HEALTHMATTERSTo Help People Be Healthy | May 2013

HAYSMED

HaysMed Surgeons Provide Cutting-Edge Care and Treatment

Residents of western and central Kansas are fortunate to have the knowledge and talents of the surgeons and

physician assistants of Southwind Surgical and Graystone Cosmetic & Re-constructive Surgery available to them.

These eight providers are unparal-leled in our region in their combined years of surgical experience and expertise. From all areas of general surgery to bariatric, reconstructive and cosmetic surgery to wound care and

endoscopic procedures, patients can have these services performed close to home by skilled providers who know and care about them.

In addition to clinics in Hays, our surgeons travel to nine other Kansas communities, covering hundreds of miles every month so patients don’t have to travel. It is comforting to know these services are available to our patients in rural Kansas without the need for them to travel to Kansas City or Denver.

JAY MOORE,EXECUTIVE

DIRECTOR OF

PRACTICE

ADMINISTRATION

WE’RE HERE TO HELP

Area communities grateful for expertise

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Cosmetic work creates patient satisfactionpp1212

Bariatric surgery helps transform liveshhhhhhhhhhhhhh1010

HEALTHMATTERS

44From trauma to cancer, HaysMed surgeons off er full spectrum of care

Since 2006, a team of general surgeons at HaysMed has strived to off er western Kansas residents the best in cutting-edge surgical

technology and quality care.From removing cancerous tumors to

emergency care for traumatic injuries, the surgeons off er many procedures to meet a wide spectrum of needs in the community.

As a certifi ed level three trauma center, HaysMed has surgeons on-call 24 hours a day to respond to emergencies.

From farming accidents and car wrecks to exotic animal bites, the surgi-cal team strives to save lives in the most severe circumstances.

“There are unique problems with rural trauma, mainly time of transport and re-sources,” said Dr. Charles Schultz, a gen-

eral surgeon and director of HaysMed’s trauma program. “Whatever we can do to advance the care of those patients is important.”

HaysMed acts as a referral center for western Kansas. Hays surgeons, whenev-er possible, provide the needed care, but in some cases must transport patients to larger facilities.

While Hays does not have a neurosur-geon on staff , the hospital collaborates with facilities that do and make arrange-ments for those patients with traumatic brain injuries to be transferred. Having an in-house neurosurgeon also is a requirement for attaining a higher level of trauma center designation.

While the hospital has always had staff on-call for emergencies, HaysMed achieved level three certifi cation from the American College of Surgeons a year ago. The process of certifi cation involves many protocols for care and staff coordi-nation, and in many ways, takes trauma care “to the next level,” Schultz said.

“I think it shows our commitment to

taking care of injured patients,” he said. “We are a referral center for western Kansas, and trauma is a very important part of care for our population. Trauma oftentimes happens to people who are young and in the prime of their lives ... and it can be devastating.”

The accreditation is renewed every three years. HaysMed is the only certifi ed trauma center in the region.

HaysMed staff also work to educate the community about trauma preven-tion.

PAGE 4 HEALTH MATTERSIN FOCUS

THE CUTTING EDGETRAUMA, PREVENTATIVE CARE

AND TUMOR REMOVAL ARE AMONG SURGICAL SPECIALTIES

PLAY IT SAFETo help your family avoid trau-

matic injuries:• Always wear a seat belt in a

moving vehicle.• Adults and children should

wear bicycle helmets when riding bikes and motorcycles.

• Ensure children’s car seats are installed and used properly.

A helicopter prepares to land at HaysMed to pick up a patient for transport.

HEALTH MATTERS PAGE 5IN FOCUS

If patients have a history of signifi cant colon polyps from past colonoscopies, they might need to be screened more frequently. Based on these guidelines, most insurance companies will cover a colonoscopy.

Recovery time following a routine colonoscopy is minimal. Patients gener-ally are told to take the remainder of that day off work and are asked not to drive since they are sedated for the procedure. Most patients typically are in the hospital for only a few hours, Teget said.

Patients do, however, need to prepare for the procedure in advance. Doctors instruct their patients on how to perform a “bowel prep,” which is the process of cleansing the colon before the proce-dure.

