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Published by Cape Cod Healthcare, 2018-03-05 12:02:31

Cape Cod Health News - Falmouth Edition - pt1

Keywords: Cape Cod,CCHC,Healthcare,Falmouth

Cape Cod Health News A News Service of
Special Falmouth Hospital Edition!


Cape Cod Health News A News Service of
We Are FALmoUtH HospitAL
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Does your doctor know about your Urgent Care visit? – featuring Miguel Prieto, MD and Kumara Sidhartha, MD, MPH
From China to Falmouth for quality cancer care – featuring Basia McAnaw, MD
Quit smoking to cut your risk of a dangerous aneurysm – featuring James B. Knox, MD
Don’t take sleep issues lightly – featuring Mir F. Shuttari, MD
Visionary physician remembered at FH –
featuring E. Langdon Burwell, MD
Quick relief for a common cause of back pain – featuring Adam Brown, DO
An unexpected arrival made better by a caring team – Nancy Ghossein, RN; Jessica Austin, RN; Jennifer Fisher, RN; Suzan Scharr RNC, IBCLC, and Lori Ruggieri, RNC, IBCLC
sprain, strain or tear? What’s the difference? –
featuring Robert Wilsterman MD
this rehab center grows and cooks its own veggies – featuring Mary Almeida and Julianna Coughlin, RD
Would you opt out of treating early breast cancer? – Michael Fishbein, MD
Living with ALs, and making the best of it A life of giving celebrated in Falmouth
Contents


1
primAry CAre
if you go to one of Cape Cod Healthcare’s Urgent Care Cen- ters in sandwich, Falmouth, Hyannis or Harwich, your primary care doctor will receive an update about it – maybe before you even get back home.
“I always get an email noti cation from the urgent care center or the er that my patient has been seen there,” said miguel prieto, mD, a specialist in internal medicine with emerald phy- sicians at the Bourne Health Center. “Whatever treatment was done is made available to me, so we can provide follow-up.”
“it’s a very neat process in terms of how we coordinate with the urgent care and the er, said Kumara sidhartha mD, mpH, a specialist in internal medicine and medical director at emer- ald physicians in Cotuit, as well as chair of emerald’s Wellness Advisory Board. “the primary care team is the main hub, so to speak, but all the care teams are on the same page. the differ- ent entities – primary care, the urgent care and the er – work together to help the patient be cared for during their journey after an acute episode of illness.”
primary care providers receive information on their patients who have been to the urgent care centers “almost in real time,” according to Dr. sidhartha.
“it gives us a snapshot of the encounter,” he said. “it’s impor- tant for us to know what kind of clinical situation they went through, whether it was an injury, an acute illness or sudden worsening of a chronic illness.”
According to Dr. sidhartha, among the information the CCHC urgent care centers pass on to patients’ doctors are:
• The reason they went to the urgent care center •What tests were performed
•Test results
•What types of assessments were done
•What diagnosis was made
•The treatment the patient received •Follow-up recommendations
Does your doctor know about
your Urgent Care visit?
Communication between urgent care centers and primary care physicians helps patients get the best possible follow-up care.
By Bill o’neill
the advantage of that timely communication for patients is that “it prevents fragmented care,” said Dr. prieto. “We know what the urgent care center did and we can provide follow-up if something else is needed. We check with the patient to see if they’re doing better.”
patients are contacted by the scheduling team at emerald phy- sicians, often the same day they are seen at the urgent care facility, he said.
often the patient will see their primary care team after an er or urgent care visit, “so that we can follow-up on the clinical improvement of the patient and make sure they get back to good health,” said Dr. sidhartha.
“From the patient’s perspective, it’s important for them to know that, at every step along the way, there’s a care team that is making sure that their health needs from that acute episode are met. their needs are different at different stages. When they’re in the er or the urgent care, the need may be more acute than at the primary care of ce. The follow-up visit at the primary care of ce makes sure their recovery continues in the right direction and that new treatments are completed.”
Knowing that a patient had urgent or emergency care, the primary care physician will monitor what Dr. sidhartha calls their “regular baseline conditions.” if they have hypertension or high blood pressure or diabetes, physicians can follow-up and make sure their acute incident didn’t make those things worse, he said
For obvious emergencies, people should call 911 and go to the er by ambulance, he said. in other situations, he recom- mended calling the of ce of their primary care doctors, if it’s during regular business hours.
When patients call the primary care team, “we can work with the patient to make the best decision as to how best treat the patient in that situation and where the care should be,” said Dr. sidhartha. | CCHN


