CAMC Today is a publication of CAMC Health System

Inside this issue

Milestone reached for cancer centerJan. 10, 2012

Thanks to the generosity of employees, physicians, board members and others, the effort to raise money to build the new CAMC cancer center recently reached $10 million. That includes about $560,000 from CAMC employees to kick start the campaign.

“Employees from every department and every employment level have contributed,” said Gail Pitchford, CAMC Foundation president. “It is gratifying and humbling at the same time.”

The healing garden inside the new center will be named in honor of all CAMC employees as a tribute to their fundraising efforts.

The campaign’s theme, “The Power of Many,” represents the many needs of the community, the many patients being treated for cancer and the many donors needed to make this dream a reality.

Recognizing the need for many donors is part of what motivated Ed and Susan Maier to create a matching gift in September. Their $2 million in matching funds encouraged other donors to give $2 million in the last three months.

Susan Burgess needed a way to get back her life, so on Dec. 20, 2004, she had gastric bypass surgery.

“At the time of my surgery, my daughter was six years old,” Burgess said. “As she was growing up, learning to crawl and playing on the floor, I could not get down and do those things with her because of my weight.”

In addition to time with her daughter, Burgess felt like she was missing out on many things, including playing softball and volleyball.

“With the weight that I had put on over the years, I began to have problems with my knees and breathing, therefore making playing these sports nearly impossible and sometimes embarrassing,” she said.

This project will allow CAMC to build on a long tradition of quality cancer care in Charleston.

For more than 60 years, cancer services in Charleston have been accredited by the American College of Surgeons. Before the creation of Charleston Area Medical Center, care was provided at Charleston Memorial Hospital.

CAMC’s cancer program has been accredited by the American College of Surgeons’ Commission on Cancer program since 1980.

This tradition of quality cancer care lives on today at the David Lee Cancer Center (DLCC) on the CAMC Memorial Hospital campus. But there’s a problem: the number of patients continue to grow faster than available space.

If current trends continue, the DLCC expects to treat about 34,000 patients in 2017, nearly double the number it saw in 2004.

There is a need in southern West Virginia for comprehensive outpatient cancer care based on an increase in cancer, both regionally and across the United States.

“It wasn’t about being a certain size; it was about being an example for my daughter. I wanted her to have a positive example in me so that she would not grow up and have similar issues to deal with.”

There are many people in the area who share these feelings with Burgess. The CAMC Weight Loss Center offers both surgical and medical weight loss options to help them get back their lives.

“We offer two programs,” said Vanessa Bibbee, RN, MSN, FNP-BC. “We have a medical weight loss program where patients are seen by a nurse practitioner, registered dietician and exercise physiologist on at least a monthly basis. We also offer a bariatric surgical program. Doctors Robert Shin and Sam Rossi perform several surgeries,

including the Laparoscopic Roux-en-Y Gastric Bypass, Laparoscopic Adjustable Gastric Banding and Laparoscopic Sleeve Gastrectomy procedures.”

The Weight Loss Center recently expanded to a new facility at Northgate Business Park, which ensures patients’ needs are being met at a higher standard.

“Not only are we better able to take care of our patients in this larger space, we also offer free parking, larger exam rooms that are bariatric equipped, a large waiting room with bariatric appropriate chairs and a spacious exercise facility on-site that offers free weights, weight machines and cardiovascular machines,” Bibbee said. “Everything needed to improve flexibility, develop strength, tone muscles and improve overall health and wellness is there.”

Although currently only being seen for routine checkups by Dr. Shin, Burgess is impressed with the new location.

“I think the new facility is first class,” she said. “The equipment is superb and everything is very clean with an open, airy feeling.”

The new facility makes patients more comfortable, but a new location alone cannot change lives. Individuals seeking weight loss options need to be serious about their decision. Burgess offers the following advice.

“Be sure you are ready to make a change in your life,” she said. “Weight loss surgery is not a quick fix for obesity. It is a tool to help you lose weight, but it is up to you to keep it off. You have to be ready to make healthy choices, and you have to want to do it for you and no one else. “

This is sound advice from a weight loss veteran who lost the weight and has kept it off for seven years.

“I would do it again in a heartbeat,” Burgess said. “I tried all kinds of diets, diet drugs and exercise programs, and everything worked for a short time. I would lose a little bit of weight and then I would gain it all back, plus some more. After losing 142 pounds I feel great! It wasn’t easy, but it was so worth it in the end.”

