Regional Report - Gundersen Health System

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Skin cancer surgery aims to preserve healthy tissue Patients diagnosed with nonmelanoma skin cancer have another state-of-the-art option for treatment at Gundersen Lutheran. Dermatologist Kurt K. Mueller, MD, offers an innovative surgical procedure called Mohs surgery. “About 95 percent of the skin cancers we see are nonmelanoma so having Mohs surgery available is a big benefit to patients in the area,” says Dr. Mueller, who is fellowship trained in Mohs surgery. “My goal is to get the highest cure rate while preserving as much healthy skin as possible.” As the only physician in the Tri-State Region performing this procedure, Dr. Mueller is committed to this goal. And the numbers show that he is living up to his promise. After performing more than 2,000 cases in the past three years, his patients have a cure rate of more than 98 percent. Similar cure rates have not been documented for other treatments. The Mohs procedure is a microscopically controlled skin cancer surgery. It is a preferred choice in areas where appearance and function are important such as the face, neck, hands, genitalia and lower extremities. The procedure is ideal for treating nonmelanoma skin cancers that have been newly diagnosed as well as those that have been treated but continue to recur. Dr. Mueller acts as the surgeon and pathologist during Mohs surgery. “I remove what appears to be the entire cancer. I then take a thin layer from the entire outside edge of the specimen, prepare a slide and examine the tissue under a microscope,” Dr. Mueller explains. Dr. Mueller uses a sophisticated mapping process so if he finds residual cancer cells in a part of the sample, he can go to the specific location and remove only the involved area. The process is repeated until the sample is clear of cancer cells. Mohs surgery is done under local anesthesia as an outpatient GreenLight PVP – continued develop irritative symptoms with increased frequency and urgency to urinate, obstructive symptoms such as slow stream and difficulty starting urination, or a combination of both. Compare the differences: Kurt Mueller, MD Specialty: Dermatology MD Degree: University of Nebraska College of Medicine, Omaha, Neb. Residency: National Naval Medical Center, Bethesda, Md. Fellowship: Northwestern Skin Cancer Institute, Chicago, Ill. procedure in Dermatology and patients can expect to spend up to half a day at the clinic. The skin sampling itself doesn’t take long, but after each sample is taken, there is about a 30 to 40 minute wait as Dr. Mueller processes and examines it. “I prefer the Mohs procedure because I see the patient, the tumor, the defect left when the tumor is removed and the tumor under the microscope. One person acting as dermatologist, surgeon and pathologist eliminates many variables,” explains Dr. Mueller. “Mohs also takes away the guesswork of ‘blind’ procedures in which once the visible tumor is removed, we simply wait to see if it recurs.” In addition to Mohs surgery, Gundersen Lutheran offers Radiation and Medical Oncology, Plastic Surgery, Otolaryngology, Dermatopathology, Oculoplastic Surgery and Hand Surgery services. If a patient needs these services in conjunction with Mohs surgery, they can get them here as well. Dr. Mueller adds, “I’m happy to consult with clinicians who have patients they believe may be good candidates for Mohs surgery. By working together, we can deliver the best possible outcomes for patients.” Contact Dr. Mueller via MedLink. If you have patients experiencing symptoms of an enlarged prostate and could benefit from GreenLight PVP, call for a consultation or referral via MedLink. GreenLight PVP Traditional TURP • Laser coagulates blood as surgery is performed so there’s little risk of blood loss • Outpatient procedure • 45 minute to 1½ hour surgery • Limit physical activity for 3 to 4 days • Tiny risk of incontinence (less than 1 percent) • High risk of blood loss during and after surgery • Hospital stay of 1 to 3 days • 1 hour surgery • Limit physical activity for 2 to 4 weeks • Slight risk of incontinence Cost is comparable for both procedures; however, there is no hospital stay with GreenLight PVP. MedLink (800) 336–5465 4 In La Crosse 775–5465