2
tom Gorton literally travels from one end of the earth to the other to get the healthcare he knows is best for him.
He takes three airplane ights over a day and half to get from his home in nanning, China, to his former hometown of Fal- mouth for check-ups with Clark Cancer Center radiation oncol- ogist Basia mcAnaw, mD. Dr. mcAnaw treated his aggressive stage iV head cancer in 2014.
“my level of comfort here over the years is 150 percent,” Gorton said.
Doctors in China discovered a tumor on his tongue three years ago. He came back to the Cape because he had been treated at Cape Cod Hospital’s Davenport-mugar Cancer Center for persistent prostate cancer in 2000, and knew he would be in good hands again. Cape Cod Healthcare opened Clark Can- cer Center opened in 2011, and Gorton now receives his care there.
“When i was diagnosed in China, i was on an airplane to Bos- ton a week later,” he said. “i was never really scared about it. i was worried and concerned, but the healthcare i’ve had here lled me with extreme con dence, so maybe that’s why.”
Gorton, 66, began radiation and chemotherapy treatments on march 27, 2014, and it continued for three months. His medical oncologist is Victor Aviles, mD of Falmouth. the tu- mor is now gone and he is checked every three months in China, and continues to come back every year for a check-up with Dr. mcAnaw.
“What’s so amazing about tom is that he wanted to be home with his family in China, so he went home right after his radia- tion treatment. For most people, the weeks after (treatment) are even harder,” she said.
Gorton admits he was quite sick after he returned to nanking, where he lives with his wife, meizhu.
“i arrived home at the end of June and had nausea and fatigue that lasted through July and August. But by the second week in September, it got better very fast and I have felt terri c ever since,’ he said. “it was like a re-emergence into life.”
From China to Falmouth
for quality cancer care
tom Gorton traveled thousands of miles
to receive cancer treatment with the doctors and hospital he knew and trusted.
By robin Lord
A Deep Appreciation
Gorton’s treatment consisted of a technique known as external Beam imrt, whereby the radiation was targeted precisely to the tumor on his tongue and the nearby lymph nodes. the dos- age is delivered from multiple directions, ensuring maximum coverage and protection of normal tissues, according to Dr. mcAnaw.
“We try to use the safest, highest dose possible,” she said. “it’s a balancing act.”
Gorton said he was comfortable with the risks.
“it was explained to me very clearly, and i knew everything going into it,” he said.
Although Gorton has a stiff neck and temporarily lost the taste buds on his tongue, as a result of the radiation, he is fortunate that he had cancer today, when treatment is so much better, said Dr. mcAnaw.
“most people (with his stage and type of cancer), 25 years ago, would have died,” she said.
still, even today in many places, the treatment for Gorton’s tumor consists of removing the tongue and side of the neck, leaving patients unable to talk or eat without the aid of a tube, she added.
ten years ago, Dr. mcAnaw and other radiation oncologists at Cape Cod Healthcare reviewed their own data, and learned that they could spare patients’ tongues and neck area and still have a high success rate. While still not perfect, it does a much better job of preserving patients’ quality of life, Dr. mcAnaw said.
“my cancer was good it arrived when it did, and i’m glad i had the doctors i did,” Gorton said. “you need to look at it as a good experience; that i was the recipient of somebody’s hard work, education and skills.”
With six grandchildren in his life, Gorton said he is grateful to the doctors, technicians, nurses and other medical personnel who treated him.
“i have a deep appreciation that i’ll carry with me for the rest of my life,” he said. “i had stage iV cancer, but, because of quality care, i beat it.” | CCHN
Cape Cod Health News CAnCer CAre


A News Service of
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HeArt & VAsCULAr
Here’s one more reason to snuff the cigarette habit. smoking leads to a higher risk of a dangerous abdominal aortic aneu- rysm (AAA) forming in the body’s largest artery, and a recent study showed that the odds drop when people quit smoking.
“if you quit, your risk of forming an aneurysm that can lead to a deadly rupture goes down,” said James B. Knox, mD, a vas- cular surgeon at the Cape Cod Healthcare Vascular and Vein Center of Cape Cod in Falmouth.
“most patients know about the links between smoking and lung cancer, smoking and heart attacks, smoking and harden- ing of the arteries. But they often don’t realize that smoking is harmful in terms of leading to more aneurysms or rapid aneu- rysm growth and a higher risk of rupture,” he said. “All these things are very important with respect to smoking, so we stress that when we see patients who smoke.”
experts have long known that smoking raises the risk of an AAA, a weak spot in the wall of the aorta, where it passes through the abdomen, according to medlineplus, an online publication of the U.s. national Library of medicine website. the aorta is the body’s main artery, and if an aneurysm in that location ruptures, it can cause massive internal bleeding, the site notes.
published in the journal Arteriosclerosis, Thrombosis and Vas- cular Biology, the new study followed 15,792 adults for more than 20 years. the researchers found that people who never smoked had a 2 percent chance of developing an abdominal aortic aneurysm. the risk was about 8 percent for women who smoked and almost 13 percent for men who smoked.
people who quit smoking during the study period saw their risk decline by 29 percent.
“Quitting can substantially reduce the risk of abdominal aortic aneurysm,” lead researcher Weihong tang, mD, an associate professor at the University of minnesota, told medlineplus. “it’s never too late to quit.”
Quit smoking to cut your risk
of a dangerous aneurysm
A new study shows that ex-smokers reduce the life-threatening danger of abdominal aortic rupture.
By Bill o’neill
Women Are More At Risk
Dr. Knox said he sees many patients who are actively smoking or who smoked a long time and have quit. He said screening for aneurysms is a good idea for smokers, especially those with a family history of aneurysms. While aneurysms are more com- mon in men than women, women are four times more likely to have an aneurysm rupture, according to Dr. Knox.
“they’re less common in women but they are more deadly,” he said.
if an abdominal aortic aneurysm is found, the course of action depends upon its size.
“We do fairly sophisticated Ct scans designed to map out the extent and size of the aneurysm,” said Dr. Knox.
there’s no real medical treatment for an aneurysm, he said.
“We stress all the heart-healthy things: Quit smoking, control blood pressure – that’s a huge factor – diet and exercise.”
if an aneurysm grows to be 5.5 centimeters or larger, a stent- graft (a stent with a polyester tube) to keep blood from ow- ing through the aorta while excluding the aneurysm, can be inserted through small incisions in the groin, he said.
patients usually don’t feel any symptoms from an aneurysm, which is why screening is important. if the aneurysm ruptures, however, the patients will feel “sudden and severe abdominal pain, sometimes radiating through to the left side or the left lower back, usually associated with feelings of being very ill, light-headed, weak, passing out,” Dr. Knox said. “the chance of dying from that can be in the 75 to 80 percent range.”
Based on the ndings of the University of Minnesota study and his own career of treating patients with vascular issues, Dr. Knox had one word of advice for smokers: “Quit.” | CCHN


