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Volume 19, Number 1 / Summer 2009
AlphaSights
A look at tomorrow’s health care
today at Baystate Medical Center
Minimally Invasive
Spine Surgery
Image Guided
Radiation Therapy
Selective Brain Cooling
in the NICU
Breast Cancer
Survivorship Program
Pulmonary Vein
Isolation Technique

Springfield, Massachusetts Volume 19, Number 1
2
10
Table of
Contents
6
14
18
AlphaSights
Editors:
Suzanne B. Hendery
Trish Perrault
Managing Editor:
Suzanne M. Spiry
Writing:
Scott P. Edwards
Suzanne M. Spiry
Patricia Sullivan
Design:
Anna English
Photography:
Todd Lajoie
Kent Spiry
Chris Szarek
Printing:
Andrews Connecticut
2
Minimally Invasive
Spine Surgery
Neurosurgeons at Baystate Medical
Center now offer a range of minimally
invasive spinal surgical procedures,
such as transforaminal lumbar interbody
fusion, helping many people return to
a pain-free life in less time than ever.
6
Image Guided Radiation Therapy
Radiation oncologists in the Baystate
Regional Cancer Program are using
image-guided radiation therapy to verify
a tumor’s location even more accurately,
reducing the margin of healthy tissue
affected by treatment.
10
Selective Brain Cooling
Neonatologists in the Neonatal Intensive
Care Unit at Baystate Children’s Hospital
now offer a novel treatment for hypoxicischemic
encephalopathy: Selective
Brain Cooling.
Cover photo: Colored MRI scan of a side
view of the spine of a patient with discitis.
Credit: Du Cane Medical Imaging Ltd./
Photo Researchers, Inc.
14
Breast Cancer
Survivorship Program
Baystate’s Comprehensive Breast
Center offers a new program to provide
proper follow-up to detect local,
distant recurrence, and second cancers;
manage health issues that may result
from treatment; and promote wellness.
18
Pulmonary Vein
Isolation Technique
Electrophysiologists at Baystate
Medical Center are using a relatively
new approach to treat atrial fibrillation
by ablating the tiny areas of tissue
that cause this abnormal rhythm.
22
Honors & Announcements
Read current and archived issues of AlphaSights
magazine online at baystatehealth.org/alphasights.
Published by the Marketing & Communications Department, Baystate Health, Springfield, Massachusetts.
Editorial offices are at 280 Chestnut Street, Springfield, MA 01199. Telephone: 413-794-5050.
Submit article suggestions and address all communications to the Editors.
This publication was developed for the medical staff and friends of Baystate Health.

Ensuring a
Strong Future
in Uncertain Times
Like health care organizations throughout the country,
Baystate Health faced a challenging set of circumstances
in 2008. There were unanticipated changes in governmental
and insurance reimbursements, and unprecedented instability in
financial markets, investments, and regional and global economies.
In response, we did what we always do to ensure we
are prudent stewards of our resources. We evaluated
our priorities and made decisions for the good of our
patients and communities to maintain financial
strength that ensures quality care in the long-term.
This is clearly a period of scrutiny and transition for
health care, with potential health care reform on the
horizon. Our goal is to be proactive, prepared, and
adaptable to change, so that we continue to bring
the best to our patients. Many people and organizations
have cited our ability to adapt as one of our
greatest strengths.
No matter what uncertainties may exist in society,
our communities depend on the people of Baystate
Health to be there when they need us. With
outstanding staff and referring physicians,
nurses, and employees, we remain committed
to bringing nationally recognized care and lifesaving
technologies to our patients.
This issue of AlphaSights highlights a few examples,
including how our Neonatal Intensive Care Unit
features a new Selective Brain Cooling system that
helps to reduce infant brain injury, and how the latest
advances in minimally invasive spine surgery are
helping many patients live pain-free.
For more information about the performance of Baystate
Health in 2008, I invite you to view our annual report
online at baystatehealth.org/annualreport. In this
report, we provide a look back at a year of lives
touched, and of significant progress and work that
supports quality care and strengthens communities.
Sincerely,
Mark R. Tolosky, FACHE
President & Chief Executive Officer
Baystate Health
1

Baystate neurosurgeons Drs. Dennis Oh and Sherry Taylor
perform a variety of minimally invasive spine surgeries,
such as transforaminal lumbar interbody fusion.

Spinal Surgery
Minimally Invasive Techniques Benefit Patients
By Scott P. Edwards
Minimally invasive technology and expertise are revolutionizing the way surgery
is performed, from simple procedures like hernia repair, to complex procedures
like spinal surgery.
Neurosurgeons at Baystate Medical Center now offer a
range of minimally invasive spinal surgical procedures,
such as transforaminal lumbar interbody fusion (TLIF),
helping many people return to a pain-free life in less
time than ever.
“The development of minimally invasive technologies
continues to push and promote the advancement
of spinal surgery,” says Sherry Taylor, MD, chief of
Neurosurgery at Baystate Medical Center. “We can now
perform major surgeries that used to require 6 to 8 inch
long incisions with much tinier incisions and less
trauma to the soft tissues and muscles around the
spine. Our patients come to us looking for this level
of expertise.”
A Patient’s Experience
Just a few short months ago, Robert Ragone could
barely walk more than 100 feet without experiencing
excruciating lower back pain. Today, thanks to
minimally invasive spinal fusion, Mr. Ragone is not
only walking further, but is doing so without the
debilitating back pain he suffered from for years.
“Over the last two years,” Mr. Ragone says, “my
back went from quite good to quite bad.” After a
couple visits to a doctor, he was told he needed
spinal fusion, a surgical technique in which one or
more of the vertebrae of the spine are fused to stop
them from moving against each other and causing
pain. His doctor recommended the traditional open
technique, which requires a large incision in the
back and months of recovery time.
3

