For information: Marketing & Planning Department, Terrebonne General Medical Center, PO Box 6037, Houma, LA 70361-6037; call us at 1-888-543-TGMC; or visit us on the Web at www.tgmc.com.
Wellness News for Better Living from Terrebonne General Medical Center Winter 2005
A D V A N C E S I N L A P A R O S C O P I C
SurgeryABDOMINAL AORTIC ANEURYSMS
Laparoscopic Kidney RemovalB O O S T Y O U R I M M U N I T Y
Hyperbaric Oxygen Therapy
LIVING WITH DIABETES
A D V A N C E S I N L A P A R O S C O P I C
SurgeryABDOMINAL AORTIC ANEURYSMS
Laparoscopic Kidney RemovalB O O S T Y O U R I M M U N I T Y
Hyperbaric Oxygen Therapy
LIVING WITH DIABETES
I
1 Winter 2005
In the fall of 2004, Lauren beganexperiencing pains very uncommon fora 25-year-old. With continual pain anddiscomfort in her upper right side andnausea that just would not cease, shemade an appointment with her doctor.
Knowing her family history of gallbladder disease, her doctor ordered anultrasound thinking these symptomsmight be her gall bladder and possiblegallstones. Lauren’s ultrasound didn’tshow any stones, so he ordered a HIDA scan with an ejection fraction,which will show the percentage of gall bladder function.
“The HIDA scan showed that mygall bladder was only functioning at acertain percentage of what it shouldhave been functioning.”
As a result, her doctor scheduledher for a laparoscopic cholecystectomy,
or gall bladder removal. Her surgerytook place early in the morning andtook about an hour, from the time she was taken back into surgery untilthe time she came out of recovery.Lauren was discharged later that same afternoon.
Having never had inpatient or outpatient surgery prior to removal ofher gall bladder, she credited her fastrecovery to being in good physicalhealth, as well as having the proceduredone laparoscopically.
“I recuperated fast,” she said. “Mysurgery was performed on a Thursday,and I was back to work the followingFriday. I followed my doctor’s instruc-tions, and I think that helped with healing and getting back to normalmore quickly.”
The Evolution of Laparo
Laparoscopic surgery was not common among
general surgeons until the firstlaparoscopic cholecystectomy,or gall bladder removal. That
was the first procedure thatreally replaced conventional
open surgery.
2Terrebonne General Medical Center
scopic Surgery
T H E H I S T O R Y O FL A PA R O S C O P I CS U R G E R Y
In the late 70s and early 80s, a fewbrave gynecologists ventured beyond the confines of safety into a new world of performing surgical procedures without“opening” patients. As a result, gynecolo-gists claim original settlement of thepractice of laparoscopic surgery and werethe first to widely use the laparoscope, aspecial camera or scope inserted into theabdominal cavity, to perform surgery.Surgery performed with the aid of thesecameras is often referred to as minimally-invasive surgery.
In contrast to laparoscopic surgery,traditional, open surgery requires a longincision or cut down the center of theabdomen. Laparoscopic surgery elimi-nates the need for this large incision and uses smaller incisions for insertion of the scope.
According to Dr. Charles Ledoux, ageneral surgeon, “Laparoscopic surgeryreally started coming into its own in themid 80s and early 90s. OB/GYNs hadbeen doing it for some time before that,but it was not common among generalsurgeons until the first laparoscopiccholecystectomy, or gall bladder removal.That was the first procedure that reallyreplaced conventional open surgery. It isthe preferred method for gall bladderremoval and is still the most common.”
Laparoscopy, Ledoux explained, waspart of a medical trend in the late 1970s,that went along with other proceduresthat were replacing open surgery such aslithotripsy for kidney stones, a non-surgi-cal procedure using sound waves to breakup stones in the kidney.
Laparoscopic surgery has made itsway into a number of specialty surgeries.Urologists are now using laparoscopy inmany of their surgical procedures includ-ing the removal of a kidney, ureter, adrenal gland, prostate or lymph nodes.