Preparations generally include increas-ing consumption of clear liquids and also might include an enema or laxatives.

“If you’re going to go have your colonoscopy, the prep is the worst part,” Teget said. “And doctors are aware it’s not

the most fun part, but it’s very important.”Having a clean colon ensures doctors

will be able to see any polyps or other abnormalities. While many colonos-copies are done at HaysMed annually, Teget said the numbers are not high enough.

“I think the general population doesn’t understand just exactly how important screening colonoscopies are,” he said. “We could do more to help pre-vent cancer if people would schedule a colonoscopy.”

In addition to colonoscopies, ad-vanced technology has made it possible for a wide variety of surgical procedures to be done as subtly as possible.

Whenever feasible, HaysMed surgeons opt for a minimally invasive approach using special tools and requiring only a tiny incision.

A dramatic presentation to warn teens against drunk driving is hosted at area high schools, and another initia-tive is in the works to help prevent falls, which are a common cause of traumatic injuries.

The state of Kansas also keeps a trauma registry, which tracks the causes of traumatic injuries and helps identify trends and prevention needs.

“That’s part of the initiative, is to make people aware,” Schultz said.

As the saying goes, an ounce of pre-vention can go a long way.

Prevention is considered especially important in regards to one of the most prevalent types of cancer — colon cancer.

“If it’s caught early, it is a very treat-able disease,” said Dr. Paul Teget, a gener-al surgeon. “If it’s caught in later stages, where it gets outside of the colon and metastasizes to other parts of the body, it’s a more diffi cult cancer to cure.”

Colonoscopies are minimally invasive surgical procedures that use a scope with a light and camera on one end. Doctors are able to get a clear and de-tailed view of the large intestine as they search for polyps, which are abnormal cell growths.

Seventy percent of polyps are benign, meaning they would not pose a can-cer risk. However, there is a 30 percent chance polyps will degenerate and be-come colon cancer. Polyps are removed with the scope during the colonoscopy to prevent a polyp from growing into a cancer, Teget said.

“If you get them out, you don’t have to worry about them degenerating into a cancer,” he said. Even the benign polyps can cause problems. Some can become large enough to block the colon.

People age 50 and older are encour-aged to undergo routine colonoscopies once every 10 years. Patients who have a fi rst-degree family member diagnosed with colon cancer should begin screen-ing 10 years earlier than the age of the youngest relative who was diagnosed. They also should get screened every fi ve years.

PREVENTATIVE CARE

TIP FOR HEALTHIn the words of Dr. Paul Teget, “only good things come from taking fi ber.”Not only has fi ber proven to help keep the digestive tract regular, it is

thought to prevent diverticular disease, boost the immune system and even help lower cholesterol.

The easiest way to boost fi ber intake is to purchase a daily powder supplement that can be mixed with food and drink, Teget said.

ADVANCED TECHNOLOGY

A model colon.

CONTINUED ON PAGE 6

PAGE 6 HEALTH MATTERSIN FOCUS

“It’s less painful and there’s fewer complications,” Dr. Zurab Tsereteli, a general surgeon, said. “It minimizes long-term complications, and recovery is almost twice as fast.”

Most abdominal surgeries can be done laparoscopically including hernias, gallbladder removal, stomach proce-dures, small and large bowel resections, and other procedures.

The laparoscopic approach requires surgeons to complete additional train-ing.

Not all patients, and not all proce-dures, are good candidates for this mini-mally invasive approach, he said, noting pre-surgery evaluations help doctors determine how to proceed.

When patients are diagnosed with breast cancer, surgery often becomes an important part of curing the disease.

Four general surgeons at HaysMed often are called on to perform lumpec-tomies, a procedure to remove a cancer-ous tumor, and mastectomies, which involve removing the entire breast.

“Surgical management is required for a defi nitive cure,” said Dr. Brandon Cun-ningham, a general surgeon.

General surgeons work closely with medical and radiation oncologists, pa-thologists and the cosmetic surgeon to determine the best course of treatment for individual patients.

Factors such as tumor size and the aggression of the cancer help doctors decide which path to take, Cunningham said.

When deciding between a lumpec-tomy and mastectomy, appearance can be another important factor, he said.