For more information about the life-changing programs at the CAMC Weight Loss Center, call (304) 388-4965 or visit camc.org/weightloss.

Even with recent renovations, the David Lee Cancer Center has major space constraints.

Administrators believe this comprehensive, consolidated and freestanding outpatient cancer center will bring hospitals, physicians, allied health professionals and communities together to provide quality, convenient care.

The estimated cost is more than $39 million. It will be built on the old Watt Powell Park property, a vacant lot across the street from CAMC Memorial Hospital. The building will be three floors and will include street level parking (no garage). The exact floor plans are not complete.

“CAMC has the busiest cancer center in West Virginia – we have more new patients each year and more research protocols than any other hospital in the state,” said CAMC President and CEO David Ramsey. “We expect oncology patient volume at CAMC to grow significantly in the years ahead, largely due to our state’s aging population and concentration of Baby Boomers.”

To meet the soaring patient need, two new oncologists joined the DLCC in 2010 with an additional oncologist scheduled to arrive in 2013. However, there is no additional office space or patient treatment space in the current facility to accommodate the new physicians. Right now demand is outpacing capacity.

“The new center will move most ambulatory cancer patients off-site, creating significantly more capacity for other services on the Memorial campus,” said Jeff Goode, vice president, CAMC Ambulatory Services. “We will have the ability to provide regular multidisciplinary clinics in one location to streamline both diagnosis and treatment.”

Many cancer and cancer-related services will be more effectively and efficiently served by the new center, including: radiation oncology, medical oncology, oncological surgery office space, clinical trials and an infusion center.

Continued on page 3

Local woman gains back life after weight loss surgery

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It’s extremely important for patients to keep a current list of medications that they are taking…Page 2

CAMC Women and Children’s Hospital will have private post-partum rooms this year, among many other improvements…Page 3

THe CuTTing edgeAn Elkins woman with a painful TMJ disorder got relief from a specialized surgery at CAMC…Page 4

The Dean Ornish Spectrum program is helping participants feel better, live longer, lose weight and gain health…Page 4

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The History of CAMC

“Instead of having an admission list, an inpatient list and a list of medications to continue at home, the home medication list will now be able to be modified. Physicians will be working from one list instead of three that need to be reconciled before the patient leaves,” Wright said.

Upon discharge, patients will have a simplified, legible home medication list.

“It seems like a simple process, but it can actually be very difficult if you don’t start with good information. If a patient doesn’t bring their medication bottles with them or doesn’t keep a list, it can be difficult to sort things out. We can’t know what medications a patient is taking just by seeing that person,” Wright said.

The more information a patient brings to the hospital, the better. “Keep an updated medication list in your wallet, or bring your medications in their original bottles in a bag to the hospital,” Wright said.

19761977

Recognizing symptoms early important for treating COPD

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Published by CAMC Marketing & Public AffairsElizabeth Pellegrin Editor

Dale Witte Jessica Duffield Editors/Writers

Tony Campbell Graphic Designer

Julia Noland Leslie CarpenterAshley ShowenWriters

“We’re all just one piece of a big puzzle in health care,” Hollosi said.

When asked about sleep, both Nazeef and Hollosi said that residents just have to be more creative about finding time to sleep, whether it be planning ahead for personal needs like grocery shopping and laundry, or being able to adjust to a variety of different shifts and taking the opportunity to sleep whenever possible.

Regardless of the specialty they choose, all medical residents share common experiences. They all depend on each other and the rest of their health care teams to provide the best care possible to each patient.

“No matter how busy you are, when you’re in front of the patient, it’s all about them,” Hollosi said.

The residents are encouraged to build interdepartmental camaraderie, and have been known to play department vs. department kickball games.

CAMC currently has 158 medical residents, not including interns or fellows. After completing residencies, doctors can go on to fellowship programs, join a medical staff as an attending physician, open a private practice or pursue countless other opportunities.

But the hard work doesn’t seem to bother Nazeef. She chose medicine because she wanted to do something intellectually challenging that would be significant to others.

“In medicine, there’s just no end to learning,” Nazeef said.

A medical resident is a physician who has graduated from medical school and is pursuing training in a specialty. Most residencies are either four or five years long.

Dealing with sickness and even death on a regular basis, the emotional tax on a medical resident is tough.

