MyGeorgetownMDSpring 2016

A MedStar Georgetown University Hospital Publication

IN THIS ISSUE 2 Renewal of Hospital Chapel to Provide

Comfort for Patients and Visitors3 Keeping Patients Active With the

Right Approach to Elbow Surgery5 When It Comes to Stroke Treatment,

Act FAST!

Second Opinion Gives Blood Cancer Patient a Second Chance By Leslie A. Whitlinger

Living Liver Donor, ‘Hero’ of Baby’s Life-Saving TransplantBy Jennifer Davis

Diana Rotter, a 30-year-old from Denton, Md., is a movie theater manager who loves watching films. She never imagined one day she would star as the real-life hero in a dramatic storyline of her own.

Last July, Diana’s mother came home from a christening at her church distraught after learning the baby being celebrated would die within months if she didn’t get a new liver.

Diana Rotter, left, donated part of her liver to save baby Natalia Walker’s life. Diana is doing well following her surgery and is thankful to the Living Donor Program at MedStar Georgetown for matching her with Natalia and providing expert care.

continued on page 6

Alecia, wearing red, was the 50th bone marrow transplant patient treated at MedStar Georgetown, following her multiple myeloma diagnosis. In recovery, she has enjoyed spending time with her grandkids, Corey, far left, Caylee and Craig Jr.

When Alecia Benjamin was diagnosed with a relatively rare type of blood cancer, multiple myeloma, in 2015, she wasn’t about to gamble with her health. The resident of the U.S. Virgin Islands traveled stateside on two separate occasions to get second opinions.

One of them was a referral to MedStar Georgetown University Hospital, where its life-prolonging Bone Marrow and Stem Cell Transplant (BMT) Program gave Alecia the second chance she hoped for.

“Once considered experimental, BMT is today’s established gold standard

for treating patients with a number of malignant and benign diseases of the blood and bone marrow, including multiple myeloma, lymphoma, and acute and chronic leukemia,” says Scott Rowley, MD, MedStar BMT program director. “For some conditions, it can actually be a cure; for others, it definitely prolongs survival and improves quality of life.”

Multiple myeloma is a blood cancer that resides in the bone marrow, eventually leading to anemia, kidney failure, bone loss and other serious conditions. The cancer affects approximately 30,000 new patients in the United States each year. continued on page 7

Photo courtesy of Diana Rotter

Photo by Herman Farrer

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The Huntington’s Disease Society of America (HDSA) designated the Huntington’s Disease Care, Education and Research Center at MedStar Georgetown University Hospital as an HDSA Center of Excellence, one of only 39 designated Centers across the country. The designation comes with a grant to support services for Huntington’s disease patients and their families, including clinical and social services, patient education and research. The Center at MedStar Georgetown is a collaborative effort with support from Georgetown University Medical Center, MedStar Georgetown and the Griffin Foundation.

“Our Center opened in 2012 as the first comprehensive, multidisciplinary

center in the Washington, D.C. area,” says Carlo Tornatore, MD, interim chair of neurology at MedStar Georgetown. “The center hosts multiple services provided by a social worker, neurologist, neuropsychiatrist, neuropsychologist, genetic counselor, speech therapist and occupational therapist. Patients also have access to clinical trials for emerging therapies.”

The goal of the Center of Excellence Program is to increase access to the best possible multidisciplinary clinical care and services for individuals affected by Huntington’s disease.

Renewal of Hospital Chapel to Provide Comfort for Patients and Visitors By Ronni Cranwell

Over the past 69 years, the MedStar Georgetown University Hospital chapel has been an important place of worship, respite and healing for patients and families of all backgrounds and religious or spiritual denominations. It serves as a tranquil and sacred place where hospital visitors can find solace during some of their most difficult times.

“The chapel is meant to be a place of comfort to all people, not just those of any one particular religious faith or tradition,” says Deacon Thomas J. Devaney, director of mission and pastoral care at MedStar Georgetown. “We welcome anyone who is looking for a quiet place of reflection or prayer. Providing this kind of space on campus is important, but it needs updating.” The MedStar Georgetown chapel was built in 1947 along with the main hospital and has had very few upgrades.