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Cape Cod Health News LUnGs, BreAtHinG & sLeep
Don’t take sleep
issues lightly
Falmouth Hospital sleep Lab staff has special training to diagnose and treat sleep disorders like sleep apnea and narcolepsy.
By rich Holmes
“it’s kind of a chicken or egg situation,” Dr. shuttari said.
The Process
in addition to sleep apnea, the sleep lab can diagnose, study and treat
• Narcolepsy, which causes a person to fall asleep involuntarily
• Restless leg syndrome, which may manifest in an irresistible urge to move the legs and broken sleep from leg movements
• Sleepwalking, when a person gets up and moves about while sleeping
• Insomnia, or dif culty getting or staying asleep.
once a patient arrives at the sleep Lab, they are taken to one of the four rooms, which somewhat resemble hotel rooms, though without windows. there, patients change into paja- mas and a technician hooks them up to a variety of leads and devices. A thick, paste-like substance is used to attach some of the electrodes to the scalp and face. it can be scrubbed off with soap and water the following morning. A harness of wires is hung around the neck.
the wires of two electrodes are passed down to anchor one on each leg. A blood oxygen sensor is clipped to a nger and belts go around the waist. then, the patient may read or watch tV until ready to turn out the lights and go to sleep.
According to Dr. shuttari, these leads and devices include an electroencephalogram or eeG, which tracks three channels of brain wave activity. the eeG shows if a patient is going to sleep and the stage of sleep they’re in. Another device, the electrooculogram, measures eye movements and helps con rm if the patient is in a dream state.
the temperature of air exhaled from the nose is warmer than air being inhaled. A temperature sensor measures it to see if breathing continues throughout the study.
“if it (cessation of breathing) happens for more than 10 seconds, then it is apnea,” Dr. shuttari said.
A ow sensor also monitors nasal air pressure. Abdomen and chest belts detect the degree of effort a patient makes to breathe. these devices can help determine if sleep apnea is obstructive — caused by the tongue or other tissue blocking
(continued on next page)
in the basement of Falmouth Hospital sits a block of four rooms where patients sleep while technicians in an adjoining space oversee a host of inputs monitoring their sleep patterns. this is Cape Cod Healthcare’s sleep Lab, and growing awareness of the seriousness of sleep apnea and its involvement in cardiac and other ills is driving more doctors to send their patients to the facility for diagnosis.
“We are booked up three to four weeks ahead,” said the lab’s medical director, mir F. shuttari, mD, a pulmonologist with a board certi cation in sleep medicine.
Unlike privately operated sleep labs, the Falmouth facility is the only one in the region connected to a hospital. if any medi- cal issues arise, a patient could easily be transported to the emergency department within the hospital to receive immedi- ate care, Dr. shuttari said.
Unlike sleep apnea studies performed by patients in their homes with a portable monitor mailed to them with a set of instructions, a sleep study in the lab collects more sources of data that are immediately interpreted by trained sleep medi- cine technicians. Furthermore, if breathing issues are identi- ed midway through the night, those technicians can treat the problem during the second half of the night with a CpAp (con- tinuous positive airway pressure) mask, he said. this device assists breathing by keeping the patient’s airway open.
sleep apnea – the repeated cessation of breathing for short periods during sleep – has been linked to potentially fatal ill- nesses, such as irregular heartbeats, congestive heart failure, heart attack and stroke, as well as contributing to high blood pressure, depression and obesity. symptoms include snoring, a shirt neck size 17 or larger, gasping during sleep, and sleepi- ness during waking hours, according to the national Heart, Blood and Lung institute.
Fifty percent of patients with congestive heart failure also have sleep apnea, Dr. shuttari said. Congestive heart failure occurs when the heart becomes less effective at pumping blood, and the kidneys respond by making the body retain more salt and water, so uid builds up in the lungs and extremities. Experts disagree whether sleep apnea causes congestive heart failure or congestive heart failure causes sleep apnea, but the two conditions are closely associated, he said.


