 1/13/15 11:52 AM

Bicuspid aortic valve (BAV) disorder is a common heart condition that can be hereditary. So, it’s important that family members of BAV

patients be screened .Bryan Heart cardiologist Keith Miller,

MD, notes that up to 2 percent of Ameri-cans have this valvular heart disease, so close relatives of those diagnosed with BAV also are at risk for an aneurysm of the aortic root and ascending aorta.

“Early detection is critical,” he says, “since as many as 40 percent of BAV patients will experience complications by the time they reach their 50s.”

Such complications may mean they will need valve replacement surgery or aortic root repair.

An estimated 20,000 Nebraskans have life-threatening BAV, so American College of Cardiology/American Heart Association guidelines recommend that the patient’s parents, siblings and children also be screened.

“Familial clustering suggests this is a unique opportunity to detect additional patients by using appropriate screening echocardiograms,” says Dr. MIller.

“Clinical studies reported a 9 percent prevalence of BAV in first-degree relatives, and up to 30 percent of first-degree relatives of BAV patients have enlargement of the aortic root, which places them at risk for aortic dissection and rupture. But with early detection, patients who have BAV can enjoy a normal life expectancy.”

Now you can schedule your loved ones for counseling and a screening at Bryan Health’s Early Detection Center.

28 Winter 2015

B R Y A N E A R L Y D E T E C T I O N C E N T E R

Do you have BAV? Screen your family, too!

Early detection coordinator Bobbi Clinch, RN, says patients or families with known or suspected BAV-related heart abnormalities receive counseling and clinically indicated screening echocardio-grams.

The center also offers screenings for heart disease, vascular disease and atrial fibrillation.

To learn more, ask your physician or contact Clinch at 402-481-8018, or email her at bobbi.clinch@bryanhealth.org.

After Donette Shenk of Polk (seated) had surgery for bicuspid aortic valve disorder, she followed her cardiologist’s advice to have her family screened for BAV. Donette’s daughters, Angela Wiegert, Amber Ackerson and Andrea Adams, came to the Early Detection Center on the same day to have echocardiograms, and her sisters have since come to Bryan for the screening.

Signs and symptoms of heart valve disease

• Shortness of breath.• Palpitations (rapid heatbeats or skipping heartbeats).• Swelling of ankles, feet or abdomen.• Weakness or dizziness.• Quick weight gain.• Chest discomfort.

Call your physician if you have any of these symptoms!

W11997.indd 28 1/15/15 7:27 AM

Bryan Journeys 29

B R Y A N C O L L E G E O F H E A L T H S C I E N C E S

Registered nurses seeking a Bachelor of ScienceinNursingwouldbesmarttoapplytothenewB-SMARTprogramatBryanCollegeofHealthSciences.

“OurRNtoBSNcompletionoptionisattractivetocandidateswhoalreadyhavefull-timejobsormayberaisingafamily,becausetheyneedaprogramthathassomeflexibility,”saysprogramcoordinatorMichelleJohnson,PhD,RN.“Oursisahybridoption,inthataboutone-fourthofthenursingcourses’class time is face to face in a classroom setting—studentsareoncampusthreeFridaysandSaturdayseachsemester—andtherestofclasstimeisofferedonlineorasindependentstudyassignments,whichisconvenient for our students from across the state.”

B-SMART—whichstandsforBryanNursing:StartingMyAcademicResponsibilityToday—involvescorenursingcoursesoverthreesemestersandonesummer.Studentscompletegeneraleducationclassesindependently.

TheInstituteofMedicinesetagoalofhaving80percentofAmerica’snursesearningaBSNby2020.“Sowe’reseeingalotofschoolsofferingRNtoBSNprogramsinresponsetothischallenge,”Dr.Johnsonsays.

TenBryanMedicalCenternursesareselectedfor$10,000forgivableloans,whichareforgivenwhenstudentsmakeathree-yearcommitmenttoBryanHealthfollowinggraduation.

“LisaVail,Bryan’schiefnursingofficer,isaphenomenalsupporterofnursesandtheirprofessionalrolesandresponsibilities,includingtheircontinuingeducation,”Dr.Johnsonadds.“We’reveryproudtoofferB-SMART,whichaccommodatesourprofessionalnurses’needs.It’sagreatcombination of a classroom environment whileallowingstudentstocompleteonlinecoursesfromhome,attimesthatareconvenientforthem.”

March1isthedeadlinetoapplyforcoursesthatbeginintheFall2015semester.ProspectivestudentswillbeinterviewedinApril,withthenextclassofB-SMARTstudentstobeannouncedinMay.