“The desired result is to have each patient achieve the best cosmetic result while not compromising our ability to cure the cancer,” he said.

“This required a multidisciplinary team approach and often we are able to give treatment such as chemotherapy or endocrine therapy prior to surgery so that breast conservation is still an option.”

Radiologists assist by providing im-ages during lumpectomy procedures to help guide the surgeon and ensure complete removal of the cancer.

BATTLING CANCER

“The desired result is to have each patient achieve the best cosmetic result while not compromising

our ability to cure the cancer.”Dr. Brandon Cunningham, general surgeon

Dr. Babu Prasad, radiation oncologist, Dr. Brandon Cunningham, surgeon, and Dr. Anne O’Dea, medical oncologist.

The specialized clinic is dedicated to the treatment of non-healing wounds, or wounds that are chronic or older than 30 days.

“We’re a referral center for all of northwest Kansas,” Dr. Anthony Hornick, a general surgeon, said. “From time to time, the outlying facilities have troublesome

wounds that need to be addressed. We’re available and willing to assist them with these patients.”

Non-healing wounds can be caused by many underlying medical conditions, such as diabetes, insuffi cient blood fl ow or several types of ulcers.

CONTINUED ON PAGE 8

HEALTH MATTERS PAGE 7IN FOCUS

Patients might need radiation or che-motherapy after a surgical procedure, but the amount of time needed to recover from surgery alone is minimal, Cunning-ham said. Some patients return to work less than a week after the operation.

In some cases, it is necessary to remove the entire breast. Patients sometimes even opt to have both breasts removed, which reduces the risk of recurrence by as much as 95 percent, he said.

Those who undergo a mastectomy have the option of reconstructive sur-gery, a process that continues for several months.

Staff also test breast cancer patients’ sentinel lymph nodes to determine if the disease has spread to the lymph nodes. If cancer is found, some patients undergo another surgery called axillary node dis-section, in which the surgeon essentially removes the lymph nodes located in the armpit.

Axillary node dissection previously was considered a standard for breast cancer treatment. Recent studies, however, indi-cated the surgery was not always neces-sary and put patients at risk for developing lymphedema, or swelling of the arm.

“It can be very mild or very debilitating,” Cunningham said. “And if you can pre-vent a woman from having lymphedema unnecessarily, then we would do it every time.”

When choosing a breast surgeon, Cunningham said it is important for patients to research the facility they are considering and make sure they are able to provide the latest in cancer treatment. HaysMed strives to stay on the cutting edge and off ers a multidisciplinary ap-proach to treatment, as well as a special-ized breast center, he said.

“The surgeon’s very important, because you need somebody who’s going to get the tumor out,” he said. “You have to be at a place that can do the new procedures. There’s places that can’t do sentinel node biopsies because they don’t have the abil-ity. Then you’re going to possibly commit somebody to more surgery than they need.”

Outside of the operating room, the surgeons help operate HaysMed’s Wound Healing and Hyperbaric Center.

HEALING TOUCH

Michelle Weigel, hyperbaric technician, readies a patient for hyperbaric oxygen therapy.

∆

The most common wounds seen at the Hays facility are diabetic foot ulcers, Hornick said. Diabetes can cause poor circulation and lack of feeling in the feet.

“They’ll get a new pair of shoes, and because they don’t have feeling in their feet, they don’t realize they’re too tight,” he said. “They take the shoe off , and they have blistered toes. And they rapidly get infected.

“Or they’ll take a walk and not realize they’re hurting their feet walking too far.”

HaysMed physicians work closely with diabetic patients to educate them about the importance of wound care. Those patients are instructed to exam-ine their feet every day, he said.

It is important to catch diabetic foot ulcers early on, as the patient’s condi-tion can deteriorate rapidly. Nearly half of patients who undergo amputations each year are diabetic.

When patients are diagnosed with a non-healing wound, they fi rst are tested to help doctors determine the most eff ective treatment option.

Several treatment methods are avail-able. Physicians can remove unhealthy tissue from the wound to optimize the healing process and can apply treat-ments such as skin substitutes, which encourage skin growth over the af-fected area.