In an effort to maintain this peaceful and meditative space, the Office of Philanthropy at MedStar Georgetown started the Chapel Renovation Fund to provide an uplifting and comfortable space for patients and visitors. Improvements will include refurbished pews and a new organ.

To date, the Chapel Renovation Fund has raised a third of its $100,000 goal, thanks to many supportive donors who understand the importance of

the chapel to the hospital and the community. The funds will go toward updating the space with new furniture and a new audiovisual system to allow patients to watch services from their rooms.

To donate to the Chapel Renovation Fund or to learn more about other philanthropic efforts, visit MedStarGeorgetown.org/ Donate or call the Office of Philanthropy at 855-546-1087.

To learn more about the Huntington’s Disease Care, Education and Research Center at MedStar Georgetown, visit MedStarGeorgetown.org/Huntingtons or call 855-546-1895.

Huntington’s Disease Center Designated as Center of Excellence By Marianne Worley

Planned updates to the hospital chapel will provide a tranquil and meditative space for all members of the community and beyond.

Photo by Hunter Hardinge

Join Us for a Free Lecture May 18, 2016 • 7 p.m.GERD: Serious Help for Serious But Treatable IndigestionLearn more about the causes and cures of Gastroesophageal Reflux Disease.

MedStarGeorgetown.org/GERDLecture855-546-0777

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Elbow injuries tend to happen to active people, and 83-year-old Richard Wright of Montgomery Village, Md., certainly fits that profile.

The avid cyclist was out for a ride in the woods in November of last year when his bike drifted off a path obscured by leaves and jackknifed. He was thrown to the ground, breaking his arm.

“It was a pretty sharp pain when I hit the ground,” Richard says. “I actually thought about getting back on the bicycle, but I was feeling enough shock I thought that wouldn’t be a good idea. So, I called my daughter and got a ride home.”

Not one to slow down, the retired engineer had planned to read at his church that evening and went on as scheduled. But, the next morning, he knew he needed to head to his local emergency room when the pain wouldn’t subside. Doctors there recommended setting his arm, but Richard wanted a second opinion. That led him to the MedStar Orthopaedic Institute at MedStar Georgetown University Hospital.

“Most patients know something is wrong, because when they try to straighten their arm, they can’t do it and it’s extremely debilitating,” says MedStar Georgetown orthopaedic hand surgeon, Curtis Henn, MD. “They almost can’t do anything with their arm. There is a lot of swelling and it’s very painful.”

Richard had a displaced fracture at his elbow, rendering useless the muscle used to straighten his elbow. Dr. Henn recommended a surgery called open reduction and internal fixation of an olecranon fracture.

It restores proper alignment of bones, allowing movement of the elbow while the fracture is healing. This approach prevents joint stiffness. Without surgery, his elbow would be in a cast for four to six weeks, which could lead to profound and permanent elbow stiffness.

“Of all the joints in the body, the elbow is one most prone to stiffness after the shortest period of time,” explains Michael Kessler, MD, chief of Hand and Elbow Surgery in the Department of Orthopaedics at MedStar Georgetown. “Addressing this injury early with surgery allows patients to move their elbow right away. If you don’t do that, once the

stiffness sets in, you can get stuck, and the only way to release that stiffness is another surgery.”

Richard’s operation was fairly standard, lasting less than two hours. Seven screws and a plate were used to put his elbow back together and he was out of the hospital that day.

Richard wore a splint for two weeks, but was able to write within a week. Ten days after surgery, once his postoperative dressing was removed, he began working on elbow motion through physical therapy. Three months later, his elbow was nearly back to normal, and his incision healed so well the scar is barely visible.

“This can be a home run of a procedure because patients can regain full motion and can get back to doing what they want to do, once the fracture is healed,” Dr. Henn explains.

Richard’s main focus was to get back on his bike. “We see a lot of patients like him who are still very active,” says Dr. Henn. “Part of our role is to help them stay active, which in turn keeps them healthy.”

Richard says he is working his way back to exercise. “I’m using a stationary bike now, but it’s nowhere near as much fun. I think, when the weather eases, I will give serious consideration to getting back on the bicycle, and I thank the great service I received at MedStar Georgetown for making that possible.”