At his wife’s request, Mr. Ragone requested a second
opinion from Dennis Oh, MD, a neurosurgeon at
Baystate Medical Center, who has performed more
than 100 minimally invasive spine surgeries over
the past several years, including minimally invasive
spinal fusions.
Mr. Ragone suffered from debilitating back pain that
radiated down through his buttocks and thigh, and
did not respond to conservative treatment. Dr. Oh
diagnosed L5-S1 spondylolisthesis (a forward slip
of one vertebra in the lower back in relation to another
vertebra), degenerative disc disease, and severe
stenosis of the spinal column. He recommended a
minimally invasive version of a procedure called
TLIF—transforaminal lumbar interbody fusion.
Less Trauma,
Quicker Recovery
The open TLIF procedure requires a long incision and
involves cutting or stripping the muscles from the
spine. Minimally invasive TLIF is similar, but because
smaller incisions are used, there is less damage to
surrounding tissue and muscle.
Baystate’s newest neurosurgeon, Dr. Robert Schapiro, specializes
in tumors, spine and pediatric neurosurgery, and also performs a
range of minimally invasive procedures.
The surgeon makes four small incisions—each
about 1/2 inch in length—and uses microscopic
instruments to gently separate the muscles
surrounding the spine. This causes less damage to
the spinal musculature and minimizes scarring.
For the patient, this means less pain, muscle damage,
and blood loss, as well as a shorter hospital stay and
a quicker recovery period.
Two hours after his procedure, Mr. Ragone was up
and walking. “They asked if I wanted to get out of
bed,” he says. “I stood up and felt surprisingly well.
I walked across the room to the doorway and then
proceeded to walk around the entire floor of the
hospital unit.”
“Our patients come to us looking
for this level of expertise.”
He continues, “My restrictions right now are more
self-imposed. At first, there was no lifting, twisting,
or bending. I can do some of that now. I still can’t
bend down and touch the ground, but it’s only been
a couple of months since my procedure. Once the
soreness is gone, I think I’ll be quite well.”
4

Other Microsurgical
Techniques
In addition to TLIF, Dr. Oh, Dr. Taylor, and Baystate’s
newest neurosurgeon, Robert Schapiro, MD, also
perform a variety of other minimally invasive spine
surgeries. These include foraminotomies, which
enlarge the space where a spinal nerve root exits
the cervical spinal canal to relieve a pinched nerve;
laminectomies to remove bone and relieve excess
pressure on spinal nerves in the lower back; and
microdiscectomies to relieve debilitating pain and
weakness caused by a herniated disc or pinched nerve.
Surgeons performing lumbar microdiscectomy use
a surgical microscope and microsurgical techniques
to access and treat the lumbar spine. By providing
magnification and illumination, the microscope
allows for limited dissection, so only that portion
of a herniated disc that is pinching one or more
nerve roots is removed.
Dr. Oh says minimally invasive microdiscectomy is a
“faster, shorter procedure” than an open discectomy,
resulting in less tissue damage and less trauma to
the muscles. “This could even be performed as an
outpatient procedure,” he says, “but we typically keep
patients overnight so that we can give them three
doses of antibiotics to reduce the risk of infection.”
Baystate neurosurgeons also use minimally invasive
procedures to treat a host of other back and spine
problems, including sciatica, scoliosis, degenerative
disc disease, spinal fractures, and tumors.
Today, thanks to minimally invasive spinal fusion, Robert Ragone
is not only walking further, but is doing so without the debilitating
back pain he suffered from for years.
For more information,
or to refer a patient, call Baystate
Neurosurgery at 413-794-4440.
5

Image Guided
Radiation Therapy
Improving Accuracy and
Confidence in Cancer Treatment
By Scott P. Edwards
For years, radiation oncologists have faced a huge challenge when treating their
patients: how to deliver an appropriate dose of radiation to a tumor site without
harming surrounding healthy tissue and organs.
To ensure they were targeting the entire tumor with a
therapeutic dose of radiation, they often had to build
in a margin of healthy tissue around the tumor as well.
While effective at treating tumors, this approach was
not without drawbacks. Because internal organs and
certain tumors are prone to movement, such as those
in the lung and prostate gland, the radiation field
changes, often requiring the delivery of radiation to
some healthy tissue to ensure that the tumor receives a
full dose of radiation. In addition, radiation oncologists
were often forced to reduce the amount of radiation
targeted at tumors close to critical structures.
In the late 1990s, however, the technology for delivering
radiation to tumors drastically improved, allowing
radiation oncologists to adjust radiation beams with
greater accuracy to deliver the dose directly to the
target and spare nearby tissue. Today, many hospitals,
including Baystate Medical Center, are using imageguided
radiation therapy, or IGRT, to verify a tumor’s
location even more accurately and thus further reduce
the margin of healthy tissue that is affected.
Radiation oncologists at the Baystate Regional Cancer
Program were the first in the region to begin offering
intensity modulated radiation therapy (IMRT) at the
D’Amour Center for Cancer Care in 2004. IMRT was
used to “paint” precise radiation doses on even the
most complex tumor shapes, allowing higher doses
to be delivered at reduced risk to adjacent tissue.
“IGRT is a shift in degree, rather than a radical shift,
in how we provide radiation therapy,” says Brian Acker,
MD, chief of Radiation Oncology at Baystate. “It is,
however, an important shift because we can cut in
half the margin of healthy tissue that is hit by the
radiation beam.”
6

“CT on rails was one of the first advanced IGRT technologies,” says
Dr. Brian Acker. “It gives us beautiful, high resolution, cross-sectional
images to look at internal organs and other anatomical structures.”