A News Service of
5
air ow, or central — caused by the brain sending incorrect impulses to the nerves controlling breathing.
sensors on the arms and legs detect movement, as does one on the chin, as the lower jaw moves during sleep. Body posi- tion sensors show if a patient sleeps on their back or side.
An electrocardiogram, or eKG, traces heart rhythms during sleep. A video camera and a microphone allow the technicians to record any signi cant sights or sounds, such as snoring. | CCHN
BUsiness oF HeALtHCAre
Dr. e. Langdon Burwell, an innovator and forward thinking physician, was remembered for his commitment to Falmouth Hospital during a dedication of two conference rooms in his name.
the conference rooms, which were formerly known as Faxon i and ii, were renamed in november and are now known to- gether as the Burwell education and Conference Center.
“the reason this came about is we wanted to recognize Dr. Burwell’s signi cant contributions to the history of Falmouth Hospital,” said Deborah Dougherty, senior development of cer with Cape Cod Healthcare. “With his commitment to educa- tion, it seemed a perfect match.”
the rooms were refurbished with new lighting, wall coverings, tables, chairs and updated audio visual equipment funded in part by a donation from nina Heald-Webber who had known Dr. Burwell.
“she wanted to support this honor in his memory,” said Dougherty.
Dr. Burwell and two other physicians were instrumental in the founding of Falmouth Hospital. they had a vision in 1955 that Falmouth “could and should have a hospital,” according to the Falmouth enterprise. And they set about getting it done.
the Falmouth Hospital Association was formed to oversee the fundraising and plans for development of the new hospital. Construction began on st. patrick’s Day, 1961.
Visionary physician
remembered at FH
Falmouth Hospital has named a conference center in memory of Dr. e. Langdon Burwell, one of the founders of the hospital and past medical chief.
By roberta Cannon
“i was intrigued from the start with the idea of uniting in Fal- mouth the brilliant minds and latest equipment of a big city hospital with the pleasant surroundings and the intimacy of a smaller community hospital,” Dr. Burwell said as the rst chief of internal medicine, at the opening of the hospital in 1963.
Dr. Burwell moved to Falmouth in 1953 from Washington, D.C. where he worked with the United states Department of public Health. He and two other physicians formed Falmouth Medical Associates that same year. Their of ces also housed laboratory equipment, an X-ray machine, and an eKG machine so patients would no longer need to travel to pocasset or tobey Hospital in Wareham for testing.
Dr. Burwell practiced internal medicine until his retirement in 1990. He died in 1993.
He believed strongly in the bene ts of health education, and he encouraged colleagues to empower patients with information for healthy lifestyles and illness prevention. He also believed that physicians and nurses should set an example through their own health choices and would encourage staff to quit smoking and use the stairs instead of the elevator.
His mission will continue through the use of the rooms for medical, nursing, employee, patient and community learning opportunities. | CCHN


6
Cape Cod Health News LiVinG WitH CHroniC ConDitions
Quick relief for a common
cause of back pain
Falmouth pain doctor diagnoses and treats chronic pain caused by arthritis.
By Laurie Higgins
For a medial branch block, patients are usually put in a face- down position and Dr. Brown uses a special type of X-ray called a uoroscopy. He then guides a needle to touch a point in the bone where the nerve resides and injects a small amount of a local anesthetic to numb the problem nerve.
The nerve remains numb for about ve hours and Dr. Brown encourages his patients to be active during that time. if the back feels considerably better afterwards, Dr. Brown knows the pain is most likely caused by arthritis in that joint.
the treatment is almost identical to the test, only instead of putting a numbing agent through the needle, he uses heat to cauterize those nerves.
“it’s called a radiofrequency ablation because you are inten- tionally trying to cauterize that medial branch nerve,” he says. “it works very well.”
the results from the ablation last from six months to two years, with the average time being eight to 12 months. most people nd relief with yearly treatments.
Another type of back pain that responds well to treatment is a narrowing of the spine, which is called spinal stenosis, Dr. Brown explained. in that case he does an epidural steroid in- jection, which he says works very well, with one drawback: the treatment doesn’t last long.
“the positive is that it really provides dramatic pain improve- ment and the negative is that it’s something we need to re- peat,” he says. “typically we would do between two and four per year on most patients that i see with chronic pain issues.”
He has seen steroid injections work for longer periods of time or even cure a problem, but those are usually with younger people who have acute pain that is more in ammatory in na- ture. older people with issues that are more degenerative and chronic need frequent treatment.
“in those cases steroid injections are meant to provide pain management – not a cure, which it de nitely doesn’t,” he said. “But if it were me or my family, i would much rather have a steroid shot every four or ve months than take a pill.” | CCHN
Adam Brown, Do, unravels mysteries every day.
As the pain specialist at the Falmouth Hospital pain Center, he works with patients who have debilitating pain to try to nd the cause and arrive at the best treatment. His tools are the patient’s history, a physical exam, mris, Ct scans, lab tests and even electrical tests if there is evidence of nerve damage or injury.
those suffering from back pain or any other pain should seek treatment sooner rather than later, Dr. Brown said. one of the rst things he does is to nd out whether the pain is acute or chronic. Chronic pain is any pain that lasts for more than three months.
“it seems brief in the big span of things, but unfortunately chronic pain behaves vastly differently than acute pain or something that is brand new,” Dr. Brown said. “our bodies respond differently to each, and with chronic pain, our brains and spinal cord actually change.”
Chronic pain includes a phase called neuroplasticity, where patients have demonstrable changes in their brain and spinal cord that can be seen with mris and also in autopsies when people die and donate their bodies to science.
“our bodies respond very quickly and poorly to chronic pain, where in some ways pain becomes the disease itself,” he said. “At some point there’s no cause anymore other than the brain and spinal cord and disease itself.”
Dr. Brown sees a lot of chronic back pain. With the age of the population on Cape Cod, it’s not surprising that arthritis is often a culprit.
symptoms include pain that improves when you rest and gets worse when you’re active, or pain that gets much worse when you extend backwards. if an mri shows that the facet joints of the spine are in bad shape, Dr. Brown often uses a medial branch block to help diagnose the arthritis as a cause of pain.
“it’s almost ridiculous in its simplicity,” he said. the idea is to gauge the pain before the procedure and after. if the patient feels better after an initial test treatment, he knows it is most likely arthritis and will likely respond well to the full treatment.


