Winter 2013 - West Chester Hospital - UC Health

Discover HealtH
W e s t C h e s t e r h o s p ii t a l
WINTER 2013
World Class Medicine. Locally Delivered.
Spine Surgery
Can Be a Successful Solution
p. 4
An Inside Look at the Thyroid p. 6
Palliative Care Improves
p. 7
Quality of Life
p. 7
Exercise & COPD p. 2
Life After a Heart Attack p. 3
West Chester Hospital 1

Working Together for a
Stronger Community
Kevin Joseph, MD
It is a critical part of the vision at West Chester Hospital to be the
community’s quality health care partner and a regional leader in
solving complex medical problems.
Being a partner means giving back to the community, reaching
beyond our hospital walls and improving the communities that our
patients and employees call home.
West Chester Hospital has an ongoing, robust commitment to
contribute in-kind services and financial support to fellow nonprofit
organizations that share our goal of improving health care services.
In 2013, we will continue that support, which takes the form of
donations to events and organizations, sponsorships of health
programs, free health screenings and an array of free community
education and outreach events.
For example, West Chester Hospital makes contributions to more than
three dozen local community groups and charities. These donations
support a wide variety of charitable initiatives and organizations within
the community. In addition, West Chester Hospital will again host free
monthly seminars on a wide range of medical issues and diseases (please
see our calendar on page 8 for details).
West Chester Hospital will remain committed to strengthening our
community. We stand by our promise to serve as our community’s
quality care partner, and will continue to serve as a steadfast partner
for continued growth and sustainability.
Yours in health,
Kevin Joseph, MD
President and CEO
West Chester Hospital
Exercise & Pulmonary Disease
The lung is an amazing organ when
you consider it has a capacity of
about six liters (1.5 gallons) of air.
During normal breathing, we only
use a small amount of that volume.
Unfortunately, it is because the lung
is such a robust organ that it may not
be obvious at first that something
bad is happening if we contract a
lung illness like chronic obstructive
pulmonary disease (COPD).
“Human lung capacity is so great
that you can lose around half of
Charles Kim, MD, Pulmonologist your lung function before you even
know it,” says Charles Kim, MD, a pulmonologist at West Chester Hospital.
“That’s why people may not know they have COPD. Once you have
the symptoms, it may mean the damage is done.”
COPD, one of the most common lung diseases, makes it difficult to
breathe. The two main forms are chronic bronchitis, manifested by a
long-term, mucous-filled cough, and emphysema, which results in the
destruction of lung tissue. Most people with COPD have a combination
of these conditions.
The primary cause of COPD is smoking. Other causes stem from heavy
exposure to pollution, workplace fumes or secondhand smoke (basically
repeated toxic lung injury over a period of time).
Dr. Kim says one warning sign is a change in your tolerance of exercise.
Diagnostic tools include a chest X-ray and pulmonary function or
breathing tests.
The hard reality about COPD, as Dr. Kim puts it, is that “The lung
doesn’t regenerate.” The other reality is that COPD can set in even if
a heavy smoker quit more than a decade ago.
“Everyone’s lungs worsen as they grow older. For smokers, their lungs
worsen twice as fast, with lung function declining at an earlier age.
With COPD, destruction of the actual lung tissue takes place, decreasing
the amount of lung you can use.”
The primary cause of COPD is smoking.
What Can COPD Patients Do
Exercise can be key to maintaining what’s left of lung capacity. Pulmonary
rehabilitation, a certified exercise program can help the body
utilize oxygen more efficiently and improve energy levels, circulation
and endurance. Dr. Kim says many people may find it helpful to enroll
in a structured pulmonary rehabilitation program.
Of course, since it’s harder to breathe, it’s harder to exercise. However, Dr.
Kim says, he’s seen many patients overcome the disability.
“I always find it amazing what people can accomplish when challenged
and how much the mind can overcome the body,” he says. “Once a patient
comes to the realization of how poor their lung function is, amazing
progress can be made. The goal of exercise therapy is to preserve
lung function for as long as possible.”