Another area in which minimallyinvasive surgery is being used is in the
chest, and is referred to as video-assist-ed thoracic surgery (VATS). VATS isbeing used for both diagnostic and ther-apeutic interventions for a number ofchest problems that previously requiredlarge, open surgical incisions includinglung biopsies; lung-volume reduction forpulmonary emphysema; and surgery forlung cancer and coronary artery disease.
Other laparoscopic surgical applica-tions include the removal of the spleen,hernia repair, appendectomies and manyother surgeries including orthopedicprocedures. Dr. Eric Rau, a general surgeon, said, “Now, we can do almostanything laparoscopic that we can do inopen surgery.” Rau explained that colonresections are a common proceduredone laparoscopically to treat and stop a number of colon diseases such ascolon cancer, as well as alleviate painand discomfort.
“With colon resections, a patientusually has one area of the colon that isaffected. With traditional, open surgery,a large incision is required to gatherenough of the colon to resection the areabeing removed,” Rau said. “laparoscop-ic incisions are much smaller yet stillallow access to the whole abdomen to remove the portion of the colon that is diseased.”
T H E B E N E F I T S O FL A PA R O S C O P I CS U R G E R Y
The benefits of laparoscopic surgeryare numerous. Rau said the first ques-tion patients typically ask is, “Is itcheaper?” While the actual procedure isnot less expensive, recovery is less cost-ly in terms of a shorter hospital stay.
From a patient’s point of view, faster recovery means less time off from work or family activities. Patientsalso experience less post-operativepain and better cosmetic results due to smaller incisions.
“Long term, because you are more
3 Winter 2005
precise in the incision and are notexposing the whole abdomen, less trau-ma is inflicted on surrounding organs,”Rau said. “We also notice when we goback on patients who have had laparo-scopic colon resections, they have lessadhesions and scar tissue.”
Ledoux cautioned that not allpatients are candidates for laparoscopicsurgery. He explained that in caseswhere there is a history of scar tissue, a disease process or previous open surgery, laparoscopy may be prohibited.
“Laparoscopic is really finding itsway; however there are certain instancesthat may require open surgery asopposed to laparoscopy,” Ledoux saidexplaining that these vary with eachpatient, but can include being over-weight or having had a number of previous surgeries.
All of the surgeons at TGMC can perform laparoscopic surgery. Formore information or a list of physiciansaffiliated with Terrebonne General,please call 1-888-543-TGMC.
K. Gerald Haydel, Sr., M.D.; CharlesLedoux, M.D.; Felix Mathieu, M.D.; andVictor Tedesco, M.D. are general surgeonswith Haydel Surgical Clinic.
David Rau, M.D.; Eric Rau, M.D.; FrederickRau, M.D.; and Donald Schwab, Jr., M.D.are general surgeons with Bayou SurgicalSpecialists.
4Terrebonne General Medical Center
Abdominal aortic aneurysms (AAA) can take years to develop, andthere are no warning symptoms. However,if an aneurysm ruptures, not only cansymptoms be present, this represents amedical emergency that requires medicalattention as soon as possible.
The heart specialists at TerrebonneGeneral Medical Center have been at the forefront of treating abdominal aortic aneurysms before they rupture,using a minimally-invasive technologyknown as Endovascular AorticReconstruction (EVAR).
W H AT I S A N A A A A N D W H O I S AT R I S K ?
An abdominal aortic aneurysm (AAA)is an abnormal bulge in the abdominalaorta, and most are commonly seen in menbetween the ages of 40 and 70. “WhileAAAs are not hereditary, there is a trend for aneurysms to run in the family,”according to Dr. Tommy Fudge, a cardiovascular thoracic surgeon withCardiovascular Institute of the South. Dr. Peter Fail, a cardiologist and endovas-cular specialist with CardiovascularInstitute of the South, agrees, adding,“Aneurysms tend to affect the people who are at risk for heart related diseases:smokers, people with diabetes and people who are overweight.”