Vascular Institute sees success with Stat TIA & Stroke Care program A transient ischemic attack (TIA), by definition, lasts less than 24 hours and most last less than one hour. “The cause and appropriate treatment for TIA are very similar to stroke. However, patients with TIA often receive less aggressive diagnostic testing and treatment than stroke patients. This is despite a five-year stroke risk of more than 30 percent,” reports Jon Zlabek, MD, Gundersen Lutheran Vascular Institute. In addition, up to 25 percent of patients with TIA will die within the first year after the initial event, 15 percent of strokes are preceded by a TIA and the risk of a stroke after a TIA is very high, especially in the first 48 hours. In a collaborative effort, medical staff from Gundersen Lutheran’s Vascular Institute, Neurology, Internal Medicine inpatient service (Hospitalists), and Trauma & Emergency Center (TEC) have established a new Stat TIA & Stroke Care program. This model provides patients with TIA the best possible care. In addition to expanded treatment in the TEC, a Stat TIA Clinic (part of the Vascular Institute and staffed by providers in Neurology and Vascular Medicine) quickly sees clinic-based patients with TIA. “About two years ago we were named a Joint Commission Primary Stroke Center. As such, we are continually looking for ways to incorporate the best science available to treat patients. A study reported in the Lancet medical journal shows that if appropriate treatment is initiated quickly and aggressively after protocols to ensure that all medical staff—no matter where a patient might present—follow best practices in treating patients with TIA.” If you want more information on the Stat TIA & Stroke Care program contact Dr. Fischer or Dr. Zlabek via MedLink. TIA protocol pocket cards available To standardize care, a pocket card has been created with recommendations for the latest medical therapy for patients with TIA and stroke. On the back of the card is the ABCD scoring system to assist with appropriate triage. The ABCD score can predict which patient with a TIA is most likely to go on to have a stroke: Age: Over 60 (1 point) Blood pressure (BP): systolic BP above 140 and/or diastolic BP above 90 (1 point) Clinical features • Unilateral weakness (2 points) • Speech problem only (no weakness) (1 point) Duration: 10-59 minutes (1 point), 60 minutes or more (2 points) The seven-day risk of cerebrovascular accident (CVA), or stroke, is more than 30 percent for those scoring six points or above. In a prospective study in the journal Lancet, all patients who had a stroke within one week of a TIA had scores of four or more using the ABCD score. These statistics further illustrate the importance of a quick and proper evaluation and treatment of TIAs. If you would like a TIA pocket card, please call the Gundersen Lutheran Vascular Institute at (608) 775-GLVI (775-4584). Gregory G. Fischer, MD Specialty: Neurology and Neurophysiology MD Degree: University of Minnesota Medical School, Minneapolis Internship: Hennepin County Medical Center, Minneapolis, Minn. Residency and Fellowship: University of Minnesota Medical School, Minneapolis Jonathan A. Zlabek, MD, FACP Specialty: Vascular Medicine and Internal Medicine MD Degree: University of Wisconsin Medical School, Madison Internship and Residency: Gundersen Lutheran Medical Foundation, La Crosse, Wis. a TIA, we can reduce the risk of a subsequent stroke by up to 80 percent,” reports Gregory Fischer, MD, medical director of the Stroke Center, Neurology department chair and a member of the Vascular Institute. Dr. Fischer and Dr. Zlabek head up the Stat TIA program at Gundersen Lutheran. “The Trauma & Emergency Center has always done a great job in evaluating and treating patients who present with TIA,” says Dr. Zlabek. “With this program, we use evidence-based News Brief Gundersen Lutheran launches revamped Web site The updated Gundersen Lutheran Web site— gundluth.org—offers great new features such as: • Updated look and navigation including links to news, locations, maps and directions on the home page. • A section for clinicians that will be a resource for referring providers and have information on topics such as education, training, medical library, quality and safety, journal articles, etc. • Enhanced class registration, so people can register and pay for classes online. • E-greetings allowing family and friends to send a customized message to a loved one in the hospital and more. MedLink (800) 336–5465 5 In La Crosse 775–5465
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Regional Report - Gundersen Health System

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