FordetailsaboutB-SMART,contactrecruitmentcoordinatorJennyLempkaat402-481-8863,oremailheratjenny.lempka@bryanhealth.org.n

To learn how your gift can support Bryan College of Health Sciences, please call the Bryan Foundation at 402-481-8605.

B-SMART offers route to BSN

We remember BettySuhr,house mother and secretary

FormerBryanSchoolofNursinghouse mother and secretary Betty SuhrofSewarddiedMarch17,2014,atage84.

Her family says she truly enjoyedworkingcloselywithstudent nurses and the Bryan employeefamily.Betty’sfirstdayatBryan,inJanuary1971,includeddrivingfromSewardthroughasnowstorm.Her20yearsofserviceendedinasimilarway—herlastdayasaBryanemployeewasduringtheHalloweensnowstormofOct.31,1991.

Betty is survived by her husband AlvinSuhr;theirdaughtersLinda(Larry)ZilligofLincolnandPatricia(Larry)StantonofFt.Calhoun;andfour grandchildren and seven great grandchildren—withaneighthdueinFebruary.

Bryan Chief Nursing Officer Lisa Vail, DNP, addresses the first class of B-SMART students.

W11997.indd 29 1/13/15 11:52 AM

30 Winter 2015

B R Y A N C O L L E G E O F H E A L T H S C I E N C E S

Scenes from Dec. 19, 2014Commencement

Dr. James Wickless spoke, Dr. Marilyn Moore presented diplomas, and Dr. Kay Maize hooded master’s recipients, like Katie Sladky.

Joslin Stonacek (left) and her father, Troy, celebrated, and graduating senior Katelynn Synhorst (center) was all smiles as she approached the stage.

Congratulations to our 74 most recent graduates! The college awarded five master’s, 68 bachelor’s and an associate of science degree.

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Bryan Journeys 31

A C H I E V E M E N T S

MOD salutesWright

Bryan College of Health Sciences nursing student Jackie Wright is a 2014 March of Dimes Nurse of the Year honoree.

Other nominees were Bryan College of Health Sciences Assistant Professor Nancy Hula, RN, MSN, Bryan Chief Nursing Officer Lisa Vail, DNP, and Bryan Medical Center registered nurses Amanda Fox, Leah Logan and Corey Sabatka. n

Henricksenearns CRA

NHA luncheon honorsWohleb, Swanson, Vontz

Three are Hall of Famers

Radiology manager Danielle Henricksen passed the Certified Radiology Administrator (CRA) board exam in November.

The CRA designation attests to high standards of leadership attained by medical imaging leaders. It is the only credential specifically for radiology managers and focuses on managing human resources, assets, finance, opera-tions and communications. n

Pharmacy director Jerome Wohleb, PharmD, MBA, received the 2014 Quest for Excellence Award during the Oct. 24 Nebraska Hospital Association Caring Kind Awards Luncheon. This award recognizes exceptional work in hospital quality and performance improvement.

Bryan Medical Center case management social worker Danielle Swanson, MSW, and Ashley Vontz, RN, of Crete Area Medical Center received Caring Kind Awards. According to the NHA, these star performers exhibit sincere kindness to patients and dedicated team-work, ensuring that care is safe, quality-driven and cost-effective. n

Three alumni of local colleges were named to the Hall of Fame in their respective sports this fall.

Emergency physician John Hansen, MD, was a standout linebacker for the Nebraska Wesleyan University football team in 1985-87. This all-conference player also was an honorable mention NAIA All-American.

Mental health counselor and program development manager David Miers, PhD, was a defensive back on Nebraska Wesleyan University’s 1989 football team. That stellar squad was recognized for winning the conference championship in ’89 and NWU’s only postseason victory.

Events and marketing specialist Becky Ernstmeyer Loewe, Advancement, was named to Concordia University’s Hall of Fame. Loewe was a top volleyball player from 1993-97, setting records for the Bulldogs and earning all-conference and NAIA recognition. n

Danielle Swanson (left), Jerome Wohleb and Ashley Vontz were recognized at the Caring Kind Awards Luncheon.

Dr. David Miers (left), Becky Loewe and Dr. John Hansen are in their respective alma mater’s Sports Hall of Fame.

W11997.indd 31 1/15/15 7:36 AM

Your connection to fun and friends

THIS YEAR’S LEADERSBryan Sterling Connection Advisory Board members are (standing, from left) Caroline Caawe, Karen Beek, Carolyn Henning, Lori Lee, Dorene Casey, Ken Majors, Theresa Hohmeier, Deanna Troxel, Diane Belschner, Paul Lommasson, Debbe Bundy, Gordon Bair, Diane Engelsma, Kathy Wolf and Pam Bly, and (sitting) Tom Beachell, Cathy Weichel, Bill Schuller, Norma Hyman and Mary Wit.