A News Service of
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preGnAnCy & CHiLDBirtH
Brian and Courtney Kelly of Bourne thought April 30, 2016 was going to be like any other day, and were following their usual routine and getting ready for work. Their rst child was due in may and preparations for the baby’s arrival were almost complete.
Courtney was looking for a new job as a pharmacist and wait- ing to hear back about a position she had applied for in the public pharmacy at Cape Cod Hospital.
the day changed rapidly when she unexpectedly went into la- bor, and by 8:30 a.m., she was headed to Falmouth Hospital.
“When we arrived at the emergency room, a nurse offered me a wheelchair but I said no, I could walk to the maternity oor,” said Courtney. “Boy was i wrong, that was the longest walk of my life!”
things moved along as her labor progressed quickly and all of a sudden they were faced with the baby’s heart rate dropping. Courtney needed an emergency Cesarean section to deliver the baby.
“it was chaotic for a few minutes and there was no time for me to think,” said Courtney.
All turned out well and by noon their daughter, Claire, was born.
the couple had not expected the personal care and attention to detail they received during their stay at the hospital after Claire’s delivery.
Courtney wrote a letter to thank the staff and talk about her positive and reassuring experience. she especially noted nancy Ghossein, rn; Jessica Austin, rn; Jennifer Fisher, rn; suzan scharr rnC, iBCLC, clinical coordinator of maternity services and Lori ruggieri, rnC, iBCLC.
she still gets teary-eyed when she thinks about the experience.
“i wrote it (the letter) because i’m in healthcare and i know what it’s like to be appreciated when you do your day-to-day job and someone lets you know how much they value what you do for them,” she said. “the whole experience was just amazing from the moment we arrived. every person we inter- acted with was so nice to us.”
An unexpected arrival made
better by a caring team
nurses at Falmouth Hospital go the extra mile to reassure new parents Brian and Courtney Kelly.
By roberta Cannon
Before she delivered, Courtney had been undecided about breastfeeding, but with the support she received, it changed her mind.
“i got so much support from the nurses and they made it seam- less to go home and continue breastfeeding,” she said.
scharr and ruggieri are both lactation specialists at Falmouth Hospital. they provide teaching and support to moms through- out their breastfeeding experience.
After moms and babies are discharged, the support continues through clinic hours that provide one-on-one meetings with moms as well as support groups. they also weigh the babies, discuss how feedings are going, help solve problems and up- date the baby’s progress with their pediatrician as needed.
“it has really made a difference in providing those extra couple of steps after the moms go home,” said ruggeiri. “everything can go great in the hospital but when they get home, that all can change.”
Claire is growing by leaps and bounds. Courtney was offered the pharmacist’s position at Cape Cod Hospital the day after she delivered and accepted it.
And Brian decided to be a full-time stay-at-home dad.
“He loves being at home with Claire,” said Courtney.
At the end of her letter, Courtney wrote, “thank you again for making the birth of our rst daughter an amazing experience we will never forget. We will be forever grateful to all of those we met at Falmouth Hospital and look forward to coming back for the birth of our next child!” | CCHN


8
Family time, often means a game of touch football or even a tennis match, if the weather cooperates. But with it comes the risk of motion injuries. run just a little too hard in that family softball game and you might suffer a sprain.
or is it a strain? or a tear?
people can get these injuries confused, so we asked, robert Wilsterman mD, an orthopedic surgeon based in Falmouth, to straighten things out.
“the three terms are often used inappropriately and get all jumbled up,” he said. “the language is not perfectly logical.
“these kinds of injuries, unfortunately, are pretty common.”
•Sprains: “The technical de nition of a sprain is an injury to a ligament,” he said. “A ligament is a band of tissue that connects a bone to a bone and helps stabilize them. When a ligament gets damaged, that’s called a sprain. it can be par- tially injured or completely disrupted, but it’s still a sprain.”
Wrenching your ankle is a common type of sprain. typical symptoms include pain, in ammation, bruising or instability in the joint.
•Strains: “A strain is when a muscle or a tendon is over- stretched. A tendon is a cord of tissue that attaches a mus- cle to a bone. it’s very distinct from a ligament.” A strain can be the result of a single incident or long-term repetitive movements. symptoms include muscle spasms, weakness, cramping and immobility, pain, bruising or swelling.
• Tears: A tear is the most severe of these three injuries. “you can tear a ligament, you can tear a tendon, you can tear a muscle,” said Dr. Wilsterman. it can involve tearing some or all of the muscle bers, tendons or ligaments attached to a bone or muscle.
sprain, strain or tear?
What’s the difference?
soft-tissue injuries are common for athletes young and old. our expert tells you how to tell them apart, and what to do about them.
By Bill o’neill
tears can happen in many ways but examples he cited in- cluded people who fall on slippery steps and rupture the quad tendons or a coach who jumps out of the dugout on a cold, practice day and ruptures an Achilles tendon. tears may re- quire surgery to repair. symptoms include swelling, bruising, redness due to the injury, pain or weakness when the muscle or joint is used, or inability to use the muscle.
Treatment: initial care involves ice, elevation and compression to contain the swelling and promote healing, he said. A doctor should be contacted, if the injury is signi cant or if home care does not bring relief within 24 hours, he added.
these injuries almost always can be diagnosed with a physical exam, although sometimes mris are used, he said.
“it’s important to avoid repetitive insult,” he said. “When a kid gets hurt or a weekend warrior gets hurt, you have to have enough sense to step back off from activity, which is not al- ways easy. A coach or teammate might want you to brush it off and go back in, but it’s best to be cautious.”
Prevention: the best way to prevent sprains, strains and tears is by stretching and warming up before exercising, said Dr. Wilsterman.
“Being t is another great preventative,” he said. “The week- end warriors – it’s good that they’re out there, but he or she is better served by being active in general, as opposed to once every couple of weekends.” | CCHN
Cape Cod Health News Bones & mUsCLes


