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breakthroughsLIVING WELL ON THE WESTSIDE | FALL 2014
AWASH IN HAPPINESSModern treatments for rheumatic conditions restore patients’ lives. p.26
2 breakthroughs FALL 2014
letterfrom the CEO
In January, I journeyed from my office at Swedish Health Services in Seattle to Santa Monica to be part of a transition team to listen to Saint John’s physicians. My goal was to solicit their opinions of how to effectively add Saint John’s Health Center and the John Wayne Cancer Institute to the Providence Health & Services system. During the two days I spent at the Health Center, I was able to meet many members of the staff. What a first impression! I was struck by the devotion the physicians and staff displayed and by the strong commitment to the community. I never have witnessed such a warm, welcoming environment.
Now I am privileged to be the new chief executive of this storied, outstanding health care institution. I couldn’t be prouder and more excited about my new role. Providence Saint John’s Health Center already is nationally ranked in such fields as cancer, neurosciences, cardiac care and orthopedics. The John Wayne Cancer Institute is a center for innovation and research. And yet the Health Center has never lost sight of the fact that its first priority is to care for, serve and meet the needs of its community.
In the weeks and months ahead, I’m looking forward to partnering with all caregivers to build upon this long tradition of excellence. With our talented physicians, compassionate nurses and dedicated staff and volunteers, we possess all of the characteristics for continued success. But we won’t stop there. We will strive to advance high quality and safe health care by embracing leading-edge strategies and solutions.
My wife Jane and I are eager to experience life on the Westside and become part of the fabric of this great community. We are humbled by the opportunity to join the Providence Saint John’s Health Center and John Wayne Cancer Institute families, and look forward to meeting all our new family.
Marcel LohChief Executive
SAINT JOHN’S HEALTH CENTER EDITORIAL STAFF
Chief ExecutiveMarcel Loh
Director of Marketing & Communications
Connie Matthews Barilla
VP, Branded Media Emily S. Baker
Art Director Angela Akers
EditorShari Roan
Copy Editor Laura Watts
ContributorsDawn Hoffman, Lorie Parch,
Zoe Sophos
PhotographersScott Gilbert, Michael Neveux, Lauren Pressey, Remy Haynes
Managing Partners Charles C. Koones
Todd Klawin
breakthroughsLIVING WELL ON THE WESTSIDE
FALL 2014
58 11th Street, Hermosa Beach, CA 90254
Tel 310-376-7800 Fax 310-376-0200moontidemedia.com
With utmost respect,Marcel
FALL 2014 breakthroughs 3
profiles 20 | Sharing and Caring
A long-standing support group helps people who are insulin-dependent.
24 | No Generation Gap Here Karen and Emma Register share a love of volunteering.
contentsdepartments 2 | Letter from the Chief Executive 14 | On the Horizon 31 | Happenings 34 | Shout Outs
in good health 4 | Acupuncture for Cancer Patients 5 | The Best Infection Control, Hands Down 6 | Q & A: The Emergency Department and Contagious Illness 10 | Around the Providence Health & Services Network 11 | Healthy Recipe 13 | Some Kids Still Aghast at Eating Vegetables
ON THE COVERAimee Bower has
returned to an active lifestyle after treatment of
rheumatoid arthritis.
features 16 | Brave of Heart
With new treatment options, Saint John’s cardiologists alleviate their patients’ fears.
22 | Things Are Looking UpNew screening technology and improved surgeries have altered the outlook on lung cancer.
26 | Taking the Ache out of Arthritis
Early treatment can significantly curb the risk of disability.
in good health
4 breakthroughs FALL 2014
Many postmenopausal women with breast
cancer take a type of medication called
an aromatase inhibitor. This drug blocks
the body’s production of estrogen and is a
proven therapy for breast cancers that are
hormone-sensitive. However, aromatase
inhibitors can cause significant joint pain.
Many patients discontinue the therapy be-
cause of this side effect.
Maggie DiNome, MD, chief of general sur-
gery at Providence Saint John’s Health Center,
acting director of the Margie Petersen Breast
Center and medical director of the Cancer
Prevention Clinic, has launched a clinical trial
that will examine whether acupuncture can
successfully reduce treatment-related joint
pain. Dr. DiNome and her colleagues at the
John Wayne Cancer Institute believe the estro-
gen deprivation induced by the treatment may
trigger an inflammatory response that causes
the joint pain.
“Acupuncture has been
used for centuries to treat
inflammation,” Dr. DiNome
explains. “More recent-
ly, Western medicine has
studied the benefits of acu-
puncture. With our brilliant
immunologists at the John
Wayne Cancer Institute,
we are setting out to study,
with much more depth, the
body’s immune response to
acupuncture.”
“It’s particularly important to address
this issue because we are placing more
women on long-term aromatase inhibitor
therapy—often in lieu of chemotherapy,” Dr.
DiNome says. “Unfortunately, up to half of
the women will experience joint pains, and
almost 20% of these women will discontinue
this otherwise lifesaving therapy because of
this side effect. If women cannot derive the
intended benefit from our recommended
treatments because of intolerance, then we
are doing a disservice if we do not attempt to
address the problem with them.”
The Angels of the ER volunteer group has
received new uniforms thanks to a generous
gift by the Irene Dunne Guild. The uniforms
are blue jackets or polo
shirts with a logo incor-
porating Providence, the
Health Center’s new spon-
sor, into the design.
“We had several different
uniforms in use,” says Janie
Crane, the Angels coordi-
nator. “Some were old, and
some were new. We decided
to start fresh. We hope
everyone will look all spiffy
and nice.”
The Angels are a spiffy organization, to be
sure. The group was formed 14 years ago to
provide volunteer services to patients and
families in the emergency department.
Now composed of 43 members, two
Angels are on duty each day from
9 a.m. to 9 p.m. They check to see if patients
need reading material, a blanket, a glass
of water or would like to contact family or
friends. They communicate with the health
care team to make sure the patients’ needs
and concerns are promptly addressed.
“Our main job is to advocate for the pa-
tients,” Crane explains. “We help make their
stay at Providence Saint John’s as pleasant as
it can be. No one wants to come to the ER, but
we try to make the patient comfortable and the
experience as stress-free as possible.”
The Angels were the recipients of an
award from the American Hospital Associa-
tion in 2011 for Volunteer Excellence.
Examining Acupuncture for Side Effects of Breast Cancer Treatment
The Angels are Outfitted
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FALL 2014 breakthroughs 5
All Hands on Deck
Research led by Daniel F. Kelly, MD, director of the Brain Tumor
Center and Pituitary Disorders Program at Providence Saint John’s
Health Center, adds to the growing concerns about the long-term
repercussions of brain trauma suffered by football players. The study,
published recently in the Journal of Neurotrauma, found that multiple
concussions were associated with reduced levels of some hormones
and that diminished hormones increase the risk of other disorders.
The impact of multiple concussions in athletes of all ages is one of
the most pressing issues in sports medicine and neurology. The study
by Dr. Kelly adds to the list of potential complications from multiple
concussions. He analyzed 68 retired NFL players who were, on average,
47 years old and who had an average of three concussions and a poor
quality of life based on mental component scores.
The study found deficiencies in either growth hormone, gonad-
otropin or testosterone in 23.5% of the retired players. Men with
reduced levels of growth hormone typically have high levels of fats
and cholesterol in the blood and can have an increased risk of heart
disease and diabetes. Deficiencies in testosterone and gonadotropin
can impact mood and contribute to erectile dysfunction.
Infection control is always a priority at Providence Saint
John’s Health Center. However, with the first cases of Ebola
virus infection recently confirmed in the United States, the
health care staff has been undergoing additional training
to ensure preparedness to treat an Ebola patient while
protecting the staff and other patients.
Numerous occupational safeguards are undertaken as
part of this response plan. For example, in caring for a
patient with Ebola, all donning and doffing of their personal
protective equipment—such as gowns, gloves and masks—
would be under supervision, and health care workers will not
be permitted to enter or exit a room without the approval of
a safety officer.
The Health Center also is conducting drills to familiarize
the staff with recently released government protocols
regarding donning and removing personal protection
equipment. In one exercise designed to help employees
use personal protective equipment, water color paints are
dabbed on gloves, gowns and masks before employees
practice removing their gear. The protective gear has to be
removed without paint transferring to the skin or clothing,
indicating that the protocol was followed successfully.
Numerous employees are involved in planning for a
possible Ebola patient, and Providence Health & Services
hospitals are sharing resources. One Providence hospital, St.
Patrick’s, in Missoula, Montana, is one of the four Biosafety
Level 4 facilities in the country.
Shopping on Amazon can now benefit the research at John Wayne
Cancer Institute at Providence Saint John’s Health Center. Just log
in to your Amazon account at smile.amazon.com and type “John
Wayne Cancer Institute” in the search bar. Select the Institute and
begin shopping. Amazon will automatically donate a half-percent
of your total purchase to the Institute every time you shop.
Multiple Concussions Alter Hormones
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6 breakthroughs FALL 2014
Do people know when
to use—or not use—the
emergency room?
“Most people who come
here are pretty sick. One in
four patients who visit the ED stay in the hos-
pital. So on average, the people who come here
need to come.”
Is it hard for people to know when to
come to the ER for flu symptoms?