Dr. David Chin says the CT on rails is a better technology because
it can image soft tissue as well as other structures like bone.
8
Delivering Accuracy
IGRT employs sophisticated imaging technology to
increase the accuracy of radiation therapy. During the
treatment-planning phase, the radiation oncologist
uses a special CT system to image the patient’s anatomy
and map out the tumor. Precise information on
where the tumor and adjacent structures are located
is sent to a medical physicist who helps optimize the
distribution of the radiation dose.
On the day of treatment, the patient undergoes
an additional CT scan to determine if the tumor or
internal organs have shifted. Computer software
compares the two sets of images. If there is movement
of the target treatment area, the radiation field
is appropriately adjusted.
“Although IGRT adds some time and complexity to
the treatment delivery,” says Dr. Acker, “the additional
accuracy makes it worth the extra effort, especially
for patients whose tumors are located in critical areas.
It allows us to confidently deliver high doses of radiation
very accurately while protecting adjacent normal
structures.”
There are several IGRT technologies available.
Baystate uses the Siemens Primatom, which consists
of a linear accelerator and a CT scanner mounted
on a sliding gantry. After the patient is set up on the
treatment table, the table is rotated 180 degrees. The
CT scanner then slides on rails over the patient and
takes three-dimensional pictures that are transferred
to a computer system, providing real-time images that
are compared to the scans taken during the earlier
treatment planning session.
“CT on rails was one of the first advanced IGRT
technologies,” says Dr. Acker. “It gives us beautiful,
high resolution, cross-sectional images to look at
internal organs and other anatomical structures.”
Prior to IGRT, the radiation oncology team used permanent
ink on a patient’s skin to align and position
the patient and map out the radiation field. Because
this is an imprecise measurement, the treatment
area was typically expanded to compensate for the
movement of the tumor and internal organs from
such things as eating, drinking, breathing, and bowel
movements. Some types of cancers, particularly
prostate cancer, required the implantation of small
metal markers in the body to help target the radiation.

On the day of treatment, the patient undergoes an
additional CT scan to determine if the tumor or internal
organs have shifted. If there is movement of the target
treatment area, the radiation field is appropriately
adjusted. (Shown Lorraine Morrissette, radiation
therapist, and Dr. Thomas Napier, radiation oncologist.)
David Chin, PhD, chief of Medical Physics at Baystate,
says the CT on rails is a better technology because it can
image soft tissue as well as other structures like bone.
“Other technologies, like cone-beam and MV and kV
CT, can’t see soft tissue as well as CT on rails,” he says.
Because the radiation is delivered more accurately
using IGRT, the radiation oncology team is also able
to deliver a higher dose of radiation to the tumor site.
Previously, according to Dr. Acker, they had to reduce
the dose to help minimize the effects on adjacent
healthy structures that might be included in the
treatment area.
Candidates for IGRT
Baystate radiation oncologists currently use IGRT
primarily for patients whose tumors are located near
the spinal cord.
Dr. Acker notes that patients whose tumors are
not near critical structures do not need IGRT. “IGRT
is particularly important for patients whose tumors
are directly adjacent to critical structures and where
conventional means of targeting are felt to be insufficient,”
says Dr. Acker.
For example, the first patient treated at Baystate
Medical Center by Dr. Acker using the Primatom
system had lung cancer that was not appropriate for
surgery because it was situated too close to the spinal
cord. “Normally,” he says, “we would have had to
limit the dose of radiation to avoid damaging the
spinal cord. With IGRT, we were able to use a higher
dose to treat the tumor and we were able to spare
the spinal cord.”
Advancing Treatment
Since radiation oncologists at Baystate first began
using the Primatom system last October, over a dozen
patients have had their cancer treated with IGRT
through the Baystate Regional Cancer Program.
“We’re moving closer to being able to
adapt therapy on a daily basis based on
how the tumor and anatomy change.”
Dr. Acker says IGRT is a “quantitative” improvement in
radiation therapy, one that moves Baystate a step closer
to full, adaptive radiation therapy. “With IGRT, we’re
moving closer to being able to adapt therapy on
a daily basis depending on how the tumor and
anatomy change,” he says. “Going forward, we’ll
be able to adapt treatment as we go to precisely
treat a changing tumor.”
For more information
or to refer a patient, call the Baystate
Regional Cancer Program at 413-794-9338.
9

Brain cooling should begin as soon as possible
after birth, optimally within six hours, and continue
for 72 hours, says Dr. Rachana Singh (left), shown here
with Susan Chamberlain, clinical nurse specialist.

Selective Brain Cooling:
A New Treatment for Infants with Hypoxic-Ischemic Encephalopathy
By Patricia Sullivan
Until recently, no clinical intervention was available for babies who suffered a
low level of oxygen or blood supply to the brain during birth causing a condition
called hypoxic-ischemic encephalopathy (HIE).
Now, neonatologists in the Neonatal Intensive Care
Unit (NICU) at Baystate Children’s Hospital offer a
novel treatment for HIE: Selective Brain Cooling.
The NICU at Baystate’s Children’s Hospital has the
region’s only brain cooling system. This treatment has
been shown to decrease the risk of neurodevelopmental
disabilities in the babies with moderate to severe HIE.
Baystate purchased Olympic Medical’s Cool-Cap ®
System, the only FDA-approved brain cooling device,
in January of this year. Before that, says Bhavesh Shah,
MD, director of Newborn Services, “Treating babies
with HIE was a dissatisfying experience because we
could mostly only offer supportive care to the infant,
and could not provide any specific therapy directed at
brain injury. We are very excited to offer selective brain
cooling, a promising new treatment.”
The concept behind selective brain cooling is simple,
yet requires a complex instrument, continuous monitoring,
and close assessment of various organ systems.
Full-term newborns with HIE wear a cap that circulates
cooled water at carefully controlled temperatures in
order to lower the baby’s brain temperature. A radiant
warmer maintains the infant’s core body temperature
within a narrow range at a safe level. Selective brain
cooling slows the metabolism and reduces energy need
to lessen brain injury and allow time for healing.
Rachana Singh, MD, a Baystate neonatologist, explains
that the Cool-Cap ® System consists of a cooling unit, a
control unit, a water-filled cap and three temperature
sensors – rectal, skin, and scalp. The system adjusts the
water flow to maintain the infant’s core temperature at
34 degrees C ± .5 degrees. During this time, the baby’s
brain activity is continuously monitored with a cerebral
function monitor or an amplitude electroencephalogram
(aEEG).
Brain cooling should begin as soon as possible after
birth, optimally within six hours, and continue for 72
hours. “Each baby responds differently to cooling and
then to re-warming,” says Dr. Singh. “We must find the
‘sweet’ point – the best temperature – for each baby.
The first six hours are critical to achieve the target
stable temperature.”
“We’re fortunate to be able to obtain this technology
to support our patients, especially in these financially
uncertain times,” says Lindsey K. Grossman, MD,
chair, Department of Pediatrics. “One of the areas of
pediatrics in which we’ve seen dramatic improvement
is in increased survival rates in the NICU. But survival
doesn’t mean that all babies come through unscathed.
Those with HIE are at risk of life-long disabilities.”
11