If those methods fail, patients can be referred to the clinic’s hyperbaric unit, which opened in 2011. Patients spend time in hyperbaric chambers, which fi ll with pure oxygen under pressure. This treatment saturates the patient’s blood plasma with oxygen, which aids the healing process.

In some cases, surgery might be necessary to close the wound issue. As HaysMed surgeons staff the wound clinic, patients have the advantage of continuity in care, Hornick said.

Weigel adjusts the setting on the hyperbaric oxygen chamber.

PAGE 8 HEALTH MATTERSIN FOCUS

FYIWound types treated at the

Wound Healing and Hyperbaric Center include:

• Any wound failing to improve with multiple treatments or therapies

• Diabetic foot ulcers• Lower leg ulcers• Pressure ulcers• Bone infection (osteomyelitis)• Gangrene• Skin tears or lacerations• Late eff ects of radiation

therapy• Post-operative infections• Slow or non-healing surgical

wounds• Compromised skin fl aps or

grafts• Burns

PAGE 10 HEALTH MATTERSBARIATRICS

Susan Ault was desperate for a change.Her type 2 diabetes was out of control, and she was taking up to 400 units of insulin each day in an attempt to regulate her blood sugars.

“I couldn’t get them controlled,” said Ault, who lives in the small town of Rolla in southwest Kansas. “I was eating like a bird and really trying to focus on what I was eating, and I couldn’t get the blood sugars down.”

That’s when a doctor suggested she look into bariatric sur-gery. After doing some research online, Ault decided to visit Dr. Zurab Tsereteli at HaysMed.

She had a gastric bypass on June 26 in Hays. Since then, she’s lost 115 pounds and has not taken a single drop of insulin.

“The weight loss has been the icing on the cake,” Ault said. “But just the feeling of not having to be on insulin anymore is an amazing feeling.”

Gaining control, losing weight

Dr. Zurab Tsereteli and operating room nurse Marlis Norton, RN, prepare the tools needed for bariatric surgery.

HaysMed bariatric surgery patient Susan Ault, before and after surgery.

HEALTH MATTERS PAGE 11BARIATRICS

∆

Since 2008, Tsereteli has been helping patients like Ault by off ering three types of bariatric surgery, which helps patients battling morbid obesity to achieve their desired weight loss and off ers other medical benefi ts.

“Diabetes, sleep apnea, high blood pressure, dyslipidemia, infertility — a lot of diff erent conditions can be associated with morbid obesity,” Tsereteli said, not-ing there are approximately 200 medical conditions linked to obesity.

The long-term weight loss associated with the surgery alleviates other symp-toms. Some patients, such as Ault, are able to stop or reduce the amount of insulin they need to regu-late diabetes. Others are able to quit taking medications for high blood pressure or sleep though the night without sleep apnea symptoms.

Patients with a body mass index score of 40 and above auto-matically qualify for a procedure. Surgery also can be done for patients who have a BMI of at least 35 and are suff ering from a co-morbid condition.

Bariatric surgery involves reducing the size of the patient’s stomach, meaning they do not need to eat as much after surgery.

“We off er them this type of surgery when they fail to lose weight with other means, like exercising, dieting and medica-tions,” Tsereteli said.

HaysMed off ers three types of bariatric surgery: gastric by-pass, lap-band and sleeve gastrectomy.

Gastric bypass is the procedure that usually results in the most weight loss. The stomach is reduced to about the size of an egg, and a portion of the upper gastrointestinal tract is bypassed.

“This is where most food and calories are absorbed,” Tsereteli said. “So by bypassing that, we are essentially causing malab-sorption, so there are less calories absorbed.”

In the lap-band procedure, a small adjustable silicone band is used to create a small pouch at the top of the stomach, re-stricting the amount of food a patient can eat at one time.

The newest of the three procedures, sleeve gastrectomy, also involves reducing the stomach’s size. In this procedure, about two-thirds of the stomach is removed.

The procedures are done laparoscopically, a minimally invasive approach in which the surgeon uses special tools to operate through tiny incisions.

All of the procedures require signifi cant commitment and lifestyle changes to be successful with surgery. Patients can consume only small amounts of food at a time and are taught how to ensure adequate nutrition at home.