Most AAAs are diagnosed after apatient has a chest X-ray or a CT scan forsome other condition – the vast majority arediscovered by accident, said Dr. Fail. If theaneurysm expands rapidly, tears open orbegins leaking, symptoms may develop
quickly, including a pulsating sensation or “heartbeat” in the abdomen; abdominalpain; pain in the lower back, buttocks orlegs; rapid heart rate when rising from a sitting position; shock, clammy skin, nau-sea and anxiety.
T R E AT M E N TPrior to the 1990s, the only
viable treatment for an AAA wasmajor surgery, which involved makingan incision in the abdomen andreplacing the abnormal vessel with agraft made of synthetic material.
The specialists at CardiovascularInstitute of the South and TGMC werethe first in Louisiana to perform theminimally-invasive EndovascularAortic Reconstruction procedure on a non-investigational basis andhave been performing them regularly since 1999.
In the hour-long procedure, a cardiovascular surgeon makes smallincisions to provide the endovascularspecialist access to the arteries. Thespecialist then completes the proce-dure that is like “putting an innertube inside a tire that has a smallblister on it,” as Dr. Fail explained.“Once the procedure is complete, the
cardiovascular surgeon closes theincision, which takes between fiveand ten minutes,” said Dr. Fudge.
P R O G N O S I SThe prognosis for those who have
the procedure is good. “The only downside is increased surveillance,” saidDr. Fail. “We do a CT scan at onemonth to look at the device and seehow it’s doing and make sure there isno leak; then another at three to sixmonths; one at one year, and annuallyafter that.”
Most patients should be back towork within one to two weeks followingthe procedure and fully active within a month. Patients can resume as activea lifestyle as they enjoyed prior to the procedure.
Of course, the best way to enjoy along and healthy lifestyle is to practicepreventive maintenance: people whoexercise, maintain a healthy diet,watch their weight and who don’tsmoke reduce their chances of devel-oping an aneurysm.
If, however, you should experiencesevere abdominal pain or any othersymptoms of an AAA, seek medicalattention immediately.
For more information or a list ofphysicians affiliated with TerrebonneGeneral, please call 1-888-543-TGMC.
Peter Fail, M.D. is a cardiologist andendovascular specialist. Tommy Fudge,M.D. is a cardiovascular thoracic surgeon.They, along with 38 other physicians, areassociated with Cardiovascular Institute of the South.
M I N I M A L LY - I N V A S I V E T R E A T M E N T A V A I L A B L E F O R
Abdominal Aortic AneurysmsP H Y S I C I A N P E R S P E C T I V E
5 Winter 2005
TTerrebonne General Medical Center’s
(TGMC) Wound Care Clinic is home to
Southeast Louisiana’s only hyperbaric
oxygen (HBO) therapy units, which
includes two hyperbaric chambers staffed
by a Medical Director, a Certified
Hyperbaric Registered Nurse and a
Certified Hyperbaric Technician.
Some five million Americans develop
chronic wounds each year, due to the
result of diabetes, vascular disease, radia-
tion therapy and other conditions that
may inhibit the body’s ability to carry out
the normal healing process. In some
cases, these wounds take weeks, months,
even years to fully heal, dramatically
affecting the quality of life. Any wound
that takes more than three weeks to heal
is considered chronic.
The Wound Care Clinic at TGMC is
the most comprehensive center of its kind
in the region. The technology at the clinic
can accelerate the healing process,
reduce amputation rates and help patients
avoid hospitalization.
Among the many services offered by
TGMC’s Hyperbaric & Wound Care
Clinic is hyperbaric oxygen therapy
(HBO). While the air we normally breathe
is only 21 percent oxygen, HBO therapy
provides 100 percent pure oxygen
within a pressurized chamber. Breathing
pure oxygen increases the level of oxygen
in the blood stream, which promotes heal-
ing by stimulating new vascular growth.
This, in turn, facilitates the normal
wound healing process. It also helps
in the preservation of damaged tissues
by increasing oxygen delivery to
injured tissue.