“You have to realize that at that moment, you are the most important person to them. They’re nervous and anxious. If I get emotional, I know I wouldn’t be able to perform as well,” Nazeef said. “It’s for your own stability—you couldn’t survive this environment otherwise.”

Nazeef said it helps having other residents around that are all going through the same thing.

Things are a little different for Steve Hollosi, DO, a fourth-year emergency medicine and chief resident. Depending on the week, his shift might be 7 p.m. to 7 a.m., 7 a.m. to 7 p.m., or pretty much anything in between. Not only does he see patients nonstop during his shifts—he is responsible for making the schedule for all 16 residents in the emergency medicine program.

Hollosi rotates between the emergency rooms at CAMC Women and Children’s, General and Memorial hospitals. He sees a variety of patients every day, and said it can be anything from the flu to a heart attack to an automobile accident.

“You see a good mix,” Hollosi said.

While he never knows what to expect in the ER and the stress level that comes with that can be high, Hollosi said the diversity of patient conditions helps keep his skills sharp.

“In emergency medicine, you have to know a little bit about a lot of things,” he said. “What burns you out is getting too comfortable with the day-to-day tasks. That doesn’t happen in the ER.”

The emergency medicine residents rotate through many different areas of the health system, giving them a very well-rounded perspective of all the departments and specialties.

Moniba Nazeef, MD, is at work before most people’s alarms go off.

As a second-year internal medicine resident, she must evaluate all her patients and take care of any issues before the daily 8 a.m. lecture or morning report meeting. Shortly after 9 a.m., the residents, attending physicians and sometimes medical students start rounding, going to each patient room and discussing the prognosis and changes in each patient—a process that can take three or four hours.

After rounds, the team gathers to discuss treatments for patients, and then spends another hour or two tying up loose ends and making sure patients are stable.

Then, if Nazeef isn’t on call, she can go home for the night.

Internal medicine residents are generally on call every four days, and then have two 30 hour calls each month. Once a month, they get what they call the “golden weekend”—Friday through Sunday off.

For most people, being out of breath after physical activity is a sign that the body’s been working hard. It’s temporary, and you know that you’ll be back to normal soon. However, people with pulmonary diseases feel this way constantly. They can’t seem to catch their breath, even after the simplest tasks of daily living.

Chronic obstructive pulmonary disease (COPD) is a condition that affects the lungs, making it harder to breathe as the disease progresses. COPD includes chronic bronchitis, which means the airway passages are irritated, narrowed and contain excessive mucus; and emphysema, which happens when the air sacs in the lungs are destroyed.

“COPD was projected to become the third leading cause of death in the U.S. in 2020, but it reached that mark much earlier, in 2010,” said Chuck Menders, director of respiratory care at CAMC. “It has been the third leading cause in West Virginia since 2000. Our state ranks number one or two in the prevalence, hospitalizations and mortality of COPD. This is no surprise, because we have a high percentage of smokers, a high median age population and four of the top 25 most air-particle polluted counties in the country.”

Smoking is by far the leading cause of COPD, accounting for 80 to 90 percent of all cases. Other risk factors include age, exposure to fumes, vapors and irritants in the workplace, outdoor pollution, genetics and gender, though the disease is becoming increasingly more prevalent in women.

“COPD develops slowly – it can take 30 years or longer for people to have symptoms that are recognizable as symptoms of COPD. Many people are not diagnosed until they’ve already lost half of their lung function,” Menders said.

Symptoms of COPD include: • Shortnessofbreath • Tightnessinthechest • Wheezing • Coughing,withorwithout mucus production

“It’s very important for people to be able to recognize COPD symptoms early, because while it’s treatable, COPD is not curable,” Menders said. “Medications can control

symptoms and slow the progression of the disease, but they can’t replace lung function that’s been lost. The most important step in both preventing and slowing the progression of COPD is to quit smoking.”

Pulmonary rehabilitation can help people suffering from COPD to improve their quality of life through education, exercise and lifestyle changes. The goal of pulmonary rehabilitation is to return the patient to his or her maximum potential, while reducing the incidence of life-threatening respiratory occurrences.

“COPD kills more people each year than breast cancer and diabetes combined,” Menders said. “It’s now estimated that of the 24 million people in our country who have COPD, half of them are undiagnosed. That’s why it’s so important to know if you’re at risk, to know the symptoms and to get help as soon as possible. The sooner someone with COPD gets treatment for their disease, the greater their quality of life will be.”