Keeping Patients Active With the Right Approach to Elbow SurgeryBy Jennifer Davis

Though a fall off his bike resulted in a broken arm, a procedure that prevents post-operative stiffness in the elbow was performed at MedStar Georgetown and allows Richard to ride again.

To learn more about hand and elbow surgery at MedStar Georgetown, visit MedStarGeorgetown.org/Elbow or call 855-546-3968 to make an appointment.

Photo by Herman Farrer

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Minimally Invasive Treatment for Rare Stomach Condition Returns Patient to His Passions By Heidi Rosvold-Brenholtz

Sixty-nine-year-old Jeff Ferrill of Alexandria, Va., can swallow and eat comfortably again, after nearly three years of appointments to treat a rare and complicated gastrointestinal condition.

Rewind to 2012, when Jeff arrived at the Emergency Department at MedStar Georgetown University Hospital. He was vomiting, delirious and in extreme abdominal pain. The physicians’ rapid assessment revealed gastric volvulus, a condition in which part, or all, of the stomach twists more than 180 degrees.

Similar to a towel being wrung out to dry, blood supply to the stomach is compromised with the condition, commonly referred to as twisted gut or colic. Common in horses, twisted gut is familiar to equine enthusiasts like Jeff. “I never realized the same condition could also happen to humans,” he says.

While rare, gastric volvulus is more frequently seen in older adult males. Without surgical intervention, it is usually fatal. About one third of gastric volvulus cases are associated with hiatal hernia, a condition in which part of the stomach protrudes through a small opening in the diaphragm muscle and into the chest, causing painful pressure, acid reflux and other symptoms.

Jeff ’s long history with hiatal hernia likely contributed to his life-threatening condition. Fast intervention and emergency surgery by the surgical team, headed by Patrick Jackson, MD, at MedStar Georgetown was critical to saving his life and a quarter of his stomach.

“Jeff’s surgery was complicated by the severity of his condition,” explains Nadim Haddad, MD, chief of the Division of Gastroenterology and

Hepatology. “A stricture, or blockage, at the surgical site between his esophagus and stomach prevented him from swallowing.”

For circumstances like Jeff’s, there are typically two options available for opening the blockage. One requires major surgery to resect, or cut and connect, the esophagus to the small bowel—an invasive option that greatly impacts a patient’s quality of life. The second option is less invasive and involves endoscopic intervention to stretch the narrowed area between the esophagus and stomach and temporarily implant stents, or miniature metal tubes, that expand to prop the esophagus open.

“Because of our team approach to surgery, we recognized the severity of Jeff’s condition and acted on it immediately, using the less invasive option,” explains Dr. Haddad. “In another setting, a surgical team likely would have moved forward with a resection.”

It’s taken Jeff three long years of hard work and persistence to recover. It’s not uncommon when treating a serious esophageal stricture like Jeff’s for the esophagus to close after stents are removed or, because of scarring, to require more stretching and stenting over many months, according to Dr. Haddad. “Treatment is very challenging for the patient and it’s very important to follow medical advice. It is not just one procedure,” he says.

Finally, after about 10 dilations, Jeff’s esophagus responded and stayed open. “With each stretching, I could swallow a little bit more,” he says. Prior to Dr. Haddad’s treatment, eating was nearly impossible for Jeff. Even with liquid supplements, followed by only specially prepared food as his esophagus began to open, Jeff lost nearly 50 pounds. Now, his weight has stabilized and he eats small portions six to eight times a day.

“My wife, Joan, and I are so thankful to MedStar Georgetown and Dr. Haddad, who has been a great teacher,” Jeff says. “He gave us detailed explanations after every procedure and made sure we understood them so we could follow his instructions.”

Cleared by his surgeons to resume regular activities, Jeff is back to his normal life, which includes long walks, gardening, bicycling, swimming and horseback riding. “They recommend that I don’t fall off a horse,” says Jeff jokingly. “But now every day is a good day.”

For more information about Gastroenterology at MedStar Georgetown, visit MedStarGeorgetown.org/GIor call 855-546-1920 to make an appointment.