“It can be hard to know. If they have symp-
toms of the flu or common cold and it’s some-
thing similar to what they’ve had before, they
usually don’t need to come to the emergency
department. They should call their primary
care doctor. But if they think its qualitatively
different and they aren’t feeling particularly
well, especially if they are older or have a co-ex-
isting illness like diabetes or an autoimmune
illness, they should come to the emergency
department. But even as a mere courtesy, peo-
ple should call their primary care provider and
let them know they are going to the emergency
department, because their doctors may want to
provide important information to us about how
to best manage the patient.”
How do you manage the emergency
department during particularly
challenging flu seasons when things
get very busy?
“We’ve had flu seasons where there have
been epidemics. We’ve instituted careful
measures for the waiting room and in triage.
For instance, we put a mask on anyone with flu
symptoms. We take pains to make sure they
don’t infect other patients, and we keep them
in an isolated part of the emergency depart-
ment. We try to run a rapid screen on them
to see if they have influenza. Then, if they are
really unwell and have something else going
on like dehydration or pneumonia, then they
would get admitted.”
Do you practice for outbreaks of
communicable diseases, like flu or
measles or pertussis?
“Yes. We get regular updates from the
Los Angeles County Communicable Dis-
eases Agency to keep us updated on what is
going on in the county. Right now, there’s
an outbreak of measles and pertussis, so
I’m constantly updating our nurses and
doctors on those illnesses. I also get Centers
for Disease Control and Prevention updates
about communicable diseases, such as the
Ebola virus. We have a plan to manage any
of these diseases. I’m always circulating the
criteria for diagnosis among the emergency
department staff and what one would do if
they thought they had a patient with a serious
communicable disease. We also have disaster
management teams for any type of disaster,
whether that’s a disease outbreak or a bomb
or radiation leak. A lot of planning goes into
running an emergency department!”
What’s your best advice for avoiding
the flu or a communicable disease?
“The most important thing you should do is
get the flu shot. Just yesterday, an article came
out that said in an office setting, a virus spreads
within two to four hours of the sick person
entering the building. The best possible advice
to give people is that they really can’t wash
their hands enough. Hand-wash every time
you touch common objects. That is the most
effective way to stop getting sick.”
The emergency room at Providence Saint John’s Health Center can be a busy place, especially during the cold and flu season. We asked
Russ Kino, MD, director of emergency services, how he manages the ER during oubreaks of infectious disease and potential threats like Ebola.
Russ Kino, MD
Making Good Use of the Emergency Department During Flu Season
in good health
FALL 2014 breakthroughs 7
LOCATION
Providence Saint John’s Health Center’s emergency
room is now located on Arizona Avenue on the first
floor of the Howard Keck Center. The ER is situated
close to imaging and diagnostics and is a straight elevator ride up to
surgery, the cath lab and labor and delivery.
PARKING
Having the ER’s entrance facing Arizona Avenue
has also greatly improved parking. Valet parking is
available 24 hours a day, seven days a week.
FAST TRACK TREATMENT FOR MINOR AILMENTS
Fast Track is designed to improve the experiences
of emergency room patients who come in for minor
ailments, such as a laceration or sprained ankle. These patients are
directed to a dedicated area where they can be treated and discharged
without waiting for more complex or serious patients to be seen. The
goal is to expedite care so we can get patients in, out and home.
YOUR GUIDE TO THE EMERGENCY DEPARTMENT AT PROVIDENCE SAINT JOHN’S HEALTH CENTER
ARIZONA AVENUE
21ST
22N
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23R
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ST JOHN’S HEALTH CENTER
ER
The emergency department sees more than 30,000 patients each year and strives to provide the best possible treatment and experience for patients. Here’s a snapshot of what makes this ER special.
STATE-OF-THE-ART CARE
The emergency department is equipped with the latest
technology to handle a vast range of critical condi-
tions. These include:
• Critical airway equipment that allows physicians superb visualization
of the airways when a patient is experiencing respiratory difficulty
requiring intervention.
• Arctic Sun hypothermia technology that is used to carefully and grad-
ually lower body temperature in cases of cardiac arrest. The cooling
minimizes damage to tissues that have been starved of oxygen.
COMFORT
Saint John’s Health Center’s emergency room features
27 spacious private exam rooms with TVs, phones
and Wi-Fi access. The rooms are designed to allow
procedures to be performed at the bedside and provide patient privacy
throughout the procedure. Our patients also receive attention from
members of the award-winning Angels of the ER volunteer group. The
volunteers assist with patient comfort and communicating with relatives
and the medical staff.
PRIVACY
Bedside registration allows emergency department
personnel to gather patient information while patients
are resting in a private area, rather than waiting for
assistance in the reception room.
PHYSICIAN PERFORMANCE
Providence Saint John’s Health Center emergency
room physicians are ranked in the 94th percentile in
patient satisfaction by Press Ganey, an independent
health care consultation company that provides comparative hospital
data nationwide.
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8 breakthroughs FALL 2014
Nationally known hospital administrator Marcel Loh took the reigns in Septem-ber as chief executive of Providence Saint John’s Health Center and the John Wayne Cancer Institute.
Loh previously served for 14 years in executive roles with Providence affiliate Swedish Health Services, a five-hospital, not-for-profit system in greater Seattle. He holds a master’s degree in hospital administration and served as an Army officer in the Medical Service Corps, retiring from the Army Reserve as a lieutenant colonel.
Loh also has been active in regional and national health care industry groups. He is the past chairman of the Washington State Hospital Association, a fellow in the American College of Healthcare Exec-utives (ACHE) and serves on the ACHE national Board of Governors. We sat down with Loh after his first week on the job to learn more about the new chief.
What led to
your interest in
health care?
“I knew I wanted
to be in health care
and, as a third-year
medical technician student, realized that
the business classes I was taking on the side
were more intriguing to me. It was then that
I found a way to put medicine and business
together and knew I could still focus on a ca-
reer that could help people. Health care and
medicine are about the patient and improving
care to the patient.”
Introducing Marcel Loh, the Health Center’s New Chief Executive
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FALL 2014 breakthroughs 9
Did you learn anything from your
military experience that has helped
in your health care career?
“I took a lot of lessons away from my
experience in the military. People think
if you’re in the military all you do is bark
orders. But it allowed me to be in leadership
positions and learn leadership skills much
earlier than I normally would have. I also
had the opportunity to serve my country.”
What excites you the most about join-
ing the leadership team at Providence
Saint John’s Health Center?
“I was fortunate to be part of a fact-finding
team exploring the possibility of adding Saint
John’s to the Providence Health & Services
system. Through this process I visited with
about 20 to 25 physicians over a few days.
There was something special about Saint
John’s that I had not seen in my 30-plus years
in health care. It was the passion and commit-
ment and loyalty of the physicians and others
I met. It almost gave me goose bumps. Saint
John’s has this welcoming family feel I never
have seen before. My wife Jane and I are both
very excited to be joining the Saint John’s
family and being a part of the very special
and unique Santa Monica community. We’re
humbled by the opportunity.”
What do you see as the Health
Center’s strengths?
“I see many strengths: the family feel,
impressive physicians, a dedicated and pas-
sionate board of directors and Foundation
board of trustees, the national recognitions
of quality and safety, and most of all, the
focus on the patient.”
It’s been called a community
hospital with academic medicine.
Is that your impression?
“Yes, and in my short time here, I would
describe Saint John’s as a community hos-
pital on steroids. There is much more going
on than a typical community hospital: the
education, the research, the John Wayne
Cancer Institute, and the degree of commu-
nity support. All of this was an added bonus,
which attracted me to Saint John’s.”
Do you see the John Wayne Cancer
Institute as an example of combining
research, education and health care?
“Yes. The John Wayne Cancer Institute
is probably one of the most unique insti-
tutes of the whole Providence system. The
physicians and researchers have been part
of many firsts in cancer breakthroughs. I
think there is a tremendous opportunity for
growth, and I’m excited to be able to work
with the Institute team.”
At Swedish Health Services, you were
involved in many innovations in health
care. Can you tell us about some of the
projects you oversaw there?
“I was the executive leader that helped
develop the Swedish Neuroscience Institute
and the Swedish Heart & Vascular Institute.
Now both are nationally recognized. I’m
very proud of that. As I look at Saint John’s,
we already offer world-class health care in
many areas and we have all the elements to
expand our world class services.”
You’ve been involved with the Amer-
ican College of Healthcare Executives
in leadership positions. What are some
of the most pressing issues today for
healthcare administrators?
“I’ve been a long-time member of the
American College of Healthcare Execu-
tives, and I’m a fellow, which is considered
board-certification for health care leadership.
A challenge for health care leaders today
is the major pace of the change. With the
Affordable Care Act and health care reform,
we’re all learning what the new environment
looks like—with population health manage-
ment, challenges with reimbursement and
physician alignment. My association with the
ACHE allows me the opportunity to not only
speak about these challenges but to learn
from my colleagues.”
Can you tell us a little about your family?
“Jane and I have been married for 36
years, and Jane has been a very active hospi-
tal volunteer. In Seattle, she volunteered at
the hospital one day a week and was active
in the fundraising of the foundation. Jane is
a retired teacher who taught both elementa-
ry education and music. We have two grown
children, Ashley and Aaron. We enjoy the
arts, music and theater and are avid boaters.
I’m an avid Seattle Seahawks football fan.
Since Los Angeles doesn’t have a team, I will
remain a Seahawks fan.”
Are you looking forward to
Southern California life?
“One thing about living in Seattle is we
have a lot of overcast days. I’m going to
enjoy seeing more sunshine.”
in good health
10 breakthroughs FALL 2014
Community Connections: Getting to Know Providence Health & Services
Providence Health & Services has
named Patrick Soon-Shiong, MD,
as the new global director for cancer
services and bioinformatics. Dr.