“We use a simple, non-invasive
procedure called Transcutaneous
Oximetry Measurements (TCOMs) to
determine a wound’s healing potential and
to see if the patient is a candidate for
hyperbaric treatment,” said Connie Wiltz,
RN, CHRN, nurse coordinator for the
Hyperbaric Medicine Department. The
T G M C H Y P E R B A R I C & W O U N D C A R E C L I N I C O F F E R S
The Region’s Only Hyperbaric Oxygen Unit
6Terrebonne General Medical Center
procedure measures the oxygen levels in a
patient’s tissue on room air and with the
patient breathing 100 percent oxygen. “If
a patient responds well and has a good
regional perfusion index (RPI), it’s a good
indication that hyperbaric oxygen therapy
will help them.”
Results can be dramatic, she said.
“Right now, we’re seeing a patient who
has only had 10 treatments. We can
already see a significant improvement in
the wound.”
Approximately 25 percent of patients
treated at TGMC’s Wound Care Clinic
receive HBO therapy. While the majority
of chronic wounds treated are caused by
circulatory problems, HBO therapy has
also proven effective in treating wounds
resulting from trauma cases and tissue
damage caused by radiation. HBO thera-
py can also be used to treat carbon
monoxide poisoning, air or gas embolism,
decompression sickness (the bends), gas
gangrene and a host of other medical con-
ditions. Clinical trials are underway for
the use of hyperbaric medicine to treat
strokes, traumatic brain injuries, heart
attacks and cerebral palsy.
“Patients may have some anxiety the
first time they see the hyperbaric chamber,
but once they get in and have their first
treatment, that anxiety normally goes away.
Once inside the chamber, the patient can
watch TV, tapes or DVDs.” Treatments
vary in length, but the average treatment
lasts about an hour and a half. For typical
chronic wounds, treatment is provided
every day, Monday through Friday, and the
average patient receives approximately 30
treatments. “After their first treatment,
patients are much more relaxed, and once
they begin to see some improvement, they
are eager to continue their treatment,”
Wiltz said.
According to Hector A. Linares, M.D.,
medical director of the hyperbaric medi-
cine department, “If patients are properly
selected, it is very rewarding to see the
excellent results obtained. During the
recent emergency after the strike of
Hurricane Katrina, we had the opportunity
to help treat patients intoxicated by carbon
monoxide, due to the use of generators.
The patients recovered nicely after
single treatments with hyperbaric oxygen
in our chambers.”
If you are experiencing chronic
wounds caused by diabetes or other circu-
latory problems, ask your doctor if HBO
therapy is right for you. Your physician
can refer you to Terrebonne General’s
Hyperbaric & Wound Care Clinic. The
clinic’s Medical Director will assess your
case and discuss with your physician
before prescribing a course of treatment.
For more information or a list of
physicians affiliated with Terrebonne
General, please call 1-888-543-TGMC.
The wound care treatment offered byTGMC can accelerate the healingprocess, reduce amputation rates andhelp patients avoid hospitalization.
7 Winter 2005
P H Y S I C I A N P E R S P E C T I V E
L A T E S T L A P A R O S C O P I C
Kidney Removal ProcedureA V A I L A B L E A T T G M C
There’s good news for patients
diagnosed with renal or kidney cancer.
A new technique in laparoscopic
kidney removal results in a smaller inci-
sion, less pain, and a shorter recovery time
than traditional surgery. And studies have
shown that the prognosis is the same for
the minimally-invasive laparoscopic pro-
cedure as it is with the traditional surgery
for patients with renal cancer.
W H AT M A K E S T H I S P R O C E D U R ED I F F E R E N T ?
The traditional procedure for remov-
ing a kidney is called open radical
nephrectomy. This surgery requires a
large incision to be made just below the
ribs and stretching to the back. Recovery
time for the patient can be six weeks or
longer with traditional surgery.
Laparoscopic procedures make use
of scopes (much like a miniaturized TV
camera) and instruments inserted through
small incisions to perform a variety of
procedures. For physicians, the advan-
tages include better visualization of the
process through the scopes and video that
displays a magnified view of the area
inside the patient’s body.