A News Service of
9
Diet & nUtrition
Photo: Julianna Coughlin RD and Mary Almeida, activities assistant prepping in the kitchen.
if you stop by JmL Care Center in Falmouth on any tues- day, you may smell the scent of freshly baked wheat bread, a reduced-sugar pie, chocolate chip cookies or other creations drifting through the hallways. Welcome to tasty tuesdays, one of the three nutritional and educational programs offered at the facility.
Activities Assistant mary Almeida started tasty tuesdays in 2015.
Most of the patients on Almeida’s oor are short-term because they are there for rehabilitation. many of the patients have chronic diseases such as diabetes and may also have issues with their appetite after discharge from the hospital, she said.
“While many have lost their appetite, some may be taking medication that alters their taste buds,” she said.
Almeida’s goal is to stimulate their appetites, provide tasty nourishment and expose patients to new foods and recipes that they may not make at home.
“it’s about providing food that raises their senses and in turn, entices them to eat more,” she said.
recently, Almeida joined forces with Julianna Coughlin, rD, a dietician at JmL, to do the Harvest of the month program that highlights a local vegetable or healthy food. Almeida and Coughlin prepare all of the dishes and both deliver the nutri- tional product to the patients.
The rst month, they made and delivered strawberry smoothies.
“each patient received about two to three ounces to try,” said Coughlin. “We really picked a good recipe for the rst time because it was enjoyed by all the patients and staff.”
they both made an avocado/cucumber gazpacho the second month to highlight the cucumber.
An Educational Component
While Almeida delivers the tasty drinks, Coughlin visits with each patient.
this rehab center grows
and cooks its own veggies
stimulating the senses is the goal of three nutritional programs at JmL in Falmouth. ingredients come from their own garden.
By roberta Cannon
“When Julianna goes into the rooms, she gives them all the facts and the nutritional bene ts of the serving. They get one-on-one interaction and the patients enjoy it so much,” said Almeida.
Both have a background working with children and found their experiences could lend themselves to the tasty tuesdays and the Harvest of the month program.
Almeida, a former pre-school teacher, developed her program by using information she gathered teaching children’s cooking classes and has altered recipes to meet the dietary needs of the patients.
Coughlin used the Harvest of the month program, which is part of the massachusetts Farm to school project, during her internship in the public school systems. the program encour- ages and exposes students to healthy food choices, while sup- porting local farmers.
A chosen fruit or vegetable is highlighted each month and the site gives its history, provides recipes and information about the ingredients and the dietary bene ts.
Sensory Baking Program
Meanwhile, upstairs on the second oor, Activities Director tina newcombe, ADC, has a sensory baking and cooking pro- gram every tuesday. she gathers residents in the activities room that includes a stove and sink where she can bake and cook.
“many of the residents have Alzheimer’s and the stimulation of tasting, smelling and holding the food is really good for awakening memories,” said newcombe. “on the day i visited, residents were enjoying the scent of chives, basil, and parsley from the garden they planted this spring.”
the facility’s three gardens include two buckets of vegetables on the second oor patio and raised gardens on the rst oor patio in the back of the building.
Vegetables include three varieties of tomatoes, zucchini and acorn squash, cucumbers and eggplant.
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Cape Cod Health News
elsie medeiros, a resident who helped plant the garden and continues to weed on Fridays, commented on the size of the two green peppers that are waiting to turn red. she said she remembers her father’s garden full of all kinds of fruits and vegetables including sweet corn, watermelon, strawberries and blueberries. she would pick the berries while her father har- vested the corn.
“i loved it,” she said.
The gardens will bene t all three programs at various times when recipes call for some of the ingredients. the tasty tues- days’ group recently had cucumber sandwiches and while the residents’ garden cucumbers weren’t ripe yet, they were able to use garden scallions.
“it’s all about food, what a natural way to unite people at the kitchen table,” said Almeida. “it’s just the thing to perk up everybody’s day.” | CCHN
Women’s HeALtH
Women with early stage breast cancer have the same outcome if they are treated or if they elect to have no treatment, accord- ing to a 2015 study in JAMA Oncology.
the study followed 100,000 women for 20 years and revealed that the death rate from stage 0 breast cancer (which affects as many as 60,000 women each year) was the same – 3.3 percent – whether the women underwent treatment or not.
The report caused a urry of controversy when it was released, and doctors differed over whether they agreed with it. It also caused confusion for patients and a urry of provocative headlines. A Time magazine cover showed a woman with her hand over her breast with the headline, “What if i decide to just do nothing?”
is that really a safe choice?
michael Fishbein, mD, the community outreach director of the Falmouth Hospital Cancer Committee doesn’t think so. He read the story in time very carefully and found it misleading.
“if you didn’t read it all the way until the end, it gave the im- pression that the patient was electing to just wait and see what happens,” he said.
the patient in the story was diagnosed with ductal carcinoma in situ (DCis) eight years ago. even though she opted not to have surgery, she did in fact follow through with medical ther- apy – meaning her doctor did do something.
Would you opt out of treating early breast cancer?
A Time magazine story and JAMA Oncology article left women wondering. But not all breast tumors are alike.
By Laurie Higgins
rather than have surgery, the patient was treated with the estrogen blocking drug tamoxifen. she was also monitored with alternate mammograms and mris every six months so that any progression of the cancer could be detected quickly and treated.
“i don’t think any doctor would say, do nothing,” Dr. Fishbein said. “in the spectrum of DCis, i don’t think that eight years is a reasonable follow-up period to say that this woman will not develop invasive cancer. plus, even though an estrogen blocker is an effective form of chemotherapy, i don’t think that alone is enough.”
not all breast cancers are created equal, he added. the JAmA Oncology study was speci cally designed to look at ductal car- cinoma in situ. the words “in situ” mean that the abnormal cells are contained within the milk ducts and haven’t spread. As long as they stay con ned, the patient is safe. But if it does spread beyond the walls of the duct it can quickly become invasive. | CCHN