Jeff and his wife, Joan, are grateful to Dr. Haddad for his expertise and individualized attention and care. Jeff is back to his normal routine following a life-saving gastrointestinal procedure.

Photo courtesy of Jeff Ferrill

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When It Comes to Stroke Treatment, Act FAST!By Brendan Furlong, MD, Chief of Service, Emergency Department, MedStar Georgetown University Hospital

The statistics are staggering: More than three-quarters of a million people in the United States experience a stroke each year, according to the Centers for Disease Control and Prevention (CDC), and one American dies from a stroke every 4 minutes, on average.

With those numbers, it’s easy to understand why the CDC, the National Stroke Association (NSA) and others say that every minute counts when it comes to stroke diagnosis and treatment.

What is a stroke?During a stroke, blood flow to an area of the brain is cut off so brain cells lose oxygen and begin to die. As a result, bodily functions controlled by that area of the brain, such as memory and muscle movement, can be damaged.

The most common strokes are: • Ischemic strokes: When the artery

that supplies blood to the brain becomes blocked. Blood clots are a major cause of blockages that lead to ischemic strokes.

• Hemorrhagic strokes: When an artery in the brain leaks blood or ruptures, causing excessive pressure that damages brain cells. Conditions that cause a hemorrhagic stroke include high blood pressure and aneurysms.

A transient ischemic attack (TIA) is the temporary interruption of blood flow to the brain, causing neurologic deficits. When the blood supply is restored, the deficits resolve. A TIA can serve as a warning sign of an impending stroke and should be treated as seriously as a stroke.

Who is at risk?Age is an important risk factor for stroke. Although anyone can experience a stroke, the chance of having one nearly doubles every 10 years after age 55. Men are more likely to experience stroke than women, but women are more likely to die from stroke.

Know the signsIt’s important to recognize the signs and symptoms of a stroke. In both men and women, according to the CDC, a stroke may appear as:• Sudden numbness or weakness in

the face, arm or leg, especially on one side of the body

• Confusion or difficulty speaking • Trouble seeing in one or both eyes• Inability to walk, dizziness, loss of

balance or lack of coordination• Severe headache with no known

cause

The FAST acronym, standing for “Face, Arms, Speech, Time” can improve detection and prompt treatment for stroke.

Stroke PreventionThe key to stroke prevention is to understand and manage your risks. Some causes of stroke, such as genetics and family history, cannot be controlled. But you can take steps to manage many common medical conditions that increase your risk, including:• High blood pressure• High cholesterol• Heart disease• Atrial fibrillation• Diabetes

Managing these conditions and making healthy choices—eating a nutritious diet, maintaining a healthy weight, exercising regularly, not smoking and limiting alcohol consumption—can help prevent stroke.

If you or someone else experiences any symptoms of stroke, call 911 immediately and get to a specialized stroke center, if possible. Prompt emergency care, whether to prevent another stroke or treat side effects of stroke, can ensure the quickest possible diagnosis and treatment.

For more information about emergency, urgent and trauma care, visit MedStarGeorgetown.org/ED or call 855-546-2051.

Brendan Furlong, MD, discusses how you can prevent strokes and recognize the symptoms.

Photo by Laura Brickley

Eating a nutritious diet, maintaining a healthy weight and exercising regularly can help prevent stroke.

Source: National Stroke Association

FACE: Ask the person tosmile. Does one side of the face droop?

ARMS: Ask the person toraise both arms. Does one arm drift downward?

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

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

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The little girl, Natalia, the daughter of a former co-worker of Diana’s mother, was born with biliary atresia, a rare and life-threatening condition that destroys bile ducts in the liver.

“When they mention transplant, it is literally a parent’s worst nightmare,” says Diane Walker, Natalia’s mother. “I thought it meant she would die.”

Baby Natalia had been added to the national organ transplant waiting list for a cadaver liver, but the wait for a cadaver liver can be long. Luckily, living donors are also possible for liver transplants, because the donor organ regenerates. None of Natalia’s close relatives were a match as a living donor. But outside donors with compatible blood types, who pass a series of other compatibility tests, also have the chance to save a life.