“We are entering a new era that will
focus on the protection of the brain,
and ultimately improve long-term
neurodevelopmental outcomes in
children,” says Dr. Bhavesh Shah.
Implementation
During her neonatology fellowship, Dr. Singh took
part in a multi-center, international clinical trial for
Cool-Cap. The results of the trial, published in the
The Lancet [2005; 365: 663-70], showed that 49
percent of infants who received cooling treatment
experienced favorable outcomes, as opposed to 34
percent of the control group. No clinically significant
complications resulted from head cooling. The FDA
approved the Cool-Cap in 2007.
“Dr. Singh’s experience has been valuable during
the new treatment’s implementation in the Baystate
NICU,” says Dr. Shah.
neurologists, physician assistants, and neonatal nurse
practitioners received additional intensive instruction.
The first baby to meet the Cool Cap criteria required
resuscitation and ventilation, and was brought to the
NICU and fitted with the Cool-Cap. After 72 hours
of brain cooling, the baby’s neurological exam was
completely normal and he went home.
“We’re very optimistic; however, we need to monitor
these infants’ long-term neurodevelopmental progress,
as they are at a higher risk for consequences of brain
injury,” says Dr. Singh. “Everyone’s great effort in the
NICU contributed to an early successful outcome.”
Susan Chamberlain, MSN, RNC, clinical nurse
specialist for the NICU and Graduate Nursery at
Baystate, says it took a “tremendous amount of
planning and a collaborative team effort to bring
selective brain cooling technology to the NICU
at Baystate and get the program running.”
The NICU at Baystate Children’s
Hospital has the only brain cooling
system in western Massachusetts.
12
The groundwork included a site visit to learn about
the system. The Cool-Cap was purchased by way
of proceeds from the 2008 Max Classic Golf Tournament,
an annual event supporting Baystate Children’s
Hospital that has raised over $700,000 (net) over the
past five years.
Once the equipment was purchased, manufacturer’s
representatives trained staff and physicians at
Baystate. Every one of the 60-plus NICU nurses
received Cool-Cap training, while a core group of
“super users,” including neonatologists, pediatric
“One of the areas of pediatrics in which
we’ve seen dramatic improvement is
in increased survival rates in the NICU,”
says Dr. Lindsey Grossman.

Looking Forward
One to two babies per 1,000 births meet the current
criteria for selective brain cooling. At this rate, Dr.
Shah expects to treat eight to 16 babies per year,
including infants born at referring area hospitals.
Before Baystate Children’s Hospital acquired its
Cool-Cap, babies born locally were transferred to
Boston for hypothermia therapy. Treating these
infants at Baystate enables doctors to start cooling
earlier, and decreases the family’s disruption and
stress by keeping their babies closer to home.
“The NICU at Baystate is a valuable resource for
families in western Massachusetts,” says Dr. Shah.
“It is our obligation to maintain a comprehensive,
ultramodern, sophisticated Level III NICU. In addition,
our multi-specialty pediatric experts provide
valuable support to these babies as they are at high
risk for multi-organ problems frequently encountered
in babies with HIE.”
He continues, “I believe selective brain cooling is just
a first step in the development of new treatments for
infant brain injury. We are entering a new era that will
focus on the protection of the brain, and ultimately
improve long-term neurodevelopmental outcomes
in children. This is an exciting time as new therapies
and interventions on the horizon become available
to reduce brain injury. The opportunities to improve
in this area are unlimited.”
For more information
about selective brain cooling, contact
Dr. Bhavesh Shah at 413-794-5370.
Cool-Cap
Criteria
Nicole Provost, RN
Selective brain cooling is indicated for use in full-term
infants with clinical evidence of moderate to severe
hypoxic-ischemic encephalopathy (HIE). Olympic Medical,
maker of Baystate’s Cool-Cap ® System, provides the
eligibility criteria below to define clinical evidence of
moderate to severe HIE.
A. Infant at greater than or equal to 36 weeks gestational
age and at least one of the following:
• Apgar score less than or equal to 5 at 10 minutes after birth
• Continued need for resuscitation, including endotracheal
or mask ventilation, at 10 minutes after birth
• Acidosis defined as either umbilical cord pH or any arterial pH
within 60 minutes of birth less than 7.00
• Base deficit greater than or equal to 16 mmol/L in umbilical cord
blood sample or any blood sample within 60 minutes of birth
B. Infant with moderate to severe encephalopathy consisting
of altered state of consciousness (as shown by lethargy,
stupor, or coma) and at least one of the following:
• Hypotonia
• Abnormal reflexes, including oculomotor or pupillary abnormalities
• Absent or weak suck
• Clinical seizures
If the infant is paralyzed, assume an abnormal evaluation
for criteria B and proceed to criteria C.
C. Infant has an amplitude-integrated electroencephalogram/
cerebral function monitor (aEEG/CFM) recording of at least
20 minutes duration that shows either moderately/severely
abnormal aEEG background activity (score of 2 or 3) or seizures.
13