Soon-Shiong is a physician, surgeon
and scientist known globally for
applying the limitless potential of
collaborative science and technology
to improve the health and well-
being of patients battling life-threatening disease. He will work
closely with oncology clinicians and researchers at Providence and
its affiliates to ensure every member of our communities, especially
the poor and vulnerable, has access to the latest and most promising
cancer treatments.
Genomics and molecular data represent the most innovative
approach to cancer risk prevention and treatment, providing
physicians with information needed to personalize cancer care.
“We are living our commitment to clinicians and patients alike,”
Dr. Soon-Shiong says. “Partnering with Providence and the many
clinicians treating cancer patients across its five-state system will
dramatically advance how we care for people facing cancer.”
Dr. Soon-Shiong is a longtime supporter of the John Wayne Cancer
Institute at Providence Saint John’s Health Center. He is also the
chairman of the Chan Soon-Shiong Family Foundation, chair and
CEO of the Chan Soon-Shiong Institute for Advanced Health, and
of NantHealth—a health care company that focuses on innovative
technologies to improve care.
Providence also is entering into a partnership to create the
country’s first clinical network for whole genomic sequencing. This
effort is a collaboration among Providence, NantHealth and the Chan
Soon-Shiong Institute of Molecular Medicine.
Providence Health & Services,
Southern California, is establishing
a center devoted to research on
end-of-life care and changing the
conversation around how to best
meet the needs of the dying. The
Institute for Human Caring will
support patients, families and
clinicians across the five states with
Providence facilities and will serve as a national resource.
Based at Providence TrinityCare Hospice in Torrance, the Institute
will be led by Ira Byock, MD, as chief medical officer. Dr. Byock is a
leading authority on end-of-life care. He has been recognized as a
visionary by the Academy of Hospice and Palliative Medicine and has
received the academy’s Lifetime Achievement Award.
The institute represents a major commitment by Providence to
accelerate value-based and whole-person health care for frail elders
and seriously ill or otherwise vulnerable patients and their families.
The goals of the center include generating greater attention to the
personal side of illness, dying, caregiving and grieving.
“There really is a crisis in the way we die,” Dr. Byock says. “When
patients are faced with a crisis and they have not discussed their
wishes with family and care providers, there is a tendency to bring
the best medical treatment to bear without considering that there is a
whole human being with personal needs.”
Part of the institute’s mission will be to help the entire Providence
system embrace the full range of end-of-life care responsibilities—
including meeting the needs of family members, managing the
patient’s pain and addressing the patient’s spiritual needs.
Providence Focuses on End-of-Life Care
Dr. Patrick Soon-Shiong to Direct Cancer Genomics Services
Earlier this year, Saint John’s joined Providence Health & Services and is now part of an expansive
health care network featuring six hospitals and other ancillary health services. Here’s a look at
some of the resources available within the Providence network.
Ira Byock, MD Patrick Soon-Shiong, MD
in good health
FALL 2014 breakthroughs 11
Healthful EatingThis festive salad is filling enough to serve as a side dish or dessert at your holiday dinner. Packed with fruit and nuts, it’s a delicious alternative to traditional Waldorf salad or a high-calorie dessert.
Courtesy of Mary Rotolo, RD, Nutrition & Diabetes Education, Providence Saint John’s Health Center
Cranberry-Waldorf Molded SaladServes 16
1 package sugar-free Jell-o, either cherry or cranberry (8-serving size box)2 cups boiling water2 cups cold water4 cups fresh cranberries 2 large (about ¾-pound) oranges, peeled and seeded
2 large (about ½-pound) red apples, cored2 cups celery, chopped1 cup chopped walnuts or almondslettuce leaves, rinsed (optional)
Mix Jell-o with boiling water, stirring until dissolved. Add cold water. Chill until thick, about 20 minutes. Coarsely chop cranberries (a mini-food processor works great). Chop oranges, apples and celery into ¼-inch cubes. Mix fruit with thickened gelatin. Add celery and nuts. Spoon into a large, fancy glass bowl or two 5- to 6-cup Jello molds. Chill for at least 4 hours or until the next day.
Serve in the bowl or un-mold onto a platter. To remove salad from mold, dip mold in warm water and wait until salad breaks away from side of mold when gently shaken, about 2 minutes. Invert serving platter on top of mold. Holding tightly together, flip mold over onto platter. Remove mold. Tuck lettuce leaves under edge of salad.
Nutrients per serving:Calories: 84Fat: 4.5 grams Carbohydrates: 10 gramsDietary fiber: 3 grams
DID YOU KNOW? Cranberry is one of only three fruit species that are native to North America. It belongs to the same family of fruits as blueberry and bilberry, which also are plants native to North America. Juice and extracts from the fruit were used as medicine by Native Americans, and the fruit was prized as a treatment of urinary conditions. Even today, cranberry is used to pre-vent urinary tract infections. Scientists believe that some of the chemicals in cranberries keep bacteria from stick-ing to the cells that line the urinary tract where they can multiply.Source: National Institutes of Health
in good health
12 breakthroughs FALL 2014
Providence Saint
John’s Health Cen-
ter is now home to
a clinic specifically
devoted to the
diagnosis, treat-
ment and research
of a mysterious
condition called
normal pressure hydrocephalus. Normal
pressure hydrocephalus (NPH) is caused
by a build-up of cerebrospinal fluid in the
crevices of the brain.
The condition causes dementia,
difficulty walking and incontinence.
But unlike many other diseases that
cause dementia, NPH can be treated
if caught early, with many patients
recovering full cognitive function.
The condition occurs if the normal flow of
cerebrospinal fluid throughout the brain and
spinal cord is blocked in some way, such as
by a tumor, infection or hemorrhage. This
obstruction causes the ventricles to enlarge,
putting pressure on the brain.
It’s not clear how many people develop
NPH; however it’s most common in people
age 70 and older. With proper screening
by their primary care physicians, patients
with this disorder can be identified for fur-
ther evaluation.
The new Adult Hydrocephalus and Neu-
roendoscopy Center at Providence Saint
John’s Health Center will provide an ob-
jective, systematic course of treat-
ment and follow-up. Data will be
compiled to help measure and
monitor progress.
There are similar cen-
ters, but typically at aca-
demic medical centers.
The program at Provi-
dence Saint John’s will
provide expertise and
research in the com-
munity, making it
simple for patients
to be treated
and return for
follow-up visits.
There are
many advantages
for patients who seek
care at a dedicat-
ed center for this
condition, says Garni
Barkhoudarian, MD, a
neurosurgeon and assis-
tant professor of neuroscience and neuro-
surgery at the John Wayne Cancer Institute.
Patients receive multidisciplinary—neuro-
surgery and neurology—evaluation and
treatment for normal pressure hydroceph-
alus as well as other disorders. Dr. Bark-
houdarian manages the clinic with David
Franc, MD, a neurologist who specializes in
dementia and neuroimaging.
“We have a formalized protocol for diag-
nosis, work-up, treatment and post-surgical
evaluation, including metrics, to monitor the
progress of each patient,” Dr. Barkhoudarian
says. “For adult patients with hydrocephalus
due to lesions in the brain, such as colloid
cysts or tumors, our neuroendoscopic tech-
niques allow for appropriate and minimally
invasive methods to surgically treat these
patients. Finally, differentiating between
NPH and non-NPH conditions is critical with
regards to assessing the patient and identi-
fying the correct diagnostic and treatment
pathways for each patient.”
Dr. Barkhoudarian, who is also director of
the skull-base and endoscopic microdissec-
tion laboratory, treats NPH patients at Prov-
idence Saint John’s, some with remarkable
results. There are two standard courses of
treatment: the surgical placement of a shunt
to drain fluid to the abdomen where it can
be absorbed as part of the normal circula-
tory process, or utilizing an endoscope to
bypass the blockage in the brain.
Treatment can help improve ambulation,
memory and incontinence by decreasing
the size of the brain ventricles. Regular
follow-up care by a physician is important in
order to identify subtle changes that might
indicate problems with the shunt or bypass.
Physicians will continue to research
the condition to improve their under-
standing of it and will follow patients to
assess outcomes.
Clinic Specializes in Normal Pressure Hydrocephalus
Dr. Garni Barkhoudarian
in good health
FALL 2014 breakthroughs 13
Kids and Those Darn Vegetables
Can good health habits spread throughout a community?
According to a new study, the answer is yes—and the way these
health habits spread may surprise you.
Previous studies suggest that environments can clearly
affect poor cardiovascular health. For example, residents of
neighborhoods with lots of fast-food restaurants, high crime
rates and few safe parks often have increased rates of heart
attacks and strokes.
The new study looked at something called “neighborhood
cohesion.” This measure reflects whether people feel their
neighbors are trustworthy, friendly and would help them during
times of trouble.
The study examined data from more than 5,000 American
adults and tracked their cardiovascular health for four years. The
researchers found that the more social cohesion in a neighborhood,
the lower the risk of having a heart attack. The association was true
despite other neighborhood characteristics, such as socioeconomic
status and individual household social support.
Tight-knit neighborhoods, the authors wrote, may help reinforce
positive health behaviors and discourage negative ones. The
research was published in the journal BMJ.
Americans need to eat more fruits and vegetables to
become healthier. Recent statistics from the federal
government show modest improvements in fruit
intake among children ages 2 to 18 over the past
decade, although vegetables are still largely sitting
untouched on kids’ plates.