When Diana’s mom asked her if she would consider donating part of her liver to this baby, she said yes. “I knew I would be helping someone,” says Diana. Fortunately for 1-year-old Natalia and her family, Diana was a match.

“More and more people are realizing they can save a life through a donation like this,” says Thomas Fishbein, MD, executive director of

the Transplant Institute at MedStar Georgetown University Hospital. “There is nothing more heroic than donating a kidney or a portion of your liver to save someone’s life. Now that we can do it with such a high degree of safety, it is becoming more common.”

Diana finally met Natalia the day before their scheduled surgeries at Natalia’s first birthday party. The following day, the two patients were wheeled into adjacent operating rooms at MedStar Georgetown University Hospital.

It took doctors four hours to remove 20 percent of Diana’s liver and nearly eight hours to transplant it into Natalia. Both procedures were successful.

“Pediatric liver transplantation is one of the most highly complex and technical undertakings in surgery,” Dr. Fishbein says. “Despite that, we have achieved a 98 percent success rate with it. This has led to our becoming one of the largest pediatric transplant programs in the nation. As a result, we have so many little babies waiting for the

exceptional opportunity for a second chance like this.”

The transplanted liver will grow to full size in Natalia, and Diana’s liver will regenerate in about 90 days.

Diana took off six weeks from work to heal, with the hope that she would be back in time for the premiere of “Star Wars: The Force Awakens.” Though she wasn’t quite ready to work on opening night, she was able to see the movie as a fan.

Today, Diana is back to work full-time. “Sometimes it almost seems like it was a dream, since I do feel entirely back to normal,” she says.

Natalia is flourishing—her skin is no longer jaundiced, she’s grown six teeth, her hair has grown back and she is almost walking, to the delight of her family.

“Within the first two weeks she was a completely different baby—she came back to life,” her mother says. “There are heroes out there. Diana, this woman who doesn’t even know us, went into the operating room and gave us a piece of her liver, receiving nothing in return. Her mission was to save my daughter’s life. Now our mission is to tell her story. We are so grateful.”

Living Liver Donor, ‘Hero’ of Baby’s Life-Saving Transplant continued from page 1

Watch Dr. Fishbein and physicians at the MedStar Georgetown Transplant Institute discuss the liver transplant process at MedStarGeorgetown.org/Liver or for more information or to make an appointment call 855-546-1149.

Baby Natalia’s family—mom Diane, dad Chris and brother Frankie—is glad to see Natalia thriving after her successful living-donor liver transplant.

Photo courtesy of the Walker Family

This woman who doesn’t even know us went into the operating room and gave us a piece of her liver, receiving nothing in return. Her mission was to save my daughter’s life. Now our mission is to tell her story. We are so grateful.

Diane Walker, mother of transplant recipient Natalia

E

Second Opinion Gives Blood Cancer Patient a Second Chance continued from page 1

Altogether, approximately 85,000 individuals are afflicted with the disease.

A transplant involves a two-step process: collecting bone marrow-like cells from the patient’s blood stream and storing them for future use. A week or so later, cancer patients will receive high doses of chemotherapy to destroy their disease. Afterward, the previously stored cells are infused back into the bloodstream, where they soon begin repopulating and rebuilding the blood and immune system.

Alecia, 75 at the time, went through a comprehensive evaluation to see if

she was eligible for BMT. To her surprise, she qualified.

“Some of my other doctors thought that BMT was still experimental or that I wouldn’t be a candidate because of my age,” Alecia says. “But it turns out that neither is true.”

Those are common misconceptions among patients and physicians alike, notes Alecia’s physician, David H. Vesole, MD, PhD, director of MedStar Georgetown’s Multiple Myeloma Program.

“Even though BMT is considered standard therapy for myeloma worldwide, in the United States less

than 50 percent of the patients who could benefit from BMT are referred for evaluation,” Dr. Vesole says. “That’s mostly due to physicians’ concerns that a patient is too old or compromised from other health conditions like diabetes, cardiac disease or renal failure. But new techniques and better supportive care have improved both patient outcomes and the entire transplant process, extending BMT to more patients than ever before.”