Survivorship
Program
Provides Support to Breast Cancer Survivors
By Suzanne M. Spiry
Of
the 11 million cancer survivors living in the United States today, over 2 million
are breast cancer survivors, and breast cancer survival rates continue to increase
due to better screening and treatments.
14
“Most women diagnosed with breast cancer today
have an 80-90 percent chance of being alive in 10
years,” says Grace Makari-Judson, MD, medical
director of the Comprehensive Breast Center, part
of the Baystate Regional Cancer Program. “An
improvement in survival of two percent a year over
the past decade is the result of better screening and
more effective treatments.”
While the large number of survivors is reason to
rejoice, the question arises: Who will care for them?
“Breast cancer survivors need to be especially vigilant
about their health, yet due to the critical shortage of
both medical oncologists and primary care physicians,
there are fewer providers,” says Dr. Makari-Judson.
For this reason, Baystate’s Comprehensive Breast
Center now offers the Breast Cancer Survivorship
Program. The goals of the program include:
• Proper follow-up to detect local
or distant recurrence.
• Proper follow-up for second cancers.
• Management of health issues that may
be a result of treatment.
• Promotion of wellness.
Before entering the Survivorship Program, women
will have completed active treatment at the D’Amour
Center for Cancer Care. They will then revert to annual
visits to the Comprehensive Breast Center, where the
focus will be on prevention and health maintenance,
rather than active treatment. For many women, this
begins after the five years of hormonal treatment.

“Breast cancer survivors need to be especially
vigilant about their health, yet due to the critical
shortage of both medical oncologists and primary care
physicians, there are fewer providers,” says Dr. Grace Makari-Judson
(left), shown here with Sandra Hubbard, nurse practitioner.

“Breast cancer survivors still need yearly mammography
as well as clinical breast exams,” says Ms. Tipton.
“For their convenience, we try to schedule their mammogram
at the Comprehensive Breast Center the
same day as their follow-up visit.”
“Breast cancer survivors still need yearly mammography as well
as clinical breast exams,” says Catherine Tipton, nurse practitioner.
Women in the program are seen by Sandra Hubbard,
WHNP, and Catherine Tipton, NP, who are trained in
health maintenance and symptom management. “Our
focus is on wellness,” says Ms. Hubbard. “During
each visit, we discuss breast, heart, and bone health;
how to avoid weight gain; and how to manage
menopausal symptoms without using estrogen. We
also update the patient’s family and personal medical
history, address any concerns they may have, and perform
a breast exam.”
“Most women diagnosed with breast
cancer today have an 80-90 percent
chance of being alive in 10 years.”
“This program provides a much-needed bridge for
breast cancer survivors from their medical or surgical
oncologist to a nurse practitioner who can address
their unique concerns and ongoing wellness,” says
Dr. Makari-Judson. “It also enables survivors to
hear about new recommendations. Because there
is so much information in the news, women need
someone knowledgeable to say ‘yes, this is important
for you’ or ‘no, this doesn’t affect you.’”
Wellness Program
As emphasized in the American Society of Clinical
Oncology Guidelines, women generally don’t need
other tests, such as blood tests or scans for monitoring.
Women do need to focus on their overall health. For
this reason, the Comprehensive Breast Center offers
a Wellness Program, run by Christine Carpenter,
wellness coordinator, and funded by Rays of Hope:
A Walk Toward the Cure of Breast Cancer. Women
are eligible for this program after their surgery or
they complete their chemotherapy.
This program, offered at no charge at the Comprehensive
Breast Center, provides breast cancer survivors with
the tools they need to live and maintain a healthy
lifestyle. Participants meet weekly for six weeks to
discuss health and nutrition, stress management, and
physical fitness. Ongoing wellness programs are offered
twice a year for patients in the Survivorship Program,
with workshops coordinated by Ms. Carpenter.
16

Rays of Hope, A Walk Toward the Cure of
Breast Cancer, funds several projects to
improve the breast health of people in
western Massachusetts. To learn more,
visit baystatehealth.org/raysofhope.
Continued Vigilance
Dr. Makari-Judson and Wilson Mertens, MD, medical
director of the Baystate Regional Cancer Program,
recently published a review of the features of second
breast cancers, and found that they were generally
smaller size and earlier stage than the first cancer.
“This serves to emphasize the importance of ongoing
surveillance,” says Dr. Makari-Judson. “The yearly
visits are also a good time to update each patient’s
family history, since any new cancer diagnoses
may change the likelihood of a hereditary cancer
syndrome. Breast cancer survivors with hereditary
syndromes, like BRCA-1 and BRCA-2 may have
higher rates of second breast cancers.”
Since the Institute of Medicine has deemed survivorship
research a high priority, Dr. Makari-Judson
has also initiated a new research study that uses a
questionnaire for breast cancer survivors to gain
information about their prior treatments, attitudes,
and unmet needs.
“Most women will survive breast cancer,” she says.
“The goal of our Breast Cancer Survivorship Program
is to provide education, health maintenance, and
preventative services to this growing sector of our
community. We want to provide breast cancer
survivors with all the tools and resources they need
to live healthy lives long into the future.”
For more information,
or to refer a patient to the Breast
Cancer Survivorship Program, call
413-794-9338. For the Wellness
Program, call 413-794-2316.
Annual Survivors’
Day Celebration
“Our community has celebrated survivorship for 12 years now
through our Annual Survivor’s Day, funded by Rays of Hope,” says
Sandra Hubbard, WHNP, coordinator of the event.
Each year, 250-300 breast cancer survivors come together in the Spring
for a fun and informative day that celebrates their lives and provides
them with an opportunity to learn the latest news about breast cancer,
recovery, and ongoing wellness.
This year’s event, held at the Sheraton in Springfield, featured keynote
speaker Lillie Shockney, RN, BS, MAS, the administrative director
of the Johns Hopkins Breast Center, and a University Distinguished
Service Assistant Professor of Breast Cancer, who discussed “The Value
of Humor when Confronted with Breast Cancer.”
Participants were also able to select from a variety of workshops on topics
ranging from genetics and environmental concerns, to healthy cooking,
stress management, and relaxation techniques. Two workshops were
also offered in Spanish.
Women also enjoy the opportunity to bring a friend and connect with
other survivors while enjoying exhibits, a healthy continental breakfast
and luncheon, and socializing.
17