The study was part of the expansive National Health
and Nutrition Examination Survey released every two
years in the United States. Between 2003 and 2010,
whole fruit intake among kids increased 67% while
intake of fruit juice declined slightly. Still, 60% of
children consume fewer fruits than recommended.
The findings on veggies were worse. There was no
change in total vegetable intake from 2003 to 2010—
despite a growth of programs, including healthier
school lunch programs, meant to encourage
vegetable intake. About 93% of kids consume fewer
vegetables than recommended. White potatoes
accounted for an average of 30% of total vegetable
intake over the study period and were consumed
mainly as less healthy forms of potatoes, such as
fried potatoes and potato chips.
Get Healthy Santa Monica
WHOLE FRUIT
FRUIT JUICE
VEGETABLES
03-0
40
3-04
03-0
40
9-100
9-100
9-10
0.40
0.24
0.31
0.22
0.55
0.54
Cup equivalents per 1,000 calories
Source: Vital Sings: Fruit and Vegetable Intake Among Children —United States, 2003-2010, MMWR, Vol. 63, Aug. 5, 2014.
14 breakthroughs FALL 2014
on the horizon
NOVEMBER—DECEMBER The Type 1 Diabetes and Insulin Pump Support Group Providence Saint John’s Health Center
People with type 1 diabetes and insulin pump users are welcome at this monthly meeting of education, infor-mation sharing and discus-sions on managing therapies. This support group helps make living with diabetes eas-ier. Please feel free to bring dinner or a snack.
Tuesday November 25, 6:30 to 8 p.m.Tuesday December 30, 6:30 to 8 p.m.Please see information on the room location at the Health Center information desk. For more information: Dalia Dvoretsky, 310-829-8077
Childbirth Preparation Classes and Maternity ToursProvidence Saint John’s Health Center
Two-part childbirth educa-tion classes: December 2 and 9, 5:30 to 8:30 p.m. One-day class: December 6, 10 a.m. to 4 p.m. Classes meet in the Howard Keck Center, third floor.
Maternity tours begin at the Howard Keck Center and are approximately two hours long:November 20 – 11 a.m. & 2 p.m.November 22 – 10 a.m. & 12:30 p.m.November 26 – 3 p.m. & 6 p.m. December 11 – 11 a.m. & 2 p.m. December 13 – 10 a.m. & 12:30 p.m. December 16 – 3 p.m. & 6 p.m.December 18 – 2 p.m. & 4 p.m.December 20 – 10 a.m. & 12:30 p.m.December 30 – 11 a.m. & 2 p.m.
Three-hour breastfeeding class to help prepare expecting women: December 23, 2 to 5 p.m.
Three-hour baby care class for expecting parents: December 3 – 5:30 to 8:30 p.m. December 7 – 10 a.m. to 1 p.m. December 7 – 1:30 to 4:30 p.m.
For more information or for reservations: Elsa Ruedas, 310-829-8887 or elsa.ruedas@providence.org
JANUARY 31, 2015California Hormonal and Pituitary Patient Health SymposiumLoew’s Santa Monica Beach Hotel1700 Ocean Avenue, Santa Monica, 8 a.m. to 5 p.m.
The Pituitary Network Association and Saint John’s Brain Tumor
Center will sponsor a patient health symposium for people with hormonal and pituitary disorders. The day-long sym-posium will feature presenta-tions by physicians as well as patients and family members. Patients will learn how to be their own best advocate in obtaining high-quality health care. Continental breakfast and lunch are included with the $30 registration fee. For more information: pituitary.org/events
HOSPITAL EVENTS
FALL 2014 breakthroughs 15
on the horizon
NOVEMBER 1 THROUGH JANUARY 22, 2015ICE at Santa Monica1324 5th Street, Santa Monica
Enjoy beachside ice-skating during the holiday season at the ICE outdoor rink on the corner of 5th Street and Arizo-na Avenue. The 8,000-square-foot rink also has a private event cabana, and begin-ners can sign up for skating lessons. The Grand Opening celebration will be held on November 6.For more information: 310-260-1199 or downtownsm.com/ice
NOVEMBER 11STEAM MachineSanta Monica PierNoon to 5 p.m.
The second annual event celebrating science, technol-ogy, engineering, arts and mathematics with a special Rube Goldberg machine competition on the Pier.For more information: 310-458-8901 or santamonicapier.org
NOVEMBER 222014 Southern California MG WalkOcean View Park9 a.m. to noon
All ages are invited to participate in this charity walk to raise funds and awareness for Myasthenia Gravis Foundation of America.For more information: mgwalk.org
DECEMBER 5Montana Avenue Holiday WalkMontana Avenue5 to 9 p.m.
Walk Montana Avenue from 6th to 17th streets to find gifts, have your photos taken with Santa, listen to live music and indulge in great food and drinks! This annual night is a wonderful way to spend time with neighbors, friends and family.For more information: montanaave.com/event/montana-ave-holiday-walk
DECEMBER 6Main Street Holiday PartyMain Street6 to 9 p.m.
You’re invited to the Main Street Holiday Party. Following the tree lighting at the museum, take part in a candlelight walk to the famous Shopping Cart Tree at Edgemar Courtyard.For more information: mainstreetsm.com
DECEMBER 6Santa Monica-Venice Christmas Run2600 Barnard Way, Santa Monica7 to 11 a.m.
Come join the running commu-nity as it kicks off the holiday season at the 37th annual Christ-mas Run. Exhibit your brand to runners and their families before and after the race at the exclu-sive Finish Line Expo. Registra-tion opens at 6 a.m., followed by the 7:30 a.m. 10K start, 9:30 a.m. 5K start and 10:30 a.m. Kids Fun Run start.For more information: christmasrun.com
JANUARY 17, 2015Lei-Out Beach Ultimate Frisbee TournamentCentral Beach9 a.m. to 5 p.m.
The 16th annual co-ed Lei-Out Tournament will feature top beach volleyball players repre-senting more than 200 teams. For more information: leiout.com
COMMUNITY EVENTS
16 breakthroughs FALL 2014
We are a nation of heart disease.
That’s been true for many
decades, and with high rates of
obesity, it will continue to be a fact for years
to come. Yet deaths from heart disease and
strokes in the United States have fallen, and
patients today generally suffer less disability
and discomfort from heart disease than in
previous generations.
Ranked among America’s 100 Best Hos-
pitals for Cardiac Care™ for the past four
years by Healthgrades™, Providence Saint
John’s Health Center’s cardiovascular health
team is leading the way in improving lon-
gevity and quality of life for patients. From
new minimally invasive surgical techniques
to better imaging to new implantable devic-
es, the Health Center is home to a number of
leaders in cardiology. Here’s a look at some
of the recent advances.
THE WATCHMAN DEVICE
FOR ATRIAL FIBRILLATION
Atrial fibrillation, or A-fib—a heart rhythm
abnormality affecting 6 million Americans—
occurs when the heart beats erratically. That
can lead blood to clot in the heart’s left atrial
appendage. The condition is progressive
and, if untreated, can lead to chronic fatigue,
congestive heart failure and stroke.
Patients can be treated successfully with
medications, such as the blood thinner
warfarin, but about half of all patients are
not able to control their abnormal heart
rhythms with drugs or can’t tolerate the
side effects. Warfarin lowers stroke risk, but
blood levels of the drug must be frequent-
ly monitored because they can be easily
thrown off by foods and other medications.
Blood thinners also have another more
obvious disadvantage—they increase the
risk of bleeding, posing a particular problem
as people age and the risk of falls increases.
“We’re stuck in a difficult position with el-
derly patients,” says Shephal K. Doshi, MD,
director of cardiac electrophysiology and
pacing at Providence Saint John’s Health
Center. “It’s a catch-22.”
Written by SHARI ROAN
Cardiovascular disease still affects many Americans, but the doctors at Providence Saint John’s are at the forefront of treatment and research.
PIONEERS in Heart Care
Pioneers in Heart Care
FALL 2014 breakthroughs 17
The Watchman device is an expandable
metal cage that looks like a parachute. It’s
guided through a catheter inserted into a
vein in the leg to the atrium to block the
appendage so blood can’t collect and clot.
Older patients with A-fib who take blood
thinners are ideal candidates for the Watch-
man device.
“It offers a way to seal off this pouch and
reduce the risk of stroke so people don’t
have to take blood thinners,” says Dr. Doshi,
who was a pioneer in using the device in
the United States and worldwide. “The data
show that the Watchman was better than
warfarin in reducing stroke and improving
survival. Patients get the benefit of blood
thinners without the risk of bleeding.”
Dr. Doshi spearheaded the trial at Prov-
idence Saint John’s and has performed
around 300 Watchman procedures—more
than anyone in the United States. Although
the Watchman does not have the Food and
Drug Administration’s approval yet, it could
come soon. An advisory committee already
has voted in its favor. Once approved, the
device will likely be covered by Medicare.
THERMOCOOL
The Health Center recently became the first
hospital in Southern California to offer the
Thermocool Smarttouch Catheter, the first
catheter approved by the FDA to feature
direct contact force technology for the treat-
ment of atrial fibrillation.
Catheter ablation is a minimally invasive
treatment for atrial fibrillation. Doctors
insert a catheter through a small incision in
the groin, which is then guided to the heart
through a blood vessel. Once it reaches
the left upper chamber of the heart—the
atrium—the catheter delivers radiofrequen-
cy energy to the heart wall to create lesions
that block faulty electrical impulses that can
cause heart rhythm disorders.