Alecia’s procedure took place on November 17, 2015, a red letter day for both her and the hospital: She celebrated her 76th birthday, and MedStar Georgetown celebrated Alecia as their 50th BMT patient.

From start to finish, BMT patients may take weeks to a couple of months to achieve full recovery. However, virtually all patients feel it’s worth it.

“I decided if BMT could prolong my life a little, why not go through with it?” Alecia says. “If it works, I will be happy and enjoy a bit more of life.”

By all accounts, Alecia’s been doing just that. After her BMT, she recuperated with family members in Accokeek, Md., spending Christmas with her grandchildren before returning to the Virgin Islands on New Year’s Day. In early March, she saw her granddaughter get married in St. Thomas. By mid-March, Alecia was back at MedStar Georgetown for her 100-day follow-up appointment where she received good news: Her cancer was in complete remission.

“I had a very good experience with BMT,” she says. “I’m feeling almost normal again!”

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To learn more about the Bone Marrow and Stem Cell Transplant Program at MedStar Georgetown, visit MedStarGeorgetown.org/BMT or call 855-546-1016 to make an appointment with a specialist.

MedStar Georgetown’s 1,000th CyberKnife Patient Treated for Prostate Cancer By Marianne Worley

Tests and a biopsy confirmed Neal Bobys, 68, of Rockville, Md., had prostate cancer. Right away his urologist recommended CyberKnife over surgery or conventional radiation.

Neal became the 1,000th patient to be treated with CyberKnife at MedStar Georgetown University Hospital.

“In general, many people prefer CyberKnife because the treatments are given for five days over one to two weeks, compared to eight weeks of conventional radiation therapy,” says MedStar radiation oncologist Sean Collins, MD, PhD. “Smaller treatment margins and higher precision allow us to give higher doses of radiation more quickly, which can decrease the risk of the prostate cancer coming back.”

CyberKnife can also be a good option for patients who have had previous radiation treatment or are too frail to undergo surgery.

“I’ve had no pain from the treatment at all,” says Neal. “Nothing about my daily life has changed—I now look forward to getting on with my active life and improving my golf game.”

For more information about CyberKnife treatment, visit MedStarGeorgetown.org/Five or call 855-546-1060.

Photo by Paula Bobys

Neal Bobys was the 1,000th patient at MedStar Georgetown to receive CyberKnife treatment, performed by Sean Collins, MD.

MedStarGeorgetown.org

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MedStar Georgetown University HospitalAdministration • 3800 Reservoir Rd., NWWashington, DC 20007-2113

Michael C. SachtlebenPresident, MedStar Georgetown University HospitalSenior Vice President, MedStar Health

Kenneth A. Samet, FACHE President and CEO, MedStar Health

Editors Karen Alcorn Paayal Malhotra

Managing Editor Benjamin Waxman

DesignerLaura Sobelman

MyGeorgetownMD A MedStar Georgetown University Hospital Publication

3800 Reservoir Rd., NWWashington, DC 20007

S. Joseph BrunoChairman of the Board,MedStar Georgetown University Hospital

WritersRonni Cranwell Jennifer DavisBrendan Furlong, MDHeidi Rosvold-BrenholtzMarianne WorleyLeslie A. Whitlinger

Welcome New PhysiciansMedStar Georgetown is pleased to introduce the following clinician:

Hematology/Oncology, Bone Marrow and Stem Cell TransplantPashna N. Munshi, MD

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MedStar Georgetown University Hospital Obtains Certificate of Need for New Medical/Surgical PavilionWe are pleased to announce that MedStar Georgetown University Hospital has successfully obtained a Certificate of Need from the State Health Planning and Development Agency for a new, state-of-the-art medical/surgical building on the hospital’s campus. The new facility will house a new Emergency Department, larger operating rooms and 156 private patient rooms in an unparalleled, modern setting that will set the standard for patient care.

This demonstration of public need and approval of the project means MedStar Georgetown is now a significant step closer to making the new medical/surgical pavilion a reality. This new facility is vital to MedStar Georgetown’s overall ability to continue to deliver the high quality healthcare the community has relied on for over 100 years and is committed to providing for decades to come.

Visit BuildingMedicalExellence.com for more information.