Restoring the Heart’s
Normal Rhythm
with Ablation:
Pulmonary Vein Isolation Technique
By Scott P. Edwards
More than 2 million Americans know the feeling. The sudden, pounding sensation
that feels like their heart is about to jump out of out their body. The pain and
pressure in their chest. The shortness of breath.
Electrophysiologists at Baystate Medical Center are
now using a relatively new approach to treat atrial
fibrillation (AF) by ablating the tiny areas of tissue
that cause this abnormal rhythm, thus restoring the
heart’s normal sinus rhythm and preventing the
formation of stroke-inducing blood clots.
Misfiring Muscle Cells
During a normal heartbeat, an electrical impulse in
the sinoatrial (SA) node fires and spreads through
the two atria, causing them to contract and forcing
blood into the ventricles. The ventricles then contract,
forcing blood out of the heart to the lungs
and the rest of the body. The normal heart beats
in a constant, repetitive rhythm, with about 60
to 100 beats per minute at rest.
When a person has AF, the most common type of heart
arrhythmia, the orderly electrical impulses that drive
the heart become rapid and disorganized, sometimes
raising the atrial rate to as high as 300 to 600 beats
per minute, and the ventricular rate up to 200 beats
per minute, causing a racing sensation in the chest.
“We’ve found that there are ‘sleeves’ of muscle cells
in these veins that are identical to heart cells,” says
Mathias L. Stoenescu, MD, a Baystate electrophysiologist.
“These cells become electrically active for some
unknown reason. They fire much more rapidly that
the normal sinus rhythm and take over the heart’s
pacemaker function.”
Atrial fibrillation increases the risk of clot formation
and thus stroke. Over time, untreated AF can lead
to heart failure and may even increase the risk of
premature death.
18

By ablating the tiny areas of tissue that cause
atrial fibrillation, electrophysiologists at Baystate can
restore the heart’s normal sinus rhythm and prevent the
formation of blood clots. (Shown: Dr. James Cook,
director, Cardiac Electrophysiology.)

Baystate electrophysiologists Drs. Mathias Stoenescu and Marshal Fox, say that PVI is much more
challenging to perform than other ablation procedures used to treat different forms of arrhythmia.
Pulmonary Vein Isolation
Treatment options for AF include medications,
lifestyle changes, and ablation procedures. Because
scientists know that most of the abnormal electrical
impulses originate in the four pulmonary veins,
the quest has been to develop an effective means
of interrupting these irregular signals.
Nearly 10 years ago, French doctors began using
catheters to find these areas of abnormal tissue and
cauterize them to eliminate AF. The technique was
effective, says Dr. Stoenescu, but carried side effects,
including scarring that narrowed the pulmonary
veins, causing the method to be abandoned.
A relatively new ablation technique, pulmonary vein
isolation (PVI), is increasingly being used to treat AF,
with excellent results. During the procedure, a flexible
catheter with an electrode attached to the tip is
inserted into the femoral vein in the groin and
directed toward the heart. Once inside the left
atrium, radiofrequency (RF) energy heats up the
electrode, and the electrophysiologist creates circular
scars around the pulmonary veins to prevent
electrical impulses from firing in the openings
of the pulmonary veins.
“We ablate these veins by burning circles at the junction
where the pulmonary veins meet the left atrium,”
says Marshal T. Fox, MD, a Baystate electrophysiologist.
“We basically isolate the veins at the left atrium,
hence the term pulmonary vein isolation.”
Drs. Fox and Stoenescu say that PVI is much more
challenging to perform than other ablation procedures
used to treat different forms of arrhythmia.
Because the catheter must travel from the right atrium
into the left atrium, electrophysiologists must perform
20

a transseptal catheterization. During this procedure,
a needle is used to make small hole in the septum
dividing the two atria. The catheter is then threaded
from one atrium to the other. After the procedure,
the hole closes on its own.
“Access from the right atrium to the left is more
difficult and takes longer,” says Dr. Stoenescu. “Also,
trying to isolate the pulmonary veins by going in a
point-to-point fashion so the electrical current can’t
slip through is tedious work.”
The average PVI procedure takes four to five hours
to complete compared to other ablation procedures,
which typically take less than two hours.
Outcomes and Risks
PVI is most effective in the initial stages of atrial
fibrillation — paroxysmal AF — during which the
heart beats in a normal rhythm with occasional
episodes of arrhythmia. Dr. Fox says patients with
paroxysmal AF respond well to the procedure, with
a 70 to 80 percent success rate.
The procedure’s effectiveness goes down in cases of
persistent AF, when the arrhythmia is usually present
with infrequent, short-lived episodes of normal sinus
rhythm, and in permanent AF, in which patients are
almost always in atrial fibrillation. “In the latter two
stages of AF,” says Dr. Stoenescu, “the success rate
drops to around 60 percent.”
While PVI is effective at stopping atrial fibrillation,
it is not without risk. As with any catheterization,
there is a slight risk of damaging blood vessels when
the catheter is inserted and directed toward the heart.
Ablating in or near the pulmonary veins can, in some
cases, lead to stenosis and reduced blood flow to the
heart. In addition, cauterizing the tissue can increase
the risk of blood clots, which if dislodged, can lead
to stroke.
Pulmonary vein isolation is
increasingly being used to treat
AF, with excellent results.
Perhaps the most serious complication of PVI is
atrial-esophageal fistula between the left atrium and
the adjacent esophagus caused by the RF energy used
to ablate abnormal tissue. Dr. Fox says that while
atrial-esophageal fistula is a “dangerous” complication,
it is rare, occurring in less than one percent of patients.
The biggest challenge doctors face in controlling
atrial fibrillation is learning more about the condition.
“Ablation for other forms of arrhythmia has a 90 to
100 percent success rate,” says Dr. Fox, “because we
know more about and understand these types of
arrhythmias and how to get rid of them. We’re still
learning about AF and how it responds to ablation.”
For more information
or to refer a patient, call 413-794-7246.
21