COPD is also treated with maintenance medicines that help
reduce inflammation and constriction in the airways and
preventative care such as yearly follow-ups. In severe cases, oxygen
therapy can be used. In extreme cases, surgery is required
for a lung transplant or to remove parts of the damaged lung to improve
breathing.
Find a primary care physician or respiratory specialist by calling
513-298-DOCS (3627). To learn about respiratory care services
at West Chester Hospital, visit UCHealth.com/WestChesterHospital
and choose “Pulmonology/Respiratory Care” under the
“Services” menu.
2 West Chester Hospital

Ady Kendler, MD, was at the gym, doing his regular exercise
routine, when he had a heart attack.
“I started feeling an intense back pain. I thought I had pulled
a muscle. Then I realized it was something more,” said
Kendler. “I asked them to call an ambulance.”
Kendler, a surgical pathologist at UC Health, had what is
called acute coronary artery syndrome, the blockage of
an artery from a clot. It was successfully removed and there
was no damage to his heart.
In many ways Kendler’s case is atypical. He was in good shape
and wasn’t overweight, unlike many heart attack victims. Even
though he is a doctor, he didn’t immediately think “heart attack.”
“It wasn’t like the textbooks with the classic description of a feeling that
your chest is being crushed,” he says. It turned out Kendler had a family
history of heart problems and the cause was likely genetic.
The prescription for his recovery program, however, was the same
for nearly all heart attack patients these days: an immediate, regular
exercise program in a controlled environment, otherwise known as
cardiac rehabilitation.
“We want to get people exercising, but perhaps not immediately at the
level they had been doing previously,” says Faisal Khan, MD, a cardiologist
at West Chester Hospital and an assistant professor of cardiology
at the University of Cincinnati College of Medicine. “Patients need
to undergo continuous monitoring of blood pressure, heart rate, and
signs of any arrhythmia.”
“Cardiac rehab
takes place within a
controlled environment
where you can slowly
increase the amount of
exercise.”
Faisal Khan, MD, Cardiologist
West Chester Hospital recently opened a cardiac rehabilitation
program.
“For heart attack patients, research shows exercise is as effective, if not
more so, than any other intervention, such as medication,” says Terry
Faulkner, RN, clinical nurse manager for the program.
Indeed, the treatment plan for heart attack patients is almost opposite
that of 20 or 30 years ago. At that time, patients were monitored in the
hospital for days, even weeks, instructed to go home and “take it easy.”
Now it’s “hit the treadmill.”
“The exercise that heart patients need is, in many ways, no different
than what anyone should be doing all along,” Dr. Khan says. “It’s the
same cardiovascular, aerobic workouts. The difference is that cardiac
rehab takes place within a controlled environment where you can
slowly increase the amount of exercise.”
Ady Kendler, MD, a surgical pathologist, was exercising at
the gym when he experienced a heart attack.
Faulkner says there is often a psychological “catch-22” about exercise
for cardiac rehab patients. They understand they need it, but have a
fear of whether their repaired heart can handle it.
“People can go into a depression because of the fear of what they can
do,” says Faulkner. “Sometimes the family unwittingly doesn’t help.
They may hover over a person telling him not to do something. Our
job is to say, ‘Why not You can do this.’ ”
Faulkner says rehab can quickly bring a person’s confidence back.
“They soon realize, ‘Hey, I am safe to exercise and by doing so, I am preventing
a second occurrence.’ ”
Three Phases of Cardiac Rehab
The West Chester Hospital cardiac rehabilitation program is furnished
with state-of-the-art equipment, including many things you see at a
gym – treadmills, bicycles, ellipticals, and other exercise accessories.
“We first educate the patient at the bedside before hospital
discharge so there is a clear expectation,” Dr. Khan says. “It includes
information about diet, exercise and lifestyle modification.”
The second outpatient phase features a rehabilitation regimen tailored
to a patient’s condition and closely monitored within the West Chester
Hospital cardiac rehab unit.