T H E L AT E S T “ H A N D SO N ” T E C H N I Q U E :
The latest technique in laparoscopic
kidney removal is the “hand-assisted
procedure.” This new technique offers
the advantages of two surgical tech-
niques – the smaller incisions and
shorter recovery times of laparoscopic
surgery and the ability for the surgeon
to use his hand in a more traditional
surgical manner.
“Being able to use the hand gives
the surgeon more tactile information,”
said Dr. Stephen Charbonnet, who has
been performing the hand-assisted
laparoscopic technique for about two
years. “It speeds up the procedure,
which means less time under anesthesia
for the patient.”
Dr. Haden Lafaye, who has per-
formed traditional, pure laparoscopic and
hand-assisted laparoscopic procedures,
noted that patient recovery is the biggest
advantage to the latest technique.
“Patient recovery time is exponentially
faster than open surgery,” Dr. Lafaye said.
Dr. Robert Alexander pointed out that
because the hand-assisted laparoscopic
procedure makes use of a smaller
incision, “There is not the abdominal
weakness associated with open surgery.
Recuperation is not only speeded up,
patients are stronger and have less pain.”
The hospital stay typically is shorter, too,
normally a period of about four days.
W H O I S A C A N D I D AT E F O RT H I S P R O C E D U R E ?
Kidney removal is most typically
used for patients with renal cell carcino-
ma or kidney cancer, according to Dr.
Charbonnet. Patients who have small
primary kidney tumors are good candi-
dates. If the tumor is larger than five
centimeters, open surgery may be a better
option, said Dr. Lafaye. According to
Dr. Alexander, renal cancer typically has
no symptoms. “Most kidney cancer is
discovered incidentally by a CT scan for
something else,” he said. “If a person
notices blood in his or her urine, they
should contact their doctor immediately.”
The prognosis for the removal of a
single kidney is good, as long as the
cancer has not spread beyond the kidney.
For more information or a list of
physicians affiliated with Terrebonne
General, please call 1-888-543-TGMC.
Robert Alexander, M.D.; Stephen
Charbonnet, M.D.; Frank Graffagnino,
M.D.; and Haden Lafaye, M.D. are
urologists with Houma Surgi-Center.
R E S T U P.Your body and your immune systemrebuild while your body is resting. A lackof sleep lowers the body’s immune func-tion and disease resistance. Researchershave found that lack of sleep can reducethe effectiveness of your immune systemby up to 50 percent!
R E D U C E Y O U RS T R E S S .Stress causes a number of physiologicalresponses that can result in fatigue, colds,flu and even cardiovascular disorders.When the body is busy fighting stress-induced problems, the immune system isweakened, and therefore more susceptibleto illness.
L A U G H !Laughter really is good medicine.Laughing reduces stress hormones likeadrenaline and cortisol. Laughter also ben-efits your immune system by increasingthe number and activity of T-cells. Theseare the natural “killer” cells that attackbacteria and viruses in the body.
E AT Y O G U R T.Yogurt actually contains living bacteria. Acommon misconception is that all bacteriais bad – it’s not! The good bacteria that isfound in yogurt stimulates the body’simmune system, reduces inflammation andhelps fight bad bacteria.
E AT W E L L .Foods rich in antioxidants, like vitamins A,C, E and lycopene, can help the body fightagainst certain damaging molecules thatcause heart disease, cancer and prematureaging. Scientists have also found that vita-min C can help ward off colds by makingT-cells more active.
E X E R C I S E .When you exercise, you stimulate andstrengthen your heart rate, muscles andeven your immune system. Exercise alsostimulates the release of endorphins,which lowers cholesterol, blood pressure,cortisol and stress hormones.
WA S H U P.The most effective measure in preventingthe spread of bacteria and viruses thatcause infections is good hand hygiene.Wash your hands with soap and wateroften, and especially before you eat, toreduce the spread of germs and bacteria.
8Terrebonne General Medical Center
BoostYour Immunity
As winterapproaches, so dosniffles, sneezes,germs, colds,sinus infectionsand the flu. Inaddition to gettinga flu shot, thereare several simplesteps you cantake to boost yourimmune systemfor the winter season.