Honors &
Announcements
Lewis Cohen, MD
Ronald Burkman, MD
Samuel Borden, MD, program director
for the Med-Peds Residency at Baystate Medical
Center, has accepted a six-year appointment
on ACGME’s Standing Panel for Accreditation
Appeals in the Specialty of Internal Medicine-
Pediatrics. Combined med-peds residencies do
not have independent ACGME review committees;
instead, they are reviewed by either the
internal medicine or pediatric review committee.The
Standing Panel serves as an adjunct
to the respective review committee whenever
an appeal arises.
Ronald Burkman, MD, former chair
of Baystate Medical Center’s Department of
Obstetrics-Gynecology, has been appointed
editor-in-chief of Female Patient magazine.
Lewis Cohen, MD, of the Department of
Psychiatry at Baystate Medical Center, and
director of the Renal Palliative Care Initiative,
received the 2008 Tufts University School of
Medicine (TUSM) Distinguished Faculty Award
in March 2009. He was one of only two
recipients of the award, presented annually
to faculty members who have brought distinction
to themselves and to TUSM in the areas
of teaching, scholarship, and service.
Baystate Medical Center
is the Western Campus
of Tufts University School
of Medicine
Daniel Grow, MD, has been appointed
chair of the Department of Obstetrics & Gynecology
at Baystate Medical Center. Since his
arrival at Baystate in 1993, Dr. Grow has
served as the medical director for In Vitro Fertilization,
Baystate Reproductive Medicine, and
Wesson Women’s Group; chief of the Reproductive
Endocrinology Division; vice-chair and
interim-chair of the Department of Obstetrics
& Gynecology.
Leng Jiang, MD, director of Non-Invasive
Cardiology at Baystate Medical Center,
received the International Cooperation Award
at the 19th Great Wall International Congress
of Cardiology. Dr. Jiang is a respected clinician
and educator in both the United States and
China and has been involved in a collaboration
between the American Heart Association and
the Chinese Heart Association.
Paul Jodka, MD, program director of
Baystate’s Critical Care Medicine Fellowship,
has been appointed to the Society of Critical
Care Medicine’s Ethics Committee, which is
charged with evaluating the ethical implications
of all aspects of the practice of critical
care, making recommendations regarding
appropriate behavior, identifying areas needing
more research or debate in order to clarify
ethical implications, and educating SCCM
members regarding ethical practice and principles.
Dr. Jodka is also a fellow in the Division
of Medical Ethics at Harvard Medical School.
Sarah Perez McAdoo, MD, an obstetrician/gynecologist
at Baystate Medical Center,
and co-founder of the Youth Empowerment
and Adolescent Health Network, was one of
six community activists named “2009 Women
of Distinction” by the Girl Scouts of Central
and Western Massachusetts.
Edward O. Reiter, MD, pediatric endocrinologist
and former chair of the Department
of Pediatrics at Baystate Children’s Hospital,
was presented with the American Heart Association’s
2008 Ralph E. Gianelly Award in
recognition of his career as an outstanding
clinician and educator, world-renowned pediatric
endocrinologist, physician scientist, and
children’s advocate.The Ralph E. Gianelly
Award, which recognizes the accomplishments
of one who has been actively involved in the
community, is named in honor of one of
Springfield’s most revered cardiologists.
Stephen J. Ryzewicz, MD, Department
of Medicine at Baystate Medical Center, has
been named president-elect of the Massachusetts
Chapter of the American Society of
Addiction Medicine.
Heather Z. Sankey, MD, Department
of Obstetrics/Gynecology residency program
director, was appointed Junior Fellow Advisor
for District I of the American College of
Obstetrics and Gynecology.
22

Daniel Grow, MD Paul Jodka, MD Edward O. Reiter, MD Heather Z. Sankey, MD
Daniel Skiest, MD
Sarah Perez McAdoo, MD
Jay S. Steingrub, MD
Daniel Skiest, MD, has been appointed
chief of Infectious Diseases at Baystate Medical
Center. Dr. Skiest received his medical degree
from Case Western Reserve University School
of Medicine in Cleveland. He completed
residency training in internal medicine at
the University of Maryland in Baltimore, and
fellowship training in infectious diseases at
the University of Connecticut Health Center
in Farmington. Prior to joining Baystate in
2005, Dr. Skiest served as fellowship program
director in Infectious Diseases at the University
of Texas Southwestern. He joined Baystate’s
Infectious Diseases Division as director of
the HIV Program and professor of Medicine
at Tufts University School of Medicine.
Jay S. Steingrub, MD, vice chair for
the Research Division in the Department of
Medicine at Baystate Medical Center, was
awarded the 2008 Weinberg Family Prize,
Baystate Health’s highest academic honor,
for distinguishing himself as an outstanding
clinician, impassioned educator, and a highly
successful clinical investigator who has
brought significant national recognition to
Baystate Health for the division’s program
in critical care research.
Academic Updates
Baystate Medical Center is the region’s
only academic teaching hospital, and serves
as the Western Campus of Tufts University
School of Medicine.
New Appointments
• Barbara Greco, MD, and Anthony
Poindexter, MD, were appointed as
the new associate program directors
of the Nephrology Fellowship.
• Tara Catanzano, MD, was appointed as
the new associate program director for
the Radiology Residency.
Reaccreditations
• Baystate’s Obstetrics and Gynecology Residency
Program was reaccredited for four
years, with the next site visit scheduled for
October 2012. Heather Sankey, MD, serves
as the program director.
• Baystate’s Anesthesiology Residency
Program was reaccredited for three years,
with the next site visit scheduled for October
2011. Prasad Kilaru, MD, serves as the
program director.
• Baystate’s Pain Management Fellowship
Program was reaccredited for two years, with
the next site visit scheduled for October 2010.
Ravi Narasimhan, MD, is the program director.
• Baystate’s Critical Care Medicine/Anesthesiology
Fellowship Program was reaccredited
for four years, with the next site visit
scheduled for October 2012. Paul Jodka, MD,
serves as the program director.
• Baystate’s Pediatric Endocrinology fellowship
was reaccredited for five years. Holly Allen,
MD, is the program director.
Promotions
James H. Nichols, PhD, director of Clinical
Chemistry in the Department of Pathology
at Baystate Medical Center, was promoted to
professor at Tufts University School of Medicine.
Barbara Graves, CNM, with a patient.
Baystate’s Midwifery
Education Program Transitions
to Five-Semester Curriculum
Beginning in the Fall 2008, Baystate Medical
Center’s Midwifery Education Program transitioned
to a five-semester curriculum.Through
affiliation with the Midwifery Institute of
Philadelphia University, which offers distancebased
master’s completion, the program will
incorporate concurrent master’s degree study
within its five-semester curriculum.The first
class of students participating in this new
collaborative curriculum was admitted in
September. Baystate’s Midwifery Education
Program is accredited through 2017 by the
American Council for Midwifery Education.
23