The third phase involves the patient following a continuing
exercise program away from the hospital setting that does not require
monitoring.
Kendler says what worked best for him is the group therapy nature of
being in a setting with people facing a similar problem. “I think the
most important thing was having the support of the staff and other
patients,” he says.
In the eight months since his heart attack, Kendler says he’s back to his
regular exercise routine.
Kendler says he learned the importance of managing stress, a problem
common for people from all walks of life. “I realized exercise is not just
good for your heart. It’s great to clear your mind.”
For more information about the cardiac rehabilitation program
at West Chester Hospital, located at 7675 Wellness Way, West
Chester, OH, call 513-298-7799.
West Chester Hospital 3

Spine Surgery
Can be a Successful Solution
Ian Rodway, MD, Spine Surgeon
Tips
for a
healthy back
Back pain may be one of the most common complaints of the human
condition. In the U.S., studies have shown that acute lower back pain
ranks fifth among reasons why people visit a doctor.
Back pain can have multiple causes due to the vast network of nerves,
joints, muscles, tendons and ligaments emanating from the spine. All
can contribute to a problem, with most relieved with steroid medication,
muscle relaxants or physical therapy.
People can do many things to keep their backs healthy, according to Ian
Rodway, MD, a spine surgeon at West Chester Hospital.
“The key is to maintain good core muscle and postural muscle strength,
because these muscles keep everything else in place,” Dr. Rodway says.
“If the core muscles are strong, you’ll be moving correctly and not putting
undue pressure on the lower back.”
Other tips from Dr. Rodway include:
Avoid repetitive impact activities. Do low-impact exercises such as
swimming or elliptical machines rather than running on hard surfaces
for a long time. Running – even on a treadmill – can cause
increased impact and stress on your low back and joints.
Hamstring stretching is important because hamstrings can pull on
the pelvis and the lower back.
Maintain a healthy weight to relieve extra pressure on the spine and joints.
Good posture helps maintain proper spine alignment.
A physical therapist or certified trainer can instruct you on how to
strengthen back muscles and teach proper lifting and bending techniques.
Smoking is bad for your back (in addition to everything else) as it can
cause disc degeneration, and subsequent increased back pain.
A repetitive back problem often means a person hasn’t properly rehabilitated
an injury, which leaves one prone to subsequent problems.
Find an orthopaedic specialist by calling 513-298-DOCS (3627).
To learn about orthopaedic services available at West Chester Hospital,
visit UCHealth.com/WestChesterHospital and click on “Orthopaedics”
under the “Services” menu.
At first, Allison Campbell thought it was just a pinched nerve or stiff neck.
Her pain wasn’t that bad. And the soreness would go away as the day passed.
But the pain continued. “I went through a lot of excuses, like it must be my
pillow or mattress,” says Campbell, 32, of Mason. “I was just avoiding seeing
the doctor.”
Then one morning she woke to excruciating pain in her neck and her right
arm was numb.
“At that point, things go through your mind – what’s going on with my body
I’m a mother of a 10-year-old daughter. This can’t be happening.”
Ian Rodway, MD, a spine surgeon at West Chester Hospital, first treated
Campbell with steroids, which relieved the pain.
Dr. Rodway says Campbell’s initial treatment was typical in that back and
spinal problems are almost always treated first with medication.
“We initially treat with oral steroids, muscle relaxants, physical therapy and
sometimes epidural steroid injections to calm down those pinched nerves,”
Dr. Rodway says.
Dr. Rodway believes the discussion about whether to undergo surgery
should not take place until all other treatments have failed and a patient is
unable to live with the problem.
“We also must consider whether there is significant weakness and numbness
that will contribute to permanent loss,” he says. “When conservative methods
fail, surgery is an option.”
That was the case with Campbell, a teacher at Blue Ash Elementary. Her
numbness had grown worse and extended to her arm. A magnetic resonance
imaging (MRI) scan showed Campbell had what’s known as a bulging
or extruded disc in the cervical spine in her neck. The disc can bulge or
sometimes tear through its outer shell and push into the spinal canal causing
compression of the nerves and the spinal cord.