HaysMed staff strive to off er comprehensive care, from the pre-surgery work-up to post-operative maintenance.

When a patient is preparing for surgery, requirements in-clude evaluation from HaysMed’s on-staff dietitian and psy-chological evaluation. Patients meet with exercise specialists to plan for before and after surgery, and any underlying medi-cal problems are evaluated to ensure the patient is healthy enough for the procedure.

“It’s not just surgery; how we prepare patients for surgery is important for the outcome,” Tsereteli said. “So we do a very

lengthy and meticulous work-up.”Follow-up care is also critical. Patients

are typically hospitalized for a few days after the procedure. Follow-up examina-tions are scheduled regularly once they return home.

The care model used at HaysMed is es-sentially the same used at larger surgery centers, but patients have the added advantage of more personalized care.

“It’s more accessible care and also one-to-one patient care,” he said. “We know our patients, and we take care of them.”

That support has made a signifi cant diff erence for Doug Malay, who underwent bariatric surgery in late May.

Malay, a resident of WaKeeney, has lost nearly 150 pounds and reduced the number of medications he takes from 17 to four.

His success, he said, is largely due to the care he has re-ceived from HaysMed staff . He appreciates being in close proximity to his surgeon and knows staff members are only a phone call away whenever he has questions or concerns.

“There are wonderful people in this offi ce and they support you,” he said. “With all the support systems, it makes it hard to fail.”

FYIFree seminars are available the fi rst Tuesday of every month for patients interested in bariatric surgery. For more information, visit www.haysmed.com/bariatrics.

HaysMed physicians Drs. Paul Teget and Zurab Tsereteli prepare to perform a surgery.

Dr. Kirk Potter joined HaysMed’s staff in 2008, becoming the fi rst plastic and reconstructive surgeon based in northwest

Kansas. His clinic, Graystone Cosmetic & Reconstructive Surgery, off ers patients a wide array of surgical and non-surgical treatments to help enhance patients’ lives.

One of the most popular services of-fered at Graystone is breast reconstruc-tion surgery, which is off ered to pa-tients who have had a breast surgically removed, most often due to cancer.

Breast reconstruction is the process

of surgically forming a new breast, ei-ther by using synthetic breast implants or transferring tissue from elsewhere in the body.

The procedure can be started im-mediately after the mastectomy or at a later time.

There are two types of breast im-plants available: saline water and silicon gel. Both have been approved for use by the U.S. Food and Drug Administration and do not pose a safety threat, Potter said. Silicon gel is more expensive, but it tends to have a more natural feel, he said.

Patients also have the option of nipple reconstruction and “tattooing,” which is the process of using perma-nent ink to make the nipple and areola the correct color.

Patients also have the option of undergoing a procedure, such as surgi-cal reduction or augmentation, on the other breast to ensure symmetry.

For breast cancer patients, the entire procedure is covered by insurance, Pot-ter said.

United States law mandates all insur-ance companies must off er reconstruc-tion to breast cancer patients.

Dr. Kirk Potter and Jannelle Savickas, physician’s assistant, tend to a patient in the Graystone Cosmetic and Reconstructive Surgery Clinic.

PAGE 12 HEALTH MATTERSCOSMETICS

Creating satisfactionCreating satisfaction

Breast reduction is another proce-dure that can off er patients several health benefi ts. Women with large breasts often experience symptoms such as chronic pain in the neck, back and shoulders, or rashes on the chest. Those complaints can be alleviated by surgically reducing the size of the breasts.

“This is a surgery that has a very high rate of satisfaction,” Potter said. “They decrease the weight and are able to do things they used to not be able to do, secondary to the pain.”

The tummy tuck procedure (abdomi-noplasty) is a powerful and popular procedure performed at Graystone Cosmetic & Reconstructive Surgery. It is designed to remove unwanted skin and tissue from the abdomen and tighten abdominal muscles.

The end result is a fl atter, smoother stomach and a more attractive fi gure. In some cases, abdominoplasty is per-formed in conjunction with liposuction and various body lifting procedures for

a more comprehensive treatment.Potter works with each tummy tuck

patient to determine the best way to achieve his or her goals.

Abdominoplasty can be performed under general or local anesthesia, de-pending on the patient.