The Thermocool catheter enables doctors
to more accurately control the amount
of force applied to the heart wall during
radiofrequency ablation procedures, thus
improving safety and efficacy.
“Consistent and stable application of
contact force against the heart wall has been
demonstrated to have a significant impact
on patient outcomes during catheter abla-
tion,” says Dr. Doshi. “Without this technol-
ogy, doctors have to estimate the amount of
force being applied to the heart wall through
other indirect measures that have been
shown not to be as effective.”
MINIMALLY INVASIVE TREATMENT
FOR PERIPHERAL VASCULAR
DISEASE—INTRODUCING TAVR
Peripheral arterial disease is a type of
cardiovascular disease that causes restricted
blood flow due to obstructions in the
arteries and veins of the legs. It affects more
han 8.5 million Americans. Today, however,
a number of surgical advances have made
treatment of arterial occlusive disease easier
than ever, says Rajeev Rao, MD, a vascular/
endovascular surgeon at Providence Saint
John’s Health Center.
Doctors are using minimally invasive
endovascular techniques to treat these
conditions, sparing patients from open
surgery. Endovascular surgical techniques
used for arterial occlusive disorders include
catheter-based treatments that require only
puncture wounds and spare the patient from
an open surgery requiring large incisions.
“With endovascular repair, the risks
of treatment have gone down,” Dr. Rao
explains. “In the past, these patients had to
manage with bigger surgeries, and there was
a higher risk with those open surgeries. But
now that we can do it minimally invasively,
we can try to treat these patients instead of
managing it with medication alone.”
Dr. Rao and his colleagues can also treat
peripheral aneurisms—a weak area of a
blood vessel that expands or bulges—with a
minimally invasive technique called periph-
eral endovascular aortic repair.
“Especially with aneurisms, these patients
would have been told they were not surgical
candidates at all,” Dr. Rao says. “Now we
can treat them with minimal risk, and most
can be treated as an outpatient. That’s a big
advance. The need for a big hospitalization
and major recovery are a thing of the past.”
MINIMALLY INVASIVE HEART
VALVE REPLACEMENT
The Health Center’s valve clinic has in-
troduced a new type of valve replacement
called transvascular aortic valve replace-
Peter Pelikan, MD Nicole Weinberg, MD Shephal K. Doshi, MD
Pioneers in Heart Care
18 breakthroughs FALL 2014
ment (TAVR). This minimally invasive pro-
cedure involves repairing a damaged valve
without removing it.
To perform TAVR, surgeons place a
collapsible replacement valve through a
catheter into the old valve, similar to placing
a stent in an artery. Once the new valve is
expanded, the old valve is crushed out of the
way and the new valve takes over the job of
regulating blood flow.
Traditional surgery requires opening the
sternum and putting the patient on a heart-
lung machine, and thus completely stopping
the heart, while surgeons replace the faulty
valve with an artificial one.
“TAVR is far less stressful for the patient,”
says Peter Pelikan, MD, medical director of
Saint John’s Cardiac Catheterization Lab-
oratory. “Valves are put in either through
an artery in the groin or a small incision in
the chest. The heart keeps beating, and the
patient avoids all the trauma of opening the
chest and cardiopulmonary bypass.”
In addition to suffering less pain, patients
typically experience a quicker and easier re-
covery. Carefully selected candidates for the
procedure are people for whom open-heart
surgery is too risky, generally older patients.
To properly assess prospective patients,
the hospital is laying the groundwork for
a multi-specialty valve clinic. The clinic
will allow “one-stop shopping,” Dr. Pelikan
says. Patients will be evaluated by differ-
ent practitioners—cardiologists, surgeons,
nurse practitioners—and receive needed
tests, including ultrasounds of the heart
and CT scans.
Importantly, the clinic will allow pa-
tients with valve disease to be assessed
over time—and treated appropriately. The
plan for a multi-specialty valve clinic also
calls for a hybrid operating room, which
combines the functions of a catheterization
lab and an operating room and is equipped
with the advanced medical imaging devices
required to perform minimally invasive
cardiac procedures.
SPECIALIZED CARDIAC CARE
FOR WOMEN
Providence Saint John’s Health Center has
specialists dedicated to treating women with
cardiovascular disease. Heart disease is the
leading cause of death for both men and
women, according to the American Heart
Association. However, women often experi-
ence different symptoms than men.
For example, instead of chest pain and
pressure—one of the traditional symptoms
of a heart attack—women may experience
shortness of breath, pressure or pain in the
lower chest or upper abdomen, lighthead-
edness, upper back pressure or extreme
fatigue. Moreover, some heart condi-
tions, such as coronary microvascular
disease, are more common in women than
in men.
“The message is out there that heart
disease is a leading cause of death among
women, but I don’t think women realize the
magnitude of it,” says Nicole Weinberg, MD,
a cardiologist who specializes in women at
the Pacific Heart Institute in Santa Monica.
“It kills more women than all of the cancers
combined and has some insidious disease
states associated with it that can be ex-
tremely risky.”
Heart disease often develops in women
about 10 years later than men. But women
whose fathers or brothers have been diag-
nosed can take advantage of that informa-
tion to prevent problems linked to heredi-
tary forms of the disease. All women should
understand that their risk for heart disease
rises after menopause.
“We educate women about hormone
changes and what that means,” she says.
“We talk to them about why they are OK for
now but that they can’t just wait for a prob-
lem to come along. You want to attack their
risk factors head-on."
Women often benefit from seeking cardiac
care with a specialist in women’s health,
says Dr. Weinberg, who is board-certified in
echocardiography and nuclear cardiology.
“We don’t feel like we do cookie-cutter
cardiology,” she says. “We take the time to
sift through a patient’s very specific issues
and figure out if there is a test for them that
meets their needs or find an explanation for
something that may be happening. We feel
we are able to sift through a lot of the minu-
tia to get to the root of the patient’s issues.”
STEMI
The Health Center is part of the STEMI
Program—a nationwide initiative developed
TAVR is far less stressful for
the patient.”
Pioneers in Heart Care
FALL 2014 breakthroughs 19
0 5 10 15 20 25 30
by the American College of Cardiology and
the American Heart Association to improve
the treatment of patients with symptoms of
a heart attack. STEMI is an acronym for ST
segment elevation myocardial infarction, a
severe type of heart attack that occurs when
the coronary artery is completely blocked.
The program is a collaboration among
hospital emergency departments, cardiolo-
gists and paramedics to ensure that patients
experiencing STEMIs are diagnosed, trans-
ported and treated quickly. The patient is
received in the emergency room and trans-
ported to a team waiting in the cath lab.
The Health Center was named one of the
top 14 hospitals in California for outstanding
heart attack outcomes by the Office of State-
wide Health Planning and Development.
CHANGE OF HEART
600,000Annual U.S. deaths
from heart disease
$108.9 BILLION
Annual cost in health care, medications and lost productivity from
heart disease
#1Stroke is the leading
cause of serious long-term disability
92% Americans who
recognize chest pain as a symptom of heart attack
47% Rate of sudden cardiac
deaths that occur outside a hospital
U.S. deaths attributed to stroke
1 IN 19Americans aware of all
the major symptoms of a heart attack
27%
WHO’S AT RISKAbout half of all Americans have at least one of three key risk factors for cardiovascular disease. Other medical conditions and lifestyle factors also can put people at higher risk of heart disease.
Key risk factors:• High blood pressure• High LDL cholesterol• Smoking
Other risk factors:• Diabetes• Overweight or obesity• Poor diet• Physical inactivity• Excessive alcohol use
Source: Centers for Disease Control and Prevention
DID YOU KNOW?Lifestyle factors have an enormous impact on heart disease. The landmark National Health and Nutrition Examination Survey III Mortality Study, published in 2011, examined the impact of four lifestyle factors in reducing death from cardiovascular disease. People who had these four behaviors had a 65% reduced risk of death from cardiovascular disease: healthy diet, adequate physical activity, never smoked and moderate alcohol consumption.
Source: Ford ES, Zhao G, Tsai J, Li C. Am J Public Health. 2011 Oct;101(10):1922-9.
Source: Centers for Disease Control and Prevention
Source: Centers for Disease Control and Prevention
HEART DISEASE IS THE LEADING CAUSE OF DEATH FOR PEOPLE OF MOST ETHNICITIES IN THE UNITED STATES.
18.0%
24.5%
23.2%
20.8%
25.0%
25.1%
African-Americans
American Indians or Alaska Natives
Asians or Pacific Islanders
Hispanics
Whites
All
BY THE NUMBERS
profiles in health
20 breakthroughs FALL 2014
Lean on MeMembers of an insulin therapy support group find help and camaraderie. Written by ZOE SOPHOS | Photographed by REMY HAYNES
Caution, concern and constant vigilance are realities of ev-
eryday life for individuals living with type 1 diabetes or who
depend on insulin pump therapy. One Thursday evening
each month, Providence Saint John’s Health Center hosts a special
support group for these patients, providing comfort and common
ground amid their daily struggle.
“This support group provides an opportunity for patients to foster
new relationships with others who may share the same concerns and
struggles,” says Dalia Dvoretsky, RD, coordinator of nutrition and
diabetes education at the Health Center. “It’s meant to empower and
encourage patients to manage their diabetes while promoting health.
Feeling connected and being supported is more important than ever
in our high-tech world.”