“When they discovered it, they wondered how I could be walking around and
functioning. I guess I have a high tolerance for pain,” Campbell says. “At first, I
put off surgery because of my job. Then the excruciating pain returned and I
couldn’t lie down. I was seen very quickly and my pain was addressed.”
4 West 4 West Chester Hospital Hospital

Allison Campbell enjoys
spending time with her
10-year-old daughter.
Dr. Rodway performed Campbell’s surgery at West Chester Hospital.
For Campbell, having surgery resulted in a positive outcome.
“As much as I do not like being poked and prodded with needles, that
was the only hard part,” she says. “Everyone at West Chester Hospital
was kind and professional. They catered to everything and anything
I needed.”
Dr. Rodway performed what is commonly called a spinal fusion to the
involved cervical vertebrae. Surgeons use a bone graft that acts as a
bridge between the two vertebrae, allowing the spinal fusion. Metal
plates and screws are used to hold the bone graft and vertebrae together
until the bone grows across the graft.
“Technically, it’s called an anterior cervical discectomy and fusion,” Dr.
Rodway says. “It relieves the pressure from the nerve. Often, with
these surgeries, you can return to normal activities without restrictions.”
Campbell has successfully resumed her active life that includes
a busy schedule as a wife, mom, teacher and runner since the surgery
in September.
“I’m a very physical person, an avid runner, and wave and snow boarder,”
she said. “The first four weeks of recovery I had to stick to walking
and the elliptical. After six weeks I could start running. I started slow.”
It’s not always clear what causes herniated discs, though genetics and
activities are thought to play a major role . In Campbell’s case, she could
recall no single incident where she injured her neck. Doctors know the
problems are more common when there is a family history. Being overweight
or lack of exercise can also weaken muscles making it easier for
a bulging disc to develop. In most cases, pain can lessen in a few weeks
with minimal treatment and surgery remains the exception.
Campbell is pleased that surgery was a successful solution for her and
she has no complaints. “I’ve been able to get back to my normal level
of activity as if nothing had happened.”
West Chester Hospital:
Among Best in Nation for Spine Surgery
West Chester Hospital has been named
one of America’s 100 Best Hospitals
for Spine Surgery for 2012-2013 by
Healthgrades®, a leading provider of
consumer health information.
The five-star recognition placing West Chester Hospital among
the top 10 percent in the nation for spine surgery is part of a
Healthgrades report, “American Hospital Quality Outcomes
2013,” which evaluates the performance of approximately 4,500
hospitals nationwide across 30 of the most common conditions
and procedures.
Healthgrades independently measures hospitals based on data
the hospitals submit to the federal government.
Other West Chester Hospital recognitions from Healthgrades:
2013 Spine Surgery Excellence Award
One of the top five hospitals in Ohio for Spine Surgery
The 2013 Healthgrades Report to The Nation,
including complete methodology, can be found at www.
healthgrades.com/quality.
West Chester Hospital 5

An
Inside
Look
at the Thyroid
In consumer healthcare reporting, it seems the thyroid gland is
rarely mentioned, but why For most people, the gland just keeps on
secreting, and there is actually nothing we can do to “maintain” or
“exercise” our thyroid.
“Many patients with thyroid dysfunction and/or nodules have a family
history of a thyroid problem,” says David Steward, MD, ear, nose and
throat specialist at West Chester Hospital and professor of thyroid/
parathyroid disorders at the University of Cincinnati College of Medicine.
“The main risk factors for thyroid cancer are a family history, or a history
of radiation exposure.”
Diagnosis of a thyroid condition
is fairly straightforward – a
blood test can measure the
amount of thyroid hormones.
The thyroid gland is located in the neck just below the Adam’s apple and
produces hormones that regulate the body’s metabolism; that is, how
quickly and efficiently the body’s cells use energy. It produces thyroid
hormones and controls how sensitive the body is to other hormones.