9 Winter 2005
If you believe you are at risk for dia-betes, the American Diabetes Association(ADA) recommends a fasting blood glucosetest be performed by your primary healthcare provider. According to the ADA, thefasting blood glucose test is an easy, fast and inexpensive way to diagnose pre-diabetes or diabetes.
“For individuals already diagnosed withdiabetes, the Diabetes Management Centerat Terrebonne General Medical Center pro-vides a complete education and trainingexperience based on the needs of the patientand family,” said Dr. Samir Kailani, medicaldirector of the center and an endocrinologyand internal medicine specialist.
Some of the services provided by theDiabetes Management Center include:
• Blood Glucose Monitoring• Meal Planning• Exercise Recommendations• Help in Understanding Medical
Complications• Medication and Insulin Injection• Foot and Skin Care• Coping Skills• Support GroupsAnd more….The Diabetes Self-Management
Education Program at TGMC has been recognized by the American Diabetes Association for Quality Self-Management Education.*
For more information about theDiabetes Management Center at TGMC, call 1-888-543-TGMC, or log on towww.tgmc.com.
Living with DiabetesT G M C C A N H E L P.
Diabetes is a leading cause of deathand disability in the United States,affecting 20.8 million Americans, or7% of the population.
*The American Diabetes Association recognizes this education service as meeting the National Standards for Diabetes Self-Management Education.
Unfortunately, nearly one-third of theseindividuals are unaware that they evenhave the disease.
While the true cause of diabetes is still not fully known, genetics and environmental factors such as obesity and lack of exercise play important roles.Early detection of diabetes symptoms and early treatment can greatly decreasethe onset of complications caused by the disease.
CalendarB R I G H TB E G I N N I N G S
MOMMY & MEMonthlyA group designed to offer mother-to-mother support in a fun and positive environment.Bring babies!
ESP[ Especially for Special Parents ]Monthly Parenting series for parents of chil-dren ages 5-17 years of age in asso-ciation with Steps to Success.
INFANT MASSAGEQuarterlyA class that promotes parent/infantbonding and the importance oftouch in a child’s development. Learnhow massage can reduce stress, colicand help induce sleep in babies.
PARENTING TIPS FOR DADSJanuary/Quarterly Class A great program just for dads whowant to gain more knowledge in
the responsibilities and demands of parenting.
BREASTFEEDING CLASSMonthlyClass that provides information on breast changes during pregnancy,breastfeeding following delivery,nursing at home, potential prob-lems that may develop while nursing, proper techniques and the importance of a good healthydiet while nursing.
H E A LT H & W E L L N E S S
DIABETES SCREENINGMonthly – By appointmentScreening includes checks for bloodpressure and irregular heartbeat;tests for cholesterol and glucose;and references for those who testhigh. Cost: $10 per person.Must be over 18.
KIDNEY OPTIONSMonthlyAn educational class for personsfacing dialysis or possible transplant.
SHIPPMonthlyFREE health insurance informationfor Medicare recipients.
S U P P O R T G R O U P S
RESOLVE THROUGH SHARINGQuarterlyFor families who have lost a childbefore or immediately after birth.
BOSOM BUDDIESMonthlyA support group for breast cancer survivors.
LOOK GOOD, FEEL BETTEREvery other monthMakeovers for cancer patients by a licensed cosmetologist.
CHADDMonthlyA support group for families of children & adults with AttentionDeficit Disorder.
DIABETES SUPPORT GROUPQuarterlyClass that provides support/helpwith daily coping skills and educa-tional information for diabeticpatients and their families.
ALZHEIMERS CAREGIVERS SUPPORT GROUPMonthlyEducational support group for caregivers.
MULTIPLE SCLEROSISSUPPORT GROUPMonthlyInformation and resource group forMS patients. This support groupalso teaches coping skills relating tothe symptoms of MS.
December
J A N U A R Y
FEBRUARY
10Terrebonne General Medical Center
For information on class times and/or dates, please call The OutReach Center at 985-876-7577.