A News Service of
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LiVinG WitH CHroniC ConDitions
Photo: Back Row, L-R: Mike Fishbein, MD; Serrita Williams, CNA; Giesele Castronova, friend of the family; and Ari Garber, David’s daughter. Front: David Garber.
David Garber of north Falmouth has been living his life with ALs for eight years, and he continues to live it to the fullest. He teaches us life is what you make of it, in spite of a physically debilitating disease.
I rst interviewed Garber in the winter of 2016. It was a late sunday afternoon and the wind was whipping across Buzzards Bay, tossing the water up on the beach in mountains of white and gray spray. A house on the shore has withstood many win- ter storms; much likes its owner who has stayed strong despite his chronic disease.
When i entered the living room – now a bedroom - of the north Falmouth home, i heard a quiet swishing sound com- ing from the ventilator that helped David Garber breathe. new orleans jazz music playing quietly in the background. the sun streamed in through large picture windows, outlining the medi- cal equipment and furniture that stood in wait to be put into service.
“Welcome to my seaside in rmary and spa,” typed Garber, with a glint of humor in his expression as the words march across a computer screen.
He sat in his specialized wheel chair that supports his body, his neck and head. eye-tracking assistive technology helps him communicate. By selecting letters in cells on his computer screen with his eye movements, the program spells out the words.
Garber is one of the approximately 21 Cape Cod residents living with Amytrophic Lateral sclerosis (ALs, also known as Lou Gehrig’s disease), according to ron Hoffman, founder and president of Compassionate Care ALs.
Garber’s optimism, upbeat attitude and his ability to be proac- tive have carried him far on his journey with ALs.
“i’m fond of saying that it’s been amazing to be a part of life i never knew existed. i’ve been fortunate to see friends, family and community circle the wagons for me,” said Garber.
ALs is a neurodegenerative disease that affects the nerve cells in the brain and spine. As the disease progresses, the muscles weaken, paralysis sets in and eventually patients suffer respi- ratory failure.
Living with ALs, and
making the best of it
in the face of a debilitating disease, David Garber of Falmouth says “life doesn’t stop with the illness, there are only changes”.
By roberta Cannon
Living With Enthusiasm
When Garber was diagnosed with ALs in April, 2009, he was a dentist with a thriving Falmouth practice that he started in 1978. “i really enjoyed my work,” said Garber.
“everyone in town went to him,” said michael Fishbein mD, a radiologist at Falmouth Hospital and Garber’s close friend, who has been with him every step of the way.
Garber’s symptoms began with chest fasciculation (involuntary twitching), muscle weakness and changes in his speech.
By the time he closed his practice in september 2009, he had generalized muscle weakness that had progressed from his up- per body to the lower section. He could no longer turn the caps on bottles and he had developed a classic ALs symptom of laughing or crying without warning.
As the disease began to weaken his body, breathing and swal- lowing became dif cult. He decided to have a tracheostomy to help with his breathing and a gastrostomy tube (G-tube) for liquid feedings.
But this was not going to slow down a guy who loves adven- ture. He had been an avid swimmer and indulged in the sport year-round before his diagnosis. He was even known to poke a hole in an ice-covered Buzzards Bay to swim in winter.
this past year has not been any different in his quest to have adventurous itineraries. While he cannot do anything for him- self, he is determined to “live large.”
He arranged for a group of good friends to go with him to Fen- way park for a Billy Joel concert.
“the concert was fabulous and the joy of live music in Fenway was priceless,” said Garber. “i can’t dance, never really could, but i can revel in the music.”
While he has a feeding tube and is not able to eat, Garber explained that he loves to go out to dinner.
He hosted an epic year-end “living large party” at a local res- taurant for “the many, many friends and staff who make my life the joy it has been and continues to be.”
He also attended lectures and dinners in Boston and Worces- ter. While he concedes it takes organization and willing and strong caregivers to get him where he wants to go, it is always worth the effort.
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Cape Cod Health News
It Takes a Village of Caring and Support