GOOD TIMES HAD BY ALLKen Majors, a volunteer at Bryan and Bryan Sterling Connection Advisory Board member, pours coffee Dec. 14 at the Sterling Connection Holiday Social.

Adventures await in 2015Visitbryanhealth.org/traveltodownload

yourbrochuresfortheseandothertrips,orcall402-481-3355or800-742-7844.

Multiday toursGulf Coast Discovery—March21-30.Fromashrimpingexpeditiontolighthouses,gorgeousBellingrathGardensandadolphincruise,youwillseethebestoftheGulfCoast. Nova Scotia & Prince Edward Island—June30-July7.VenturetothelandofGreenGables.Learnaboutthe rich maritime history of Nova Scotia and see thescenicMainecoastonthisvacation.

Smoky Mountains: Music, Majesty & Praise Tour —Oct.19-28.TraveltotheheartofthecolorfulSmokyMountains.

One-day tripsSandhill Cranes Migration—March19.Witness the annual migration of thousands of SandhillCranesastheymaketheirwaythroughtheflywayoftheGreatPlainstothebreedinggroundsdownsouth.

From Kolaches to Clay—May5.ComewithustoWilber—theCzechCapitalofNebraska—anddiscovertherichrootsofitsheritageonthisfunone-daytrip.

Glenn Miller Festival—June12.GlennMillerfansconvergeinClarinda,Iowa,forthe annual celebration of the music and memory ofthisfamousbandleader.ItwillbeadayfilledwithnewandfamiliarmusicandatourofMiller’sbirthplace.

Elephants to Pipe Organs—Sept.24.VisittheHenryDoorlyZooandmore!

B R Y A N S T E R L I N G C O N N E C T I O N

32 Winter 2015

W11997.indd 32 1/13/15 11:52 AM

2015 Bryan Indoor TriathlonSaturday, Feb. 21.

Firstwavebeginsat8a.m.,andanewwavebeginsevery35minutes.Thetotaltriathloneventwillbe75minutes.n 10-minuteswiminlappool,n 10-minutetransition,n 30minutesonaspinbike,n5-minutetransitionandn20minutesonatreadmill.

Notcomfortabledoingthisalone?Findtwofriendsandcompeteasateam!Teamsarecoed,allmaleandallfemale.Cost: Individualis$25,or$75forateam.Shirts are included if you register by Feb. 8.DeadlinetoregisterisFeb.15.Where: BryanLifePointeCampus,7501S.27th. Tolearnmore,gotobryanhealth.cvent.com/2015tri,orcall402-481-8855.

C O M M U N I T Y C A L E N D A R

Bryan Journeys 33

Fitness CountsA special class for those with Parkinson’s diseaseor multiple sclerosis

Feb. 10-May 2, Tuesdays, Thursdays and Saturdays10:30-11:30 a.m.

ThisclassprovidestoolsandtrainingtoimprovequalityoflifeforthosewithParkinson’sdiseaseormultiplesclerosis. Fitnessactivitieswillincludebalancetraining,resistancetrainingandgaitandcoordinationexercises,aswellasenduranceexercises.FitnessCountsparticipantsmustbecognitivelyalertwithminimalmentaldysfunctionandmustbeabletowalkindependentlyorwithacane.Physicianclearanceandapreassessmentarerequiredbeforethefirstclass,whichistaughtbyanexercisespecialist. Toregisterorformoreinformation,call402-481-6300.

Cost: $275forLifePointemembersor$300fornon-members.Where: BryanLifePointeCampus,7501S.27th.

Take a FREE 7-minute Online Risk AssessmentGo online. Get checked. Save your life.

It’squick,freeand completely confidential. Ifyouareatrisk,you’llhavetheopportunitytomeetwithanursetodiscussyourhealth. Goto:bryanhealth.org/online-screenings.

This year we recognize trauma survivors Nicholas Boruch of Seward and Taylor Graham of Lincoln and honor the dedicated professionals from throughout the statewide trauma system who were involved in saving Nicholas and Taylor. Hear their remarkable stories and salute their caregivers at this annual event.

Tribute to Trauma ChampionsWednesday, April 22, beginning at 6:30 p.m. at the Embassy Suites, 1040 P St.Cost is $20. To learn more or to register, go tobryanhealth.org/calendar, under community events.

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PRSRT STDU.S. POSTAGE PAID

LINCOLN NEPERMIT NO. 1299

1600 S. 48th St., Lincoln, NE 68506

Address service requested

TechnologyDr. Benjamin Gelber is the first neurosurgeon in Nebraska to use the new Mazor Robotic Guidance System.

Helping you prepare for what’s next in your life will always be what’s next in ours.

bryanhealth.org

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