For more information about pulmonary rehabilitation programs at CAMC, visit camc.org.

A day in the life of a medical resident

Medication reconciliation: Priority is patient safetyDo you know the names, doses and the number of times per day that you are supposed to take your medications? If you were admitted to the hospital, would you be able to remember this information to tell nurses and doctors? Does someone in your family have access to this information in case you’re unable to tell it yourself?

Knowing all about your medications is extremely important in the case of a hospitalization. Nurses and doctors need as much information as possible so they can order the correct medications while a patient is in the hospital, and know what should be continued or discontinued upon discharge.

CAMC will start a new process for medication reconciliation in February. Medication reconciliation is the process of comparing a patient’s home medications with medications ordered while in the hospital to avoid medication errors. The process is conducted when the patient is admitted, at any change in level of care (from an ICU to a step-down unit, for example) and when the patient is discharged. Patients leave the hospital with a list of all the medications that they should be taking.

“Medication reconciliation is a key process to ensure medication safety and is vital to continuity of care,” said Glen Wright, MD, clinical director for medical informatics at CAMC. “We are working to improve the process for gathering home medications and replacing the current method of home medication collection with one to reduce errors.”

With the new system, clinicians will have access to a database when creating the home medication list that includes information from pharmacies about what medications the patient has filled in the past three to four months. Medications can also be chosen from a list instead of typed in, which will reduce spelling errors and confusion.

January 1, 1972: Charleston General Hospital and Charleston Memorial Hospital merged to become Charleston Area Medical Center. These hospitals had a history dating back to the 1890s.

Later that year, CAMC and WVU formed an affiliation for WVU-Charleston Division on the campus of CAMC Memorial Hospital.

1976: The CAMC Foundation was established.

1977: The WVU building was dedicated, adjacent to CAMC Memorial Hospital.

This year, CAMC is celebrating its 40th anniversary. Here’s a look back at some of the important dates in CAMC’s history.

If you have any memories you’d like to share, we’d love to hear them. Submit them on our Facebook page at facebook.com/camchealthsystem, or mail to Marketing and Public Affairs, PO Box 1547, Charleston, WV 25326.

Moniba Nazeef, MD

Steve Hollosi, DO

Know your medications:

Medication name

Reason for use

Form (pill, liquid, etc.)

Dose

How often it is taken

Use (regular or occasional)

For a printable personal medication record, visit camc.org and click on “For Patients.”

1972The History of CAMC Timeline

19841986

19882006

F = FACE: Ask the person to smile. Does one side of the face droop?

A = ARMS: Ask the person to raise both arms. Does one arm drift downward?

S = SPEECH: Ask the person to repeat a simple phrase. Is their speech slurred or strange?

T = TIME: If you observe any of these signs, call 9-1-1 immediately.

camc.org 3

You’re talking with your spouse over dinner and unexpectedly, he becomes confused, dizzy and weak on one side of his body. As you try to figure out what’s going on, the clock is ticking…he’s having a stroke.

You are alarmed by the sudden, bizarre symptoms and call 9-1-1. Emergency medical technicians (EMTs) quickly arrive. What comes next is critical to your loved one’s survival and recovery – how quickly and accurately EMTs recognize the signs of stroke and relay that information to the appropriate hospital.

“There’s no time to lose when it comes to stroke because the longer blood flow is cut off to the brain, the greater the damage,” said Deb Rectenwald, RN, CAMC’s stroke program coordinator.

Because time lost is brain lost, CAMC offers an Advanced Stroke Life Support (ASLS) class to teach first responders, like EMTs and emergency room nurses, how to recognize the early signs of stroke and what to do in the crucial moments that follow.

“We need to know more than just ‘they’re having a stroke’ – we need to know where the stroke is occurring,” said Bridget Perry, RN, ASLS instructor. “We have focused our attention on EMS with the education. Our goal is to get EMTs oriented so they can detect strokes in the field and get them to the appropriate treatment center. There have also been a few nurses to complete the course at this time. Nurses know how to examine a patient for improvements or worsening – it’s just a different exam.”

The ASLS class was developed by experts in stroke, emergency medicine and pre-hospital care as part of a statewide effort to increase stroke awareness among emergency responders. Sponsored in partnership with the West Virginia Cardiovascular Health Program, the hands-on, eight-hour training teaches clinical assessment skills to recognize and provide emergency management of common stroke syndromes.