Family and friends provide assistance and support to Garber in whatever way is needed. several Falmouth physicians give of their time to care for a man who was once dedicated to his profession like them. Joseph Cobb, mD and X.y.David Guo mD, gastroenterologists now order and help maintain Garber’s G-tube. James o’Connor, mD, a primary care physician, and thomas irvine, mD, a pulmonary specialist, have stopped by the house to assist with medical issues and respiratory problems.
William schutten, mD, a Falmouth ophthalmologist is on call for any questions about Garber’s eyes related to changes such as dryness, or infection. Dental care is provided by michael Adams, DDs, pC of Falmouth, who has visited Garber at home on numerous occasions. Garber’s sister-in-law, Wendy stern mD, an ent specialist with southcoast physicians, did his tracheostomy.
“in my case, it has taken a village of doctors to keep me healthy,” said Garber. they volunteer their time and services
without question and because of their generosity my life is much more comfortable,” he said. He also credits his staff and caregivers for their round-the-clock care and the Visiting nurse Association of Cape Cod for its services.
He receives support from Compassionate Care ALs (CCALs) in Falmouth and from ron Hoffman. CCALs helps people with ALs and their families with the physical and emotional com- plexities associated with the disease. it also provides equip- ment, caregiving and other resources.
even though Garber can no longer swim, he hits the beach at the seacrest Beach Hotel every August to root for the swimmers who participate in his annual fundraiser, David’s old silver swim. it was started seven years ago by two young women, Ali and Kr macDonald who wanted to promote awareness about ALs and raise money for CCALs. it is now spearheaded by David’s daughters, Ari and shoshanah Garber, and the event raised $90,000 last year. | CCHN
CommUnity HeALtH
A life of giving celebrated
in Falmouth
marjorie Freeman knocked on doors to help build Falmouth Hospital more than 60 years ago. that was just one of many ways she helped.
By roberta Cannon
the Falmouth Hospital Auxiliary recognized Freeman’s efforts in october 2016, when she was presented with a service rec- ognition Award that she proudly displayed in her dining room.
“everybody was good to me, they appreciated what i did,” she said.
Other organizations also bene ted from Freeman’s volun- teerism, like the north Falmouth Village Association, the Fal- mouth public schools, megansett Grange, mothers march of Dimes, the salvation Army, and the paul e. White memorial road race.
While she fondly reminisced about her accomplishments, she admitted to missing her husband and having a bit of forgetful- ness at times. Freeman was amazed at the gratitude and honor shown to her by the Falmouth Hospital Auxiliary members.
she said she had never given volunteering a second thought.
“i kept myself busy, i just did it and forgot about it,” said Freeman.
marge Freeman will be remembered for her extraordinary con- tributions to Falmouth. | CCHN
marjorie Freeman of north Falmouth, who passed away in may 2017, was a woman with a giving heart who helped so many through her years of dedication to the community.
At 101 years old, she lived in the same home she and her late husband, Dana, built more than 60 years ago. it was a com- fortable Cape Cod-style house with many knick knacks and memorabilia. Her husband had his own business as a painter and paper hanger.
Falmouth Hospital was another building Freeman was deter- mined to help build, and she did it by soliciting donations be- ginning in the late 1950s.
“it dawned on me one day that people had to drive so far either to Wareham or Hyannis to go to the hospital,” she said last year. “if some older people had family in the hospital, they would have to drive so far to visit them. so i decided to start knocking on doors to ask people to contribute money to build one in Falmouth.”


We are Falmouth Hospital
members of the Falmouth Hospital Auxiliary generously give their time as fundraisers to help make a difference in the lives of Falmouth Hospital patients. over the years, the Auxiliary has raised almost $6 million for facilities and programs that have enhanced the quality of healthcare on the Upper Cape.
the Auxiliary supports Falmouth Hospital by:
• Managing and staf ng the Thrift Shop and Gift Shop.
• Sponsoring fundraising events, speakers and special sales.
• Serving as community ambassadors to spread the word about the mission,
activities and services of the hospital.
Learn more at www.capecodhealth.org/we-are-FH
FALMOUTH HOSPITAL
Member Cape Cod Healthcare
Auxiliary Board
Back row (L to r): nancy Leanues; maureen saunders; muriel Locklin; Barbara mcsherry; susan o’Grady; Winnie Fitzpatrick; mary eason; Jim mcGoldrick; Barbara marshall; Virginia Gray; susan Hanley;
Linda mcCann; Betty Hanson; Front row (L to r): Ann Vitullo;
shirley Gallerani; Linda Quesnel; Kate yelle; and Kathi shaffer


Cape Cod Health News A News Service of


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