The tummy tuck procedure begins with an incision along the patient’s bi-kini line. The navel is cut away from the abdominal skin and reattached after the skin has been repositioned.

After moving and suturing the abdominal muscles to make them tighter, the abdominal skin is stretched downward, and excess skin is trimmed away, creating a new hole for the navel. Finally, the skin is stretched into place, where it will heal during recovery.

Depending on how much tissue is removed, some patients could spend the night in the hospital after surgery. Stitches will be removed after approxi-mately a week.

Most patients are able to return to work after no more than two weeks, but it could take a month or more to feel completely normal again and see the full benefi ts of the abdominoplasty.

Tummy tuck patients need to wear special compression garments under their clothes to promote healing and prevent complications, such as blood clots, that could arise during recovery.

The clinic also helps patients who are concerned about potentially cancerous spots on their skin.

Often the fi rst step is to biopsy the af-fected area to determine whether can-cer is present. When cancer is found, it is necessary to remove the lesion.

Excision procedures sometimes can be done in the patient clinic. If a large area of the body is aff ected, it often becomes necessary for the patient to undergo more extensive surgery.

“If it’s a delicate area such as an eye-lid, nose, lips or ears, sometimes diff er-ent labs or grafts need to be performed,” Potter said.

Potter works closely with HaysMed’s oncologists to help the patient ob-tain any follow-up treatments that are needed after surgery. Those options include radiation therapy. ∆

Abdominoplasty/Tummy Tuck

Dermatology

While many patients travel to HaysMed for surgical ser-vices, Hays physicians also go to them.

Outreach clinics in nine surrounding communities enable western Kansas residents to access health care close to home, said Dr. Charles Schultz, a general surgeon.

“We have an elderly population in western Kansas. It’s hard for people to travel, and they appreciate us coming to them,” he said. “It’s fun, because the people really appreciate it.”

Schultz has been doing outreach clin-ics since he began practicing medicine in Hays 22 years ago.

Several Hays surgeons participate in the outreach program, traveling to each hospital monthly. Some hospitals are able to off er surgeons three weeks each month.

During outreach clinics, doctors main-tain offi ce hours and visit with new and returning patients.

They also perform some outpatient surgeries, such as colonoscopies, EGDs and various lesion removals. When the equipment is available, surgeons off er laparoscopic procedures, such as hernia repairs and cholecystectomies (gallblad-der removal).

There even have been cases when emergency procedures have been per-formed during outreach clinic hours, he said.

“Occasionally, I’ve been in an outreach clinic and somebody will come in with acute appendicitis, and I happen to be there,” Schultz said. “That happens once in a while, but it’s pretty rare.”

Most of the time, surgeons partner with local community hospitals and use their operating room staff for the proce-dures.

More extensive procedures and open surgeries still need to be performed in Hays, Schultz said, noting some patients with underlying health issues also are sent to HaysMed.

“If somebody has a need for a special-ist, they’re right there available for us,” he said. “A lot of these people already have relationships with cardiologists and other doctors, so that works out really well.”

HaysMed staff strives to keep constant communication with outlying com-munities to identify any medical needs, Schultz said. When a need is identifi ed, eff orts begin to establish a new outreach location.

Sometimes staff at a community hos-pital reaches out to HaysMed for help. That was the case when Phillips County Hospital in Phillipsburg lost its longtime general surgeon last year.

It was important for patients to still have surgery services available in Phillips County, said hospital CEO Dave Engel.

“Part of it is we’re dealing with indi-viduals who need services, and they have some traveling restrictions or just don’t feel comfortable going to a larger area,” Engel said. “It’s a service that’s defi nitely needed.” ∆

Surgeons hit the road to fi ll needsSurgeons hit the road to fi ll needs

HEALTH MATTERS PAGE 15OUTREACH

Operating room staff at Phillips County Hospital include David Grey, CRNA; Angie Babcock, RN scrub technician; Jodie Bretz, RN operating room nurse; Connie Reese, CNA scrub technician; Dr. Charles Schultz, MD; Dave Engel, hospital administrator; Kelly Bohl, RN operating room manager; and Kim Reynolds, CNA.