“We teach participants the different symptoms of a left brain stroke compared to a right brain stroke, how to distinguish between symptoms that mimic stroke and those that actually are stroke, the differences

between types of hemorrhages and the criteria for determining when patients may be eligible for the clot-busting drug, tPA,” Rectenwald said. “We also stress the importance of finding out how long it’s been since the patient last appeared to be ‘normal,’ which is critical in determining the appropriate course of treatment.”

Daniel Keeling, an EMT from Griffithsville, W.Va., completed the ASLS course in September 2011.

“Now I have a better understanding of what I’m dealing with – where a stroke is, what type it is and whether to rule in or rule out a stroke, which is information that I convey to the hospital,” Keeling said. “Communication is the key to EMS and the hospitals working together. Ultimately it improves the patient’s outcome.”

The window of opportunity to start treating stroke patients is three hours from when symptoms first begin. Early treatment may result in a reduction of the risk of disability.

“It’s especially important for outlying EMS agencies to have this training because of the increased amount of time involved when transporting a patient because sometimes you’re looking at an hour just to get to the

hospital,” Keeling said. “By knowing exactly how to treat the patient and relaying that information to the medical command communicator and ultimately to the emergency room physician and nurses, they know what’s going on.”

As the clock continues to tick, getting stroke patients to the right hospital plays a significant role in their treatment and recovery.

“Research has shown that stroke patients have better outcomes when treated at a stroke center,” Rectenwald said. “CAMC’s Stroke Center is nationally certified as a Primary Stroke Center by the Joint Commission, which means CAMC is one of the best-equipped treatment centers for people suffering a stroke. Every facet of our program, from prevention, emergency care, inpatient treatment and rehabilitation, measures up to very high standards for health care safety and quality of care set by medical experts.”

CAMC implemented the ASLS course in 2010 and has trained more than 50 first responders and other medical personnel to date, including EMTs from Kanawha, Lincoln, Cabell, Putnam and Monroe counties. The hospital offers six classes throughout the year.

For more information about CAMC’s ASLS training course, call (304) 388-3776.

CAMC trains EMTs to recognize stroke symptoms early and fast

NOTE THE TIME WHEN ANY SYMPTOMS FIRST APPEAR. If given within three hours of the first symptom, there is an FDA-approved clot-buster medication that may reduce long-term disability for the most common type of stroke. There are also two other types of stroke treatment available that might help reduce the effects of stroke.

Source: National Stroke Association

STROKE SYMPTOMS INCLUDE:

SUDDEN numbness or weakness of face,

arm or leg – especially on one side of the body.

SUDDEN confusion, trouble speaking

or understanding.

SUDDEN trouble seeing in one or both eyes.

SUDDEN trouble walking, dizziness,

loss of balance or coordination.

SUDDEN severe headache with no known cause.

Call 9-1-1immediately if you have any of these symptoms.

Source: National Stroke Association

Daniel Keeling, emergency medical technician from Lincoln County, W.Va., performs a stroke assessment on mock patient, Deb Rectenwald, CAMC’s stroke program coordinator. Bridget Perry, ASLS instructor, observes in the background. ASLS participants complete a series of hands-on demonstrations to learn the difference between actual stroke symptoms and those that mimic stroke.

STROKE WARNING SIGNSAct fast and call 9-1-1 immediately at any sign of stroke. Use FAST to remember the warning signs:

CAMC Women and Children’s Hospital provides care from birth through adulthood and is working on several projects to ensure that this care is the safest and most comfortable possible. Recently, renovations began to create private post-partum rooms.

“We are excited that, by summer, we will offer all private rooms for post-partum care with updated finishes and fixtures, as well as private bathrooms,” said Andrew Weber, vice president and administrator. “We also will have a new fetal monitoring system and an upgraded infant security system. Our focus is to provide a birthing experience that is state-of-the-art in both comfort and clinical care.”

These new rooms, along with the highest-level NICU available, give mothers the comfort of privacy with the security of specialty care for their infants.

As newborns grow, there are many services available to them at Women and Children’s Hospital.

In early 2012, the current eight-slice CT scanner will be replaced with a new 128-slice machine. This scanner is faster with more accurate views and is also equipped with I-dose technology.

“I-dose administers the lowest possible dose of radiation available,” Weber said. “We feel that it is absolutely critical in being a pediatric hospital that we’ve minimized the exposure of radiation to our patients.”