Unlike type 2 diabetes, type 1 cannot be prevented and is most
commonly diagnosed in adolescents rather than in adults. Individu-
als with type 1 diabetes are completely unable to produce their own
insulin, a hormone responsible for regulating sugar and energy lev-
els. Without insulin, the body cannot absorb glucose—energy stored
in food—and the patient’s cells quickly starve.
Individuals with type 1 diabetes combat this deficiency by giving
themselves insulin, either through injections administered through-
out the day or through an electronic pump that provides the body
Cameron Hall, a longtime member of the insulin-dependent dtiabetes support group (left) and Dalia Dvoretsky, RD
profiles in health
FALL 2014 breakthroughs 21
with a continuous supply of insulin. Some
people with type 2 diabetes find more flex-
ibility using insulin pump therapy and are
welcome to join the group.
Because the body’s response to insulin
varies based on a number of factors, in-
cluding food, exercise, stress and emotions,
knowing exactly how much insulin to take at
a given time can be a challenge. Every hour
of the day, patients must perform a com-
plicated balancing act with their immediate
and long-term health at stake.
“Diabetes has the ability to really dictate
your lifestyle from beginning to end,” says
Cameron Hall, a member of the support
group since its inception and a patient at the
Health Center for nearly four decades. “You
can find yourself having a lovely day, but you
may have forgotten to eat, and all of a sud-
den you’re having a hypoglycemic incident
where your blood sugar level drops. You are
literally unable to function properly, and it
puts you at a serious disadvantage.”
All type 1 diabetes patients who use
traditional insulin injections, as well as all
patients with either type of diabetes who
use insulin pump therapy, are welcome to
attend the two-hour-long meetings. Partic-
ipants include men and women, ages of 17
and 70. While their perspectives are unique,
these patients are united in their common
concerns and their determination to live life
to the fullest.
“We’ve talked about exercise, eating
during the holidays, preparing to travel
either domestically or internationally,
sleeping, highs and lows of the day, stress,
and the fact that you cannot ever be without
your insulin supplies because a disaster or
accident could occur,” Hall says. “These are
people who are experiencing the same things
you are. It makes you very comfortable to
know that it’s not just you.”
At these regular meetings, patients can
bring their questions, problems and feelings
to people who will understand. “They live
with diabetes day in and day out. They only
see the physician every few months,” says
Dvoretsky. “It’s good to know what other
people are doing and not feel isolated.”
In addition to providing a forum for open
discussion, the Health Center also brings in
guest speakers such as nutritionists, physi-
cians or diabetes device representatives.
No matter how many or how few people
show up on Thursday nights, the meetings
still go forward. Hall attributes the longevity
of the support group—nearly eight years—to
this type of dedication and attention to the
needs of patients.
“We will provide continuing education so
that patients can learn about different as-
pects of managing diabetes—from new prod-
ucts on the market to carbohydrate counting
that’s specific to type 1,” Dvoretsky explains.
“The group is growing, and we are inviting
people from the community to check it out.
The fact that the group has been around for
so long means it works.”
The support group typically meets the last
Thursday each month, but the schedule can
vary during the holiday season. For more
information on this support group for peo-
ple with type 1 diabetes and those who use
insulin pumps, contact 310-829-8077.
These are people who are experiencing the same things you are. It makes you very
comfortable to know that it’s not just you.”
22 breakthroughs FALL 2014
First the bad news: Lung cancer is
still a really big killer. It’s the #1
cause of cancer deaths in the world.
“Lung cancer deaths exceed those of
breast, colon and prostate cancers com-
bined,” says Clark Fuller, MD, a thoracic
surgeon at Providence Saint John’s Health
Center. “It also used to be a disease almost
entirely of men; that’s completely untrue
now. Women now exceed men in new cases
of lung cancer.”
While the death rate from lung cancer
among men has dropped 21% over the last
35 years, it’s jumped 116% among women,
reports the American Lung Association.
Stopping smoking—or not starting—
remains the single best thing you can do
to avoid developing this often devastating
cancer. (Secondhand smoke, though, can be
an important risk factor as well, particular-
ly if your parents smoked indoors when you
were young.)
However, “Smoking cessation doesn’t
make you immune,” notes Dr. Fuller. “The
latency period between stopping smoking
and the appearance of a first cancer is about
15 to 20 years.”
Like any kind of cancer, the earlier you
detect it, the better your odds of survival.
That’s the main reason that survival rates
remain so poor for this type of cancer. More
than half of people die within a year of
being diagnosed; we’re simply catching the
great majority of cases far too late.
“Most lung cancers are found in the late
stages—Stage III or Stage IV unfortunate-
ly,” says Ali Mahtabifard, MD, a thoracic
surgeon at the Health Center. “A lot of those
patients don’t even see a thoracic surgeon
like myself because it’s already too late.”
To make matters more complicated, says
Dr. Mahtabifard, most malignancies don’t
produce any obvious symptoms, so they’re
found by accident. “Someone may cough
or see a doctor for an unrelated reason,
and they get an X-ray and the doctor says,
‘We saw this on your X-ray.’ They may pick
up lesions on your lung that turn out to be
lung cancer.”
So if that’s the dark side of lung cancer,
the bright side is getting brighter all the
time. For starters, there’s now a significant-
ly better way to screen for this cancer.
“The lungs are a part of the body that’s
GAINING GROUND ON LUNG CANCER
Advances in both screening and surgery can mean much-improved odds for those with this devastating cancer.Written by LORIE A. PARCH
Gaining Ground on Lung Cancer
FALL 2014 breakthroughs 23
not easily examined, and a chest X-ray
gives a false sense of security,” because it’s
not very accurate at detecting lung cancer,
says Dr. Fuller. But the recent introduction
of low-dose CT screening, which allows
for multiple, highly detailed images of the
chest using minimal radiation, should help
improve doctors’ ability to find lung cancer
much sooner, when it’s far more curable.
“The results of recent studies show that
low-dose CT scans may reduce deaths due
to lung cancer by 20%” among current and
heavy former smokers, adds Dr. Fuller.
“This is probably going to represent our
main weapon in the arsenal to shift that
paradigm to earlier detection and thus
better outcomes.”
When lung cancer is caught at its earliest
stage (when it’s still just in the lungs), the
five-year survival rate is nearly 75%—a vast
improvement over the 4% survival rate
when the cancer is diagnosed at its most
advanced stage. Lung cancer surgery is
improving as well.
Traditionally, an operation required a
large incision called a thoracotomy that
meant cutting through muscle and spread-
ing the ribs, explains Dr. Fuller. “Then the
patient would spend six months recovering
from that. It’s a big deal; it’s the most pain-
ful incision we do in medicine.”
Quite a few patients would end up with
post-operative pneumonia, he adds, further
lengthening their recovery time. Now,
though, there’s a procedure called video-as-
sisted thoracic surgery (nicknamed VATS),
a minimally invasive surgery that has
numerous benefits for patients.
“We can now do the exact same operation
through three little incisions,” Dr. Fuller
says. “The hospital stay is cut down by
one-third, and recovery and return-to-work
times are greatly accelerated. So it has truly
changed the landscape.”
During a VATS procedure—currently per-
formed in only about one-third of hospitals
in the U.S., including the Health Center—a
thoracic surgeon uses a tiny camera to
obtain a better, more detailed, view of the
chest and lungs when removing the cancer.
“It’s like arthroscopic surgery, but it’s in
the chest. So if someone needs radiation or
chemotherapy after surgery, they also get
to that faster because they recover from the
operation faster,” adds Dr. Mahtabifard,
who is co-author of a leading medical text-
book on VATS.
Lung cancer surgery at the Health Center
can also be done with the help of robotics,
adds Dr. Fuller, who came to Saint John’s
in 2010 and has been doing robot-assisted
surgery for a couple of years.
“Surgical robots used to fill a room, and
now they’re much smaller and the visual-
ization, instrumentation and accessibility
have been dramatically improved,” he says.
“It’s becoming a useful adjunct to chest
surgery at Saint John’s as well, and as with
VATS, this surgery offers a shorter hospital-
ization, lower risk of complications and an
earlier return to full function.”
Such big improvements in surgery can
go a long way toward making a diagnosis of
lung cancer less overwhelming for patients.
“My experience is that it’s not so much
cancer that people are frightened of; it’s
what’s going to happen next,” Dr. Fuller
says. “When a hospital has a good lung
program, you can say, ‘This is what we’re
going to do, and this is the order that we’re
going to do it in.’ That takes a lot of the fear
out of it and people take encouragement
from that.”
Should You Be Screened for Lung Cancer?
Catching lung cancer early is the key to survival, and now there is a reliable way to do just that. In 2011 a landmark study called the National Lung Screening Trial was published, showing people at high risk for developing lung cancer who got low-dose CT had a 20% lower chance of dying from the disease than high-risk individuals who got chest X-rays.
According to December 2013 guidelines from the U.S. Preventive Services Task Force, you should be screened annually for lung cancer with a low-dose CT scan if: you’re between the ages of 55 and 80 and are a current smoker; have quit smoking in the past 15 years; or have a 30-pack-year smoking history. (Pack years are computed by multiplying the number of packs of cigarettes you smoked per day by the number of years you smoked. So if you smoked three packs per day for 10 years, that would equal 30 pack years.)
Right now Medicare and most insurance companies don’t cover screening, so you will likely have to pay out-of-pocket for the test. However, a decision on Medicare reimbursement is expected soon.
Low-dose CT scanning to screen for lung cancer is available at Providence Saint John’s Health Center. For more information call: 310-829-8000, option 2.