Two main thyroid problems can occur with thyroid function – an
overactive gland (hyperthyroidism) and an underactive one
(hypothyroidism).
“The symptoms for an underactive thyroid include chronic fatigue,
lethargy and weight gain,” says Dr. Steward. “For an overactive thyroid,
there can be palpitations, tremors and weight loss.”
Although symptoms are non-specific, diagnosis of a thyroid condition is
fairly straightforward – a blood test can measure the amount of thyroid
hormones. Hypothyroidism (underactive) can be treated with hormone
medication. A hypothyroid (overactive) gland also may be treated with
medication to reduce thyroid hormone production..
“Thyroid cancer may occur in thyroid nodules,” Dr. Steward said. “They can
be thought of as lumps or bumps within the thyroid with approximately
a five percent chance of malignancy.”
The presence of nodules – benign or malignant – most often have
little effect on the functioning of the thyroid. For reasons not fully
David Steward, MD, ENT specialist, discusses thyroid disorders with a patient.
understood, thyroid nodules are far more common in women,
according to Dr. Steward.
A doctor can detect nodules in a routine exam, or they might show up
on imaging of the spine, lungs or neck. Ultrasound is used to evaluate
neck, chest or thyroid nodules. If malignancy is suspected, it can be
diagnosed with an ultrasound-guided fine needle biopsy.
Thyroid cancer has one of
the highest cure rates.
Thyroid cancer has one of the highest cure rates. “Thyroid cancer is
increasing in frequency, but the prognosis is overall favorable,” says Dr.
Steward. “There are a couple types of aggressive thyroid cancer, but
thankfully, those are extremely rare.”
In general, Dr. Steward says people needn’t worry about the thyroid,
unless symptoms appear. “People with a family history of thyroid
conditions or history of radiation exposure or treatment should
always inform their primary care physician who may question them,
palpate their thyroid gland and order additional blood tests or
imaging,” he says.
For the name of an ear, nose and throat specialist or a cancer physician,
call 513-298-DOCS (3627).
Looking for Your Input
We would like to hear from you! Please
share your feedback about Discover Health
magazine as well as your ideas or health
topics that you would like to see included
in upcoming issues. Send feedback to West
Chester Hospital by emailing WCH@UCHealth.
com. Thank you for your input!
6 West Chester Hospital

Palliative Care Improves
Quality of Life
The code of medical ethics instructs physicians to “first, do no harm.” The
new palliative care program at West Chester Hospital takes the next logical
step by asking, “How can we make quality of life better”
Palliative medicine is the field of health care that focuses on relieving the
suffering of patients and improving their quality of life. It is appropriate
for all diseases and all stages of illness, not only end-of-life care. Palliative
care usually focuses on symptoms, regardless of whether the treatment has
a curative effect on the underlying causes of an ailment.
“When we started the program we decided on a motto to sum up our
approach. It is: ‘I am here to help you,’ ” says Edward Crane, MD, medical
director of hematology/oncology and the palliative care program at
West Chester Hospital. “There is a resurgence of interest in palliative
care. People are understanding you can’t exclusively focus on a disease
and not focus on the well-being of the patient.”
Although most hospitals offer some palliative care component, Dr. Crane
says the West Chester Hospital program, is one of the most comprehensive
in the region. Four staff physicians are available on a rotating basis for palliative
consultations. Three of those physicians are certified in the field, a
rarity within one hospital, according to Dr. Crane.
The program is far more involved than a physician simply paying a visit
and making spur-of-the-moment recommendations.
“It’s a multidisciplinary approach,” Dr. Crane says. “We bring in experts
in physical therapy, nutrition, spiritual care, pharmacy, social
services and other care disciplines. Our team assesses the overall
status of the patient. The physician then creates a plan based on the
team’s recommendations.”
Palliative care can apply to a range of issues, including the side effects of
chemotherapy, COPD, dementia, depression or heart failure. They make
recommendations about medicines, like morphine, for pain control.