The new CT scanner has an ambient package which creates a friendly atmosphere for both kids and adults. The room is specially-

1984: The CAMC Health System was created as the non-profit parent company of Charleston Area Medical Center.

1986: CAMC merged with Kanawha Valley Hospital.

1988: Kanawha Valley Hospital was renamed CAMC Women and Children’s Hospital.

2006: CAMC Health System bought the former Putnam General Hospital, now Teays Valley Hospital.

designed with curved walls, cabinets tucked out of the way and workspace carefully laid out to eliminate clutter and reduce stress. The wall is used to project images, providing a movie theatre-like experience without glasses or headphones needed.

“This package offers many enhancements to the care experience. For example, it teaches patients about the critical aspects of getting a CT scan like holding their breath and remaining still at certain times,” Weber said. “It may tell them to act like a blowfish, inhale and hold their breath as an animated blowfish is projected on the wall providing an illustration.”

Just like Cinemavision offered with the MRI at Women and Children’s, the ambient package helps keeps patients focused and minimizes need for anesthesia for procedures.

The pediatric intensive care unit (PICU) is also getting a facelift.

“The PICU is getting a complete renovation,” Weber said. “We are in the process of converting a four-bed open area to three private, larger than normal, intensive care bays. There also will be a family zone, patient zone and caregiver zone as we try to create an updated look, but also add comfort for our patients and their families.”

The facility means nothing if it is not filled with caregivers and specially-trained physicians to take care of patients of all ages. Women and Children’s Hospital offers more than 30 pediatric specialists, who see patients from birth to adulthood.

Private rooms, specialized care

Additionally, CAMC expects to cut patient wait times, add more infusion bays, add four new linear accelerator vaults and space for additional physician offices and exam rooms.

The outpatient center will allow for improved patient experience through a soothing atmosphere that will infuse the center with “life” with features that include: an open, light-filled environment; multiple, comfortable waiting areas; family and community meeting space; patient reference library; coffee shop and/or café; wig and prosthesis shop; and a healing garden.

To become part of “The Power of Many” and join CAMC in helping to build the cancer center of tomorrow, visit camcfoundation.org.

Continued from frontMilestone reached

Educating the physicians of tomorrow ensures that our community will continue to have access to the best possible care in the future.

“We are constantly re-evaluating our facilities and services to make sure we are providing the care that our patients deserve,” Weber said.

For more information, and a list of pediatric specialties, visit camc.org/kids.

“Women and Children’s Hospital has all of the services needed to provide care for all children,” Weber said. “These experts bring knowledge to diagnose and treat most childhood problems and diseases.”

Nursing and support staff is crucial to providing pediatric care. They become familiar with the patients and get to know their special needs. Without this support staff, the best physicians in the world cannot provide adequate care.

“We are fortunate to have very dedicated and pediatric-trained support staff including pediatric, critical care and neonatal nurses, respiratory therapists, a child-life specialist, clinical dietitians, physical therapists, social workers, lab workers and a dedicated transport team, to name a few,” Weber said.

Women and Children’s Hospital also is an instrument for educating physicians and providing the opportunity for them to start their careers here.

“One of our residents is almost finished with a pediatric nephrology fellowship and is coming back this summer to practice with us,” Weber said. “Another we are supporting to do a behavioral development fellowship and will be back in 2013 with plans to create an autism center when she returns. There also is a graduate of our surgery residency program that will be back next year to do pediatric surgery and a urology resident who completed a urogynecology fellowship at Duke and is coming back this summer.”

Millions of Americans suffer from painful popping and clicking in the jaw commonly associated with a temporomandibular joint (TMJ) disorder. Frances Frazer of Elkins, W.Va., had lived with the discomfort of TMJ for more than two decades, but when her condition got so bad that she needed surgery to relieve her debilitating pain, she was discouraged to learn that there were no physicians in her area that could help.

So in October 2010 Frazer did what millions of Americans do every day – she turned to the Internet for help. There she found Michael Jaskolka, MD, DDS, an oral and maxillofacial surgeon who had joined the CAMC Facial Surgery Center a few months earlier and just happened to be the only doctor in West Virginia performing the surgery that she needed – total custom jaw joint replacement.

“Over time Frances had developed a rare fusion of the jaw joint to the base of the skull, which reduced her ability to open and close her mouth and eat normal foods,” Jaskolka said. “Her physician in Morgantown had performed several procedures on her temporomandibular joint over the last several years, but she continued to have degeneration and pain that was impacting her every day. So the next step was to replace the entire jaw joint.”