November is Lung Cancer Awareness Month. To find out more about screening, smoking cessation and other types of lung disease, go to the American Lung Association at lung.org.
The lungs are a part of the body that’s
not easily examined, and a chest X-ray gives a false sense of security.”
profiles in health
24 breakthroughs FALL 2014
K aren and Peter Register of Santa Monica
brought their two children, Emma and John,
into the world at Saint John’s Health Center.
Today, nearly two decades later, Karen and
Emma are right back where they started—but this time as
hospital volunteers.
“I knew immediately that Karen and Emma were spe-
cial,” says Grenda Pearlman, director of volunteer services
at the Health Center. “They are warm, genuine and friend-
ly. We are really blessed to have them here.”
A FAMILY VALUESeventeen years after Karen gave
birth to Emma, both return to the Health Center to serve others.
Written by ZOE SOPHOS
Photographed by LAUREN PRESSEY
Emma Register (right) and Karen Register
profiles in health
FALL 2014 breakthroughs 25
Inspired by Karen’s younger sister, who volunteered as a candy
striper in the 1970s, Emma attended a volunteer meeting at the
Health Center in September 2013, hoping to get involved. Even
though she had already fulfilled her high school’s volunteer
requirement, the 11th-grader was considering a career in health
care and enjoyed working with people. She thought the Health
Center might be a good fit.
Karen accompanied Emma to the meeting, but once she got to
the hospital and listened to Pearlman’s presentation, something
clicked. “It was like a lightbulb going off,” Karen says. “I had this
‘ah-ha’ moment, and I thought, ‘Wow, this sounds amazing.’ I
asked Grenda if she could put me down as a volunteer, too, and it
just snowballed from there.”
The mother-daughter duo soon after received their assign-
ments: Emma in the postpartum unit and Karen as a greeter at
the front desk. Even though they don’t work together directly,
they received training for each other’s roles so they can cover for
one another in a pinch.
“It’s something we can bond over,” says Emma. “I think it’s a nice
time to set apart where my mom can help me or I can help her.”
Karen agrees that there is something special about volun-
teering with her daughter. “A lot of folks are surprised that we
volunteer together. It’s rare to find a 17-year-old and her mom
doing that. It’s nice that Emma sort of puts up with me,” she says,
laughing. “The times that we do overlap, it’s really fun.”
Together, mother and daughter make a one-of-a-kind team,
but it’s their unique personalities that make them ideal volun-
teers. As the first person who patients and family members see
when they enter the Health Center, Karen plays a key role in
directing individuals to the proper place. She volunteers one
morning a week and sometimes works with up to 200 people
over the course of her four-hour shift.
“It’s very busy, which I love, and it’s all about helping people
figure out where they need to be and calming their nerves,” Karen
says. “You feel like you made a lot of people’s visits better just by
being there.”
Pearlman emphasizes the positive role Karen plays at the
Health Center’s Information Desk, a job she does with just the
right mix of kindness, patience and empathy. “Karen’s warm
smile and greeting are a treat for all who enter the Health Center.
She happily escorts visitors to their destinations and never hes-
itates to go above and beyond to meet the needs of people who
approach the Information Desk.”
Just like her mother, Emma also goes above and beyond as
a volunteer in the postpartum unit. Her responsibilities in-
clude passing out hats and booties, making name bracelets and
checking on new moms. The nurses who work with Emma are
most impressed by her ability to read people and quickly size up
any situation—skills that help keep the patients comfortable and
content, Pearlman notes.
“I’m learning how to approach people, and it’s definitely helped
my conversational skills,” Emma says. “I think the reason the moms
enjoy it here is the same reason I enjoy it: the all-around vibe that
you get from the people who work at the Health Center.”
For Karen and Emma, the Health Center and the people who
work there will always be an important part of their lives. “I feel
like I get so much more out of volunteering than the hospital
does for having me there,” Karen says. “It’s very rewarding.”
It’s something we can bond over.”
26 breakthroughs FALL 2014
When Aimee Bower’s feet started hurting during her recreational hikes in the fall of 1999, she didn’t take it too seriously–and neither did her primary care physician. She was diagnosed with metatarsalgia, a sports-related condition marked by inflammation in the balls of the feet.
Her doctor said the pain would go away with the help of foot soaks, well-padded shoes
and some Advil. But over the next few months the pain spread far beyond Bower’s feet, to
her knees, arms, elbows, shoulders, fingers and jaw.
“My symptoms were just getting worse and worse,” says Bower, 44, of Venice, who
works in data analysis. “Everything was hurting. I couldn’t turn the key in my car ignition.
I couldn’t walk upstairs. It hurt to lift my arms to wash my hair. It hurt just to roll over in
bed. It was very scary and extremely painful.”
Bower didn’t get any relief until the following spring when, due to the severity of her
symptoms, she finally was referred to Orrin M. Troum, MD, a rheumatologist at Providence
Saint John’s Health Center. He immediately began treating Bower for rheumatoid arthritis,
an autoimmune condition that attacks the joints and affects an estimated 1.5 million
Americans, mostly women.
The disease usually strikes between the ages of 40 and 60, but it can appear in people
of all ages, even children, according to the Arthritis Foundation. If not detected early,
rheumatoid arthritis can be an extremely painful and debilitating condition.
Without treatment, patients have a 50% chance of total disability within 10 years, says
Dr. Troum, who is a member of the Doctors of Saint John’s medical group. But through
early diagnosis and proper care with the range of effective tools and powerful treatments
available today, patients like Bower can maintain active, healthy lives with remarkably little
or no pain.
Overall, the prognosis for today’s patients getting the standard of care is excellent, Dr.
Troum says. “My goal as a doctor is to get all of my patients in remission or at the point of
The Big Hurt
Rheumatologists have answers for the aches of arthritis.
Written by DAWN HOFFMAN | Photgraphed by MICHAEL NEVEUX
FALL 2014 breakthroughs 27
The Big Hurt
28 breakthroughs FALL 2014
low disease activity.”
Much to her pleasure, Bower is now back
to hiking and more. “I can go play volleyball
on the beach for hours and go backpacking
too,” she says. “I’m as active as I’ve ever
been, with no pain or impairment.”
It’s critical for people who suspect a
joint problem to seek early treatment with
a rheumatologist. Many people make the
mistake of brushing off recurring aches,
pains and joint stiffness, especially those that
occur in the mornings, as mere annoyances
that simply will go away on their own.
“Recognize that it’s not just a little
stiffness or a little arthritis,” Dr. Troum
says. And make sure your doctor isn’t hastily
ruling out more serious issues either. “Don’t
let your symptoms be dismissed.”
The pain and suffering of rheumatoid
arthritis results when the immune system
goes haywire and starts attacking the
synovium, the thin membrane that lines
the joints. No one knows the cause of
rheumatoid arthritis, though doctors suspect
that genetics plays a role, as well as smoking
and poor dental hygiene.
When the joints are attacked, fluid can
build up and cause pain, inflammation
and swelling, progressively damaging the
cartilage and bone, decreasing mobility and
potentially causing joint deformities. In
some patients, symptoms may periodically
improve, with periods of mild disease
activity followed by “flares” of increased
disease activity and more symptoms.
Eventually, poorly controlled disease can
affect other areas besides joints, including
the heart, lungs and skin.
The ultimate goal with treatment is to
eliminate disease activity or reduce it to very
low levels. Thankfully, physicians now have
The Big Hurt
an arsenal of medications to help do just
that, including newer medications called
disease-modifying antirheumatic drugs, or
DMARDs, that inhibit inflammation and
work to alter the course of the disease and
prevent joint destruction.
For the last few years, Bower has been in
remission while on a treatment regimen of
methotrexate, a DMARD, and etanercept
(brand name Enbrel), a drug in a subset
of DMARDs called biologic response
modifiers, or biologics. Bower also takes fish
oil supplements for their purported anti-
inflammatory properties.
She couldn’t be happier with her
treatment results. “I feel fine, with no pain,
tenderness or any problems,” she says.
Like many patients, Bower initially used
nonsteroidal anti-inflammatory drugs
and the corticosteroid prednisone to help
control joint inflammation.
Over the years, she also found that Iyengar
yoga has helped. “It felt good, especially in
the beginning when I was really in a lot of
pain,” she says. “It just felt good to stretch
and do something healthy for myself.”
Along with the introduction of the powerful
disease-modifying medications for rheumatoid
arthritis, doctors today also are using newer
imaging technologies to better assess the
health of joints in order to specifically tailor
treatments to individual patients and monitor
their disease progression. In the past, doctors
have used X-rays to view joint damage.
But X-rays aren’t as good at revealing all of
the signs of rheumatoid arthritis—such as
inflammation and bone erosion—compared to
ultrasounds and MRI, and additionally expose
patients to a small amount of radiation, notes
Dr. Troum.
Dr. Troum, current president of The
International Society for Musculoskeletal
Imaging in Rheumatology (ISEMIR), is a
big advocate of the newer imaging scans for
rheumatoid arthritis treatment, especially
in the early stages. Ultrasound and MRI
imaging show how active the disease is in a
patient and how much damage has occurred,
FACTS ABOUT RHEUMATOID ARTHRITIS
Nearly 1.5 million Americans have RA.
The disease affects nearly three times as many
women as men.
RA usually develops between the
ages of 30 and 60 in women and later in life in men.
The severity of RA can vary widely among individuals.
There is no cure for RA, but there are many medications that help
ease symptoms.
Early diagnosis is important to prevent joint damage.