Medical & Nursing Positions Available
at Baystate Health
Baystate Medical
Center, Springfield
• Advanced Practice
Cardiac: ICU, Intermediate Care,
Surgery, Telemetry
Cardiology
Community Health Medicine
Emergency Department
Heart & Vascular Services
Hospital Medicine
Infectious Disease Management
Neurosurgery
Orthopedics
Primary Care Medicine
Surgical Practices
• Clinical Psychologist
• Cytogenetic Technologists
• Histotechnologists
• Medical Assistants
(AAMA Certified)
• Medical Technologists
• Occupational Therapist
• Pharmacists
(Clinical/Inpatient, Ambulatory)
• Polysomnographic Technologists
• Practice Manager
• Radiology Services
CT Technologist
Vascular Sonographer
MRI Technologists
Nuclear Medicine Technologists
Radiologic Technologist
Radiation Therapist
Ultrasonographers
• Registered Nurses
Ambulatory Clinics and
Medical Practices
• Bariatric Surgical Practice
• Medical Practice Nurse
• Patient Care Coordinator
Cardiac Telemetry
Cardiovascular Intensive Care
Clinical Nurse Specialist
Clinical Research Coordinator
Community Health
Emergency Department
Flex Team: Critical Care
Homecare: Med/Surg
Intensive Care
Medical/Surgical
Oncology/D’Amour Center
for Cancer Care
Oncology Nurse Clinician
Operating Room
Pediatrics/Baystate Children’s Hospital
Pediatric Intensive Care
Post Anesthesia Care Unit
Radiology
Respiratory (RICP)
Substance Abuse & Recovery
Surgical Services
Telemetry
Women & Infants’
• Social Worker (LCSW, LICSW)
• Substance Abuse Counselor
(LADC/CADAC)
• Surgical Technologist
Baystate Franklin
Medical Center,
Greenfield
• Physical Therapist
• Respiratory Therapist
• Ultrasonographers
Baystate Mary Lane
Hospital, Ware
• Registered Nurses
To learn more
Physician Openings
(Call 413-794-2571, fax 413-794-5059,
or email: PhysicianCareers@baystatehealth.org)
• Cardiology
• Colorectal Surgery
• Critical Care/Pulmonology/Chief
• Emergency Medicine/Medical
Director
• Endocrine Surgery
• Family Practice
• Gastroenterology
• Genetics/Medical Director
& Faculty
• Geriatric Medicine
• Gynecologic Oncology
• Hematology/Oncology
• Hospitalist Medicine
• Internal Medicine
• Medicine/Pediatrics
• Neurology
• Neurosurgery
• Obstetrics & Gynecology
• Outpatient Adult Medicine
• Pediatrics/Medical Director
• Pediatric Endocrinology
• Pediatric Neurology
• Psychiatry
• Radiology/Interventional
• Reproductive
Endocrinology/Chief
• Thoracic Surgery
• Trauma Surgery
• Vascular Surgery
about career opportunities within Baystate Health
or to apply for a specific position, apply online
at baystatehealth.org/jobs, or call 1-800-767-6612.
EOE/AA
24

Springfield, MA 01199
Nonprofit
U.S. Postage
PAID
Springfield, MA
Permit No. 830
Continuing Education Calendar
(abbreviated version)
August
21 Advanced Cardiac Life Support Recertification
September
15-16 Dr. Martin Broder Education Day
17-18 Advanced Cardiac Life Support
21 STABLE
22 STABLE Cardiac
24-25 Pediatric Advanced Life Support
29 Update: Hospital Medicine
30 Ob/Gyn: What You Don’t Know CAN Hurt You
October
3-5 3 rd Annual Practical Medicine
Pediatrics Conference
6-7 Emergency Nursing Pediatric Core
22-25 End of Life Certificate Course
22-25 Not Just for Intensivists: State-of-the-Art
Approaches to Critical Care
23 13 th Annual Cardiac Nursing Symposium
27 Endocrinology & Metabolism Update
29-30 Advanced Trauma Life Support
30 Advanced Cardiac Life Support Recertification
November
4 Annual Wound Care Conference
5 6 th Annual Neonatal Conference
6 HIV Update 2009
6 Patient Safety & Risk Management in the
21 st Century: The Role of Simulation Training
12 Pediatric Advanced Life Support (Recertification)
13 Annual Psychiatry Course
17-18 Trauma Nursing Core Course
19 Lung Cancer
19-20 Advanced Cardiac Life Support
20 Transgender Medicine
Online Courses
If scheduling problems prevent you from attending
CE events, consider taking online courses for credit at
baystatehealth.org/learn. Courses are presented by Baystate
Health faculty and visiting professors and include interactive
post-tests, online evaluations, and the ability to print your
attendance verification immediately.
For more information about any of these events, please call
The Office of Continuing Education at 413-794-3466, or write:
Baystate Medical Center, Continuing Education, 361 Whitney Avenue,
Holyoke, MA 01040. For online course information or to access
your personal BH Continuing Education transcript online, go to
baystatehealth.org/learn.