Frazer said finding Jaskolka was “meant to be” because she was out of treatment options and living in extreme pain.

“It affected every part of my life – eating, talking, it even hurt to smile,” Frazer said. “And it got to the point to where I couldn’t open my mouth.”

The temporomandibular joint is one of the most frequently used joints in the body. It is located in front of the ear where the skull and lower jaw meet and allows the jaw to move and function, enabling you to talk, chew and yawn. It is uncertain what causes TMJ disorder, but symptoms often result from problems with the muscles of the jaw or with the parts of the joint itself.

JOB surfing? Apply online camc.org

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TMJ surgery helps Elkins woman smile again“I liken it to having degenerative changes of the knee or hip. The same thing can happen to the temporomandibular joint,” Jaskolka said.

Jaskolka reconstructed Frazer’s jaw using a custom-made prosthetic device, which is a newer method of treating jaw disorders that is proving to have better results than older procedures. Frazer underwent release of the jaw from the base of the skull and reconstruction in a single surgery in May 2011.

“I removed the bony fusion from her jaw joint to the base of the skull, and I was able to get her jaw moving and open. Then I replaced the joint with a custom-made prosthesis made from a high resolution CT scan,” Jaskolka said.

For Frazer, the results have been life-changing.

“I can smile again!” Frazer said. “Everybody also notices the way I talk. They say I sound a lot different. I can brush my teeth the right way. I’m eating a lot of things that I haven’t been able to eat in a long time. The pain is gone. Everything’s just better!”

As for the future, Frazer’s new jaw joint should last many years.

“There may come a time when she may need another surgery – an ‘oil change’ per se, but at this point we’re expecting between 15 to 25 years of life expectancy from this prosthesis,” Jaskolka said.

Jaskolka said although Frazer required surgery to repair the degeneration of her jaw, most TMJ disorders are less severe and can be successfully treated without surgery.

“If you were to take a poll of 10 people, at least half to two thirds would say they’ve had some periods of time where they’ve had popping, clicking, grinding or pain in their jaw,” Jaskolka said. “The first line of treatment for anybody is non-surgical management, which can include physical therapy, soft diet, anti-inflammatory [medications] and night guards or splints to help relieve symptoms. Most of the time that resolves things. Only once a patient has been evaluated or treated in that kind of fashion by their primary care physician or dentist should surgery be considered.”

Frazer is happy to be doing the things she enjoys again, like working with preschool kids and walking.

“Feeling better makes everything a lot better,” she said.

In 2010, it was estimated that 215,000 people in the U.S. under age 20 had type 1 or type 2 diabetes. By managing their blood glucose and getting proper nutrition, exercise and support, children and young adults with this condition can learn to manage their diabetes and live happy, healthy lives.

Continuity of care is very important, which is why the outpatient diabetes education program at CAMC has started seeing pediatric diabetic patients who have been inpatients at CAMC Women and Children’s Hospital, or have been referred from the WVU Physicians of Charleston pediatric endocrinology office.

“We give individualized education based on the patient’s nutritional needs for his or her age to help promote normal growth and development,” said Jenny McMillion, a registered dietitian and certified diabetes educator with the CAMC outpatient diabetes education program. “Medical nutrition therapy is important in helping prevent diabetes, manage existing diabetes and prevent, or at least slow, the rate of development of diabetes complications.”

“Our diabetic patient population includes about 400-500 kids,” said Kevin Lewis, RN, MSN, CDE, nurse practitioner in the WVU Physicians of Charleston pediatric endocrinology office. “When we see newly-diagnosed outpatients, we give them basic education and then refer them to the CAMC program for nutrition education.”

If patients are diagnosed in the hospital, they first see Amy Spadafora, a registered dietitian and certified specialist in pediatric nutrition at Women and Children’s Hospital. Lewis and Spadafora work together with nurses and other pediatric health care providers to care for inpatient diabetics.

“I give them the ‘survival skills’ education to help them know what to eat, how things are going to work and what to do if their blood glucose goes low. It’s not about changing everything they do, but teaching them how to adapt,” Spadafora said.

When patients leave the hospital but still need diabetes management, they are referred to the outpatient program.

“I strongly encourage them to go. Having this opportunity is great for continuity of care, because we know that they are getting consistent messages about taking care of themselves,” she said.