The program deals with home care needs as well. “We look at the tools
and resources that can return a patient home successfully,” Dr. Crane
says. “Our social workers get involved. Sometimes it’s just an issue of
reviewing medications. The point of palliative care is that the quality of
the patient’s life must be improved.”
While the palliative team is involved in providing end-of-life care, Dr.
Crane says the vast majority of consults involve how to improve the
quality of life for the patient who isn’t ready for hospice care.
Palliative care is the field of medicine
that focuses on relieving suffering while
improving quality of life.
Palliative care can help a patient decide upon advanced directives, often
known as a living will, and a healthcare power of attorney, specifying
the course of treatment to be allowed if patients are unable to participate
in decisions in their final days. The directives can forbid certain
burdensome treatment and may deal specifically with whether to forgo
medical devices or even food and water.
While having advanced directives is helpful for the medical team, Dr.
Crane thinks it’s not so much the documents that are important, but the
conversation that they require families to have.
“Sometimes it doesn’t matter what’s on paper, as long as the family comes
together. It’s important to promote this discussion so family members
can hear and understand the patient’s wishes.”
Dr. Crane says he became interested in establishing a palliative care
program at West Chester Hospital after working with patients in his
private practice. He wanted the program to be comprehensive and
multidisciplinary. He found an involved palliative team helps attending
physicians obtain a full assessment of his/her patient from an educated
independent outside source which can ensure that treatment goals of
the patient and attending physician are aligned. “I have been impressed
with the passion of our team which includes Dr. Prasad Kudalkar, Dr.
Charles Kim and Dr. Arvind Modawal,” Dr. Crane says. “When we
developed this program, we actually had many physicians coming to us
saying, ‘Thank you, this is going to be very helpful.’ ”
Edward Crane, MD, oncologist and medical director of the
palliative care program at West Chester Hospital, is a strong
proponent of improving quality of life for all patients.
West Chester Hospital 7

West Chester Hospital
7700 University Drive
West Chester, OH 45069
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Discover Health is a quarterly magazine published by West Chester Hospital to provide accurate and timely health information. It is offered as a health education tool featuring news and stories centered
around academic-based, discovery-driven health care - it is not a substitute for consultation with a personal physician. West Chester Hospital is located at 7700 University Drive, West Chester,
Ohio 45069. For information, call (513) 298-3000 or visit www.UCHealth.com/WestChesterHospital. If you do not wish to receive future issues of this publication, please email WCH@UCHealth.com.
Calendar of Events
West Chester Hospital is a health information resource for people in West Chester and surrounding communities. Events and
activities listed on this calendar are held within West Chester Hospital, 7700 University Drive, West Chester, Ohio 45069, unless
otherwise noted. To register for community seminars, call 513-298-3000.
UC Health Weight Loss Center Informational Seminars
Thursdays (7-8 p.m.): March 14, March 26, April 18, May 16, Plaza Conference Room, Level A
Register online at UCHealth.com/WeightLoss.
Colon Health Community Seminar
Wed., March 27 (7-8:30 p.m.) AND Sat., March 30 (9-10:30 a.m.), Plaza Conference Room, Level A
Foot & Ankle Health Community Seminar
Wed., April 24 (7-8:30 p.m.) AND Sat., April 27 (9-10:30 a.m.), Plaza Conference Room, Level A
SAVE THE DATE! Summer of Love: Second Annual West Chester Hospital Fundraiser Gala
Friday, April 26 (7-11 p.m.), Cincinnati Marriott North
Skin Cancer Community Seminar
Wed., May 15 (7-8:30 p.m.) AND Sat., May 18 (9-10:30 a.m.), Plaza Conference Room, Level A
Like Us on Facebook
and stay informed about
upcoming seminars and
events at West Chester
Hospital!
West Chester Hospital
Named one of America’s 100 Best Hospitals
for Spine Surgery TM for 2012-2013
by Healthgrades®
8 West Chester Hospital
UCHealth.com/WestChesterHospital