HOW RHEUMATOID ARTHRITIS ATTACKS JOINTS
FALL 2014 breakthroughs 29
Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases
(1) The ends of the bones in the joints are covered by a tough, elastic tissue called cartilage. A capsule surrounding each joint is lined with a type of tissue called synovium, which produces synovial fluid, a clear substance that lubricates and nourishes the cartilage and bones inside the joint capsule.
(2) Rheumatoid arthritis is an autoimmune disease which means the immune system, that normally helps protect the body from infection and disease, attacks joint tissues for unknown reasons. White blood cells travel to the synovium and cause inflammation. The synovium thickens and makes the joint swollen, painful and sometimes warm to the touch.
(3) As rheumatoid arthritis progresses, the inflamed synovium invades and destroys the cartilage and bone within the joint. The surrounding muscles, ligaments and tendons that support and stabilize the joint become weak and unable to work normally.
30 breakthroughs FALL 2014
says Dr. Troum, who has published review
articles on the subject. When doctors see
the extent of the disease, they can better
determine whether medications are working
and how aggressive to be with future
treatments, he says.
In a study published last year in the
Annals of the Rheumatic Diseases, for
instance, Dr. Troum and his colleagues
used MRI to gauge the effectiveness of the
biologic drug tocilizumab (Actemra). The
MRIs reliably revealed reductions in joint
inflammation and bone erosion that would
not have been seen on X-ray.
Unlike ultrasounds, MRIs can look
inside bone to reveal inflammation that can
lead to bony erosions. But MRIs also are
more expensive and may not be as readily
available to rheumatologists, Dr. Troum
notes. Both ultrasounds and MRIs can play
an important role in helping patients get
their disease under control and their lives on
track again. Patients should ask their doctors
about the need for imaging scans, he advises.
Looking back at her early struggles with
rheumatoid arthritis, Bower is very thankful
that she found the care she needed with Dr.
Troum at the Health Center.
“When I was first diagnosed, I was in pain
and scared and wondering, ‘What’s wrong
with me?’” Bower says. “I would go online
and get information, and I would end up in
tears reading about people being completely
debilitated. I feel so fortunate to have Dr.
Troum as my doctor. He’s provided such
good care and is so kind. I feel incredibly
lucky and grateful to have him as my
rheumatologist.”
Dr. Troum says top-notch care is the
standard for all patients at the Health
Center. That’s why in addition to being on
the medical staff since 1986, he’s a patient
there, too—with his own personal doctors
on staff.
“The patient care here is superior,” says
Dr. Troum. “It’s a very unique hospital.
The vast majority of the physicians have
been trained locally at USC or UCLA.
It’s an extremely high level of care for a
private hospital.”
Recognize that it’s not just a
little stiffness or a little arthritis,” Dr. Troum says. And make sure your doctor isn’t hastily ruling out more serious issues either. “Don’t let your symptoms be dismissed.”
Orrin M. Troum, MD
The Big Hurt
happenings
FALL 2014 breakthroughs 31
Providence Mission and Values Dedication CeremonyA ceremony to unveil and bless the core values and Mission of Providence Health & Services was held September 23 in the Tarble Atrium. Providence Health & Services assumed sponsorship of Saint John’s Health Center earlier this year, and the ceremony was conducted for the Health Center staff to formally accept and adhere to the Providence Mission and values.
New Chief Executive Marcel Loh participated in the dedication by singing “You’ll Never Walk Alone.” The day was part of Mission Week, which included a Living Our Values picnic for all caregivers and Health Center employees and a Table of the King day where soup and salad was provided free of charge to all Health Center staff and visitors.
happenings
32 breakthroughs FALL 2014
Front row, from left: Ryan Sevy, a cardiac arrest survivor; Peter Pelikan, MD; Russ Kino, MD; battalion chief Michael McElvaney; John M. Robertson, MD; Robert Klein; Sister Maureen Craig, SCL; Nicole Weinberg, MD; Irene Bristol, RN; battalion chief Jeffrey Furrows; Debbie Licht, RN; Jeff Arnett, a cardiac arrest survivor.
Dr. Russ Kino on Larry King NowRuss Kino, MD, director of emergency services, appeared on the Larry King Now show on October 11 to discuss how hospitals can prepare for patients possibly infected with the Ebola virus and the precautions and training he helped implement at Providence Saint John’s.
Your Heart and Stayin’ AliveThe Health Center hosted the Your Heart and Stayin’ Alive CPR training event September 7. The Santa Monica Fire Department, Bowers Ambulance and Health Center physicians and staff participated in the education and training of the 160 attendees in compression-only CPR.
John M. Robertson, MD, medical director of cardiothor-acic surgery, moderated the event and served as honorary chair. Heart health educational sessions were given by Providence Saint John’s cardiologists Nicole Weinberg, MD, and Shephal Doshi, MD. Chief Jeffrey Furrows of the Santa Monica Fire Department presented information about the need to call 911 immediately when a cardiac event is suspected and to begin CPR if the person is in cardiac arrest.
Survivors of cardiac arrest and family members celebrated life with remarkable accounts of heroic efforts and the power of prayer. Supported by Saint John’s Health Center Foundation, this program was planned for Grandparents Day to encourage the entire family to attend and learn compression-only CPR.
happenings
FALL 2014 breakthroughs 33
NICU ReunionAfter caring for an ill or premature baby for many days, weeks or months, it can be hard for caregivers and families to say good-bye to each other. The biannual Neonatal Intensive Care United (NICU) reunion allows doctors, nurses, parents and babies to become reacquainted. The NICU reunion was held on September 26 at the Health Center and featured a festive afternoon of music, crafts, food and clowns. Members of the Fancy Fleet Dance Studio performed, as did magician Mark Paskell.
Dr. Delphine Lee receives a check from the Avon Foundation to further innovative research on the influence of microbes on breast cancer development.
Dr. Lee with Cheryl Heinonen, senior vice president of corporate relations and chief communications officer for the Avon Foundation, and Kevin Honeycutt, executive director for marketing, Avon Foundation
Avon Walk for Breast CancerStaff members of the Health Center and the John Wayne Cancer Institute participated in the 12th annual Avon Walk for Breast Cancer on September 6–7 in Santa Barbara. A portion of the proceeds helps support innovative breast cancer research at the Institute.
At the closing ceremonies, Avon Walk leaders announced that Delphine Lee, MD, PhD, director of translational immunology at the Institute, will receive funding for a study to investigate microbial communities in the breast ducts of women. Microbes and chronic inflammation have been linked to some cancers, and Dr. Lee’s group has evidence of specific viruses or bacteria associated with breast cancer. In collaboration with Maggie DiNome, MD, and Susan Love, MD, Dr. Lee and her co-principal investigator Peter Sieling, PhD, will further investigate the association of microbes in the breast and breast cancer
shout outs
34 breakthroughs FALL 2014
“A most excellent
health care facility.
Quick triage and, at
most times, a short
wait to be seen
[in the Emergency
Department].”
The caregivers at Providence Saint John’s Health Center pays close attention to feedback from our patients and visitors. We are proud to share some of the wonderful comments we’ve received in the past few months.
“Riza, Martha and Gracia are super. El-sie and nurse Maki are amazing. Xiomara is awesome. Dr. Bilchik is great. Debora, Sara, Martha and Marisol are great. Deb-orah and Kim in ICU are great. Nurses Helen, Marvina and Melissa are angels. Jamica, Kevin and Maria are fabulous. Shawn and Beck are wonderful. Adrianna and Maria are excellent.”
I was in the hospital July 5th for a hysterectomy. I’d never had major
surgery, and it was my first time at Saint John’s. I must tell you, the nursing staff was superb. I’ve never seen such caring, wonderful people. I want to commend all of them. The pre-op nurse was kind and attentive
and answered all my questions. My gynecologist insisted on Saint
John’s, and now I know why. I would
choose Saint John’s any day.”
“I was here for bilateral hip replacement surgery last week. The hospital and staff were stellar! Thank you so much!”
By far the best hospital I’ve ever encountered. The entire
staff was nothing but awesome! Didn’t mind being here at all. Thank you!”
“Thank you, Dr. Faries, for being the best oncologist and surgeon. Thank you, Rob, for all your help and prompt return of calls even in the evening. You are all making this much more tolerable.”
“The Caritas nurses were fantastic. I cannot say
enough about Amelia, Lau-ra, Melissa and Trish—so on-
the-ball and truly caring. Guillermo was always so
very attentive. Please thank them from the bottom of
my heart. I have never felt as physically vulnerable
and emotionally broken as I did. I’m finally starting to
feel better.”
“I love Saint John’s. This is my third stay in 2.5 years—two hips and one spine surgery. It’s a great hospital with great care and a fabulous staff. I am coming back for my knees.”
2121 Santa Monica BoulevardSanta Monica, CA 90404 USA
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Saint John’s doctors pioneer advances in
cardiovascular care.
A family shares a
love of volunteering.p.24
p.16
Since its founding in 1942 by the Sisters of Charity of Leavenworth, Providence Saint John’s Health Center has been providing the patients and families of Santa Monica, West Los Angeles and ocean communities with breakthrough medicine and inspired healing. Saint John’s provides a spectrum of treatment and diagnostic services with distinguished areas of excellence in cancer, spine, orthopedics, neurosurgery, women’s health, cardiac and specialized programs such as the internationally acclaimed John Wayne Cancer Institute. Saint John’s is dedicated to bringing to the community the most innovative advances in medicine and technology.