“The arrangement has worked out very well for us,” Lewis said. “The program accommodates our patients quickly, and we all meet to discuss the curriculum on a regular basis so we are teaching the same things.”

When patients enter the outpatient diabetes program, they set goals to help meet their individual nutritional needs. The whole family is involved in the education process.

“As energy requirements change with age, physical activity and growth rate, an evaluation of the patient’s nutrition therapy plan is recommended at least every year,” McMillion said.

Rebecca Kozak, 16, is a type 1 diabetic who worked with McMillion in the outpatient program. She said the classes helped her to become more familiar with good nutrition and prepared her for getting an insulin pump.

“The classes definitely help. She taught me about eating right, high and low starch foods and long-lasting carbs, and also about the insulin pump. It wasn’t as hard as I thought it would be, and she went through things as many times as I needed,” Kozak said.

Kozak added that she doesn’t let her diabetes get in the way of school and other things. She has attended Camp Kno-Koma, a camp for kids with diabetes, for 10 years and is working to become a leader in training. She also organized a diabetes awareness event at her school.

Beth McMillion, 13, is also a type 1 diabetic who participated in CAMC’s outpatient program. She said that the program helped her with knowing what to eat, how to put meals together and learning about an insulin pump. While she’s still waiting to start on her pump, she found the educational program very helpful.

For more information about the CAMC outpatient diabetes education program, visit camc.org/diabetes, call (304) 388-5555 or email diabetes@camc.org.

Spectrum program offers participants tools to enhance their lives

Outpatient program helps kids and teens manage diabetes

that they can get specific and significant results, “Anderson said. “In the Spectrum, participants design their own program based on what their own personal goals are. It also includes baseline and exit measurements and lab results.”

Handley said that although there was a specific focus in each week’s meeting, helpful exercises were introduced in each class and there were healthy snacks provided, along with recipes.

“I particularly thought the stress management session was beneficial,” he said. “Also, Susan Poindexter spent a whole class talking about nutrition and how to read food labels, which was great.”

Through Spectrum, Handley was able to lower his cholesterol by about 10 points and lost 10 pounds by reducing his snacks and trying some of the healthier food alternatives mentioned in the class.

The program is a covered benefit of Highmark Blue Cross Blue Shield of WV and PEIA for eligible members.

“Because I met the health criteria for the program, Highmark of WV covered the cost of the classes,” Handley said. “The only costs I incurred were for the optional books dealing with different aspects of the class that I purchased.”

The Dean Ornish Spectrum program is scientifically proven to make participants feel better, live longer, lose weight and gain health. Based on the best-selling book by Dr. Dean Ornish, this six-week education program is based on making healthy choices related to four key lifestyle components: nutrition, stress management, exercise and social support.

“It is very individualized, and anyone who would like to learn to make healthier choices can participate,” said Kelly Anderson, RN, recruitment specialist and group support facilitator.

Jerry Handley, who has a family history of heart disease, joined the program because he was interested in lowering his cholesterol.

“It was above the borderline of 200,” Handley said. “My father and uncle both died of a heart attack, so after reading about the focus of the program on stress management, nutrition, exercise and social support, I thought I would try it.”

The Spectrum is designed to teach people how to incorporate healthy choices into their daily lives. They set their own goals and learn how to keep track of and evaluate their progress.

“Our other program, Ornish Reversal, has set guidelines for people to follow so

Without insurance coverage, the Spectrum program is priced affordably for anyone who wants to make an investment in their health.

“The total program cost is $267, which includes a participant manual, a strength-training and stress management manual, handouts, six weekly lectures by our professional clinical staff, baseline and exit body measurements and blood work,” Anderson said.

Handley recommends the program to anyone interested in enhancing their quality of life in a short time.

“I would definitely recommend the Spectrum program,” he said. “Since the program was only six weeks, it was easy to fit into my schedule. The workbook was well-written and the instructors presented the material in an interesting way.”

The Spectrum Program is typically offered on Thursday evenings, and healthy snacks are served during each session. The next session begins in March 2012. Due to space, enrollment is limited to 35 people per session. Call (304) 388-9411 to enroll in a future session.

(304) 388-9411 camc.org/ornish

Frazer shows an X-ray of her new custom jaw joint.

Dr. Jaskolka measures Frazer’s mouth after surgery. She could only open her mouth 1 centimeter prior to surgery, compared to 4 centimeters after surgery.