What’s in Your Medicine Cabinet?

LilaLazarus_ColumnArtOpen your medicine cabinet.  If you see a prescription bottle from “Cunningham’s Drugs” or “Perry” or “Arbor” or “Revco” or “Eckerd,” then reading this article is mandatory.  While they were once some of the biggest pharmacy names in America, they’re no longer our corner drugstores. And, you missed the memo about cleaning out your medicine cabinet every spring. 

Believe it or not, medicine cabinets all over Southeast Michigan still have containers from Michigan’s defunct drugstore chains—prescription and over-the-counter medicine that’s long past its prime.IMG_8112

No matter what name is on your prescription bottle, now’s a great time to spring clean the medicine cabinet. 

Check the Date
Nearly every product will have an expiration date.  Even sunblock, toothpaste and eyedrops should be tossed after a certain time.  Most over-the -counter drugs have just a few years and most pharmaceuticals just one year.  After that, they start to break down.   You don’t want these products in or on your body.  The moment you open your medication or hygiene product, the clock starts ticking.  And every time a hand goes in that container, new germs are introduced to the product.  That’s why this yearly cleaning is a good idea

Toss it Carefully
Not everything can be tossed in the garbage or flushed down the toilet.  We don’t want to harm our water supply or put our pets at risk.  Check with your local pharmacy to see if they have a drug disposal program.  Many have drop-off bins for your prescriptions and even over-the-counter products.  Here’s a link to www.dontflushdrugs.com containing great info on programs for disposing expired medications. (Also see 
FDA’s disposal guidelines).

And to be safe, before you start tossing meds, scratch out your name and information from the prescription label just to protect your identity and personal health information. 

If you have over-the-counter products that you haven’t opened and that haven’t expired (bandages and other first aid supplies) consider donating it to a local homeless shelter.

Location, Location, Location
The bathroom is actually the worst place to store your medicine.  It’s too warm and too moist.  Be sure what you keep is kept in an air-tight plastic bin on a high and dry shelf far from children and pets and ideally at room temperature.    And as long as your getting rid of unused products… get rid of the Old Spice, too. 

Happy Spring!

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Safe Care Starts with “My Medications” List

MedListWalletCardCan you name the medications, vitamins, herbals and over-the-counter products you are currently taking? Do you know the dosages and why you’re taking them? Hospitals use the latest technologies to keep track of your medical history, but there is something patients can do to make it all work even better – a list of your current medications.

A medications list can help you keep track of everything you take so that your doctor, pharmacist or emergency department physician can take better care of you.

“Safe care begins when all health care providers understand exactly what medications patients are taking,” says Chris Cook, St. Joe’s Director of Pharmacy. “That can get complicated whenever patients receive prescriptions from more than one specialist or take over-the-counter medications, vitamins, alternative meds and herbal therapies.”

So that patient and caregiver are on the same page, Saint Joseph Mercy Health System, in partnership with IHA, have created a personalized My Medications list in wallet size or binder size as a resource for our patients.  Taking a few minutes to download and complete the list can safe time and make your care experience even safer.

“Every time you are admitted to an SJMHS facility, or see an affiliated physician, someone will ask you about the medications you take,” says Cook. “Sometimes it feels redundant, even irritating! But it’s the best way to ensure the medication list we have for you is complete, accurate and up to date.”

It is quite possibly the smartest thing a patient can do to ensure a safer and more satisfying health care experience.

RxMedsSmart Phone Apps
There are several free or low-cost smart phone apps to help keep your medications up-to-date and easily accessible. Search for “medication lists” in your app store or try searching for one of the following:

  • MyMedsList
  • My Medication Info
  • Medication Manager

Arthroscopic Shoulder Surgery Wins over Skeptics

Dr. Michael Chrissos, MD, is an orthopedic surgeon with Michigan Orthopedic Center at St. Joseph Mercy Ann Arbor.

 Spring is here and the warmer weather means gardening, golf, spring cleaning and many other physical activities. But if a bum shoulder hinders motion, it may be a good time to look into arthroscopic surgery.

“It’s hard to imagine that only a few short years ago all shoulder repair surgeries were performed with large, wide-open wounds,” said Michael Chrissos, MD, a board-certified orthopedic surgeon with Michigan Ortho­pedic Center on the campus of St. Joseph Mercy Ann Arbor. “The vast majority of shoulder repairs — some 99 percent — are performed arthroscopically.

There is far less pain, blood loss and muscle trauma, and a much smaller scar.”

Recovery is tricky because, according to Chrissos, patients feel so good right after surgery they try to do too much too soon. “It’s critical patients understand that the healing process takes time,” he cautions. “This pro­cedure not only relieves the shoulder pain, it vastly improves their range of motion. But it takes time.”

When arthroscopy first became available, Chrissos, saw opportunity to be in on the ground floor of a wide-spread revolution. “At first there was a lot of resistance and plenty of skepticism,” he said, “and there should have been. When something new is introduced, you want to be sure it’s proven; but I knew intuitively that this technique was going to meet—or surpass—the results of open surgery.”

The NeedlePunch is a device Dr. Chrissos and his partner Dr. John Morris developed to allow surgeons to suture through small incisions.

Stretching the boundaries of the technology that was available at the time, he and a colleague, Dr. John Morris, actually worked with a local engineer to design a prototype that vastly improved the suturing process. “They designed a special needle that would load, push through and pull back in the tiny little incision,” he said. The patented product was refined and manufactured. Chrissos uses anchors to hold the sutures, comprised of an inert plastic that most patients seem to tolerate well.

There’s a misconception between joint replacement and arthroscopic surgery. “It’s important to note that when I’m talking about arthroscopic shoulder surgery, I’m not talking about shoulder joint replacements. I am referring to repairing torn or damaged tendons, ligaments and cartilage,” he said. “Because we insert a camera during surgery we can see 360 degrees, and have a much better view of what we’re doing verses traditional open surgery,” said Dr. Chrissos. “There’s also less risk of infection and less stiffness.”

Arthroscopy:  Sometimes called “key hole” surgery, arthroscopy is a minimally invasive procedure performed via small incisions using specially designed instruments and a viewing scope that is inserted into the affected area and projects images onto monitors in the operating room.

Candidates for shoulder repair generally fall into two categories:

  • Under 40 years of age, who have suffered some kind of trauma— young athletes, accident victims or other injury sufferers
  • Over 40 years of age, with an accumulation of wear-and-tear from general use, arthritis or other underlying condition

“Tremendous strides have been made with arthroscopic shoulder surgery, that Dr. Chrissos wants patients and referring physicians to know that there is no need to delay. “Early evaluation is critical and we can avoid complications and worse outcomes with timely intervention.”


Entering Into the Chaos of Another

By Michael Miller, Chief Mission Officer

“Mercy is the willingness to enter into the chaos of another.”

This is my favorite definition of mercy. 

I learned it from a moral theologian — James Keenan, S.J. — and I share it every chance get. I often share it during new employee orientation at Saint Joseph Mercy Health System. My job is to support my colleagues as we ensure that our mission, values and Catholic identity are tangible in the work we do each day. I get to remind my co-workers about the sacred opportunity we have to be mercy for others. 

Everyday, people walk into hospitals not knowing why they are sick, anxiously waiting for a diagnosis. Some of them are afraid that they don’t have enough money to pay for the care they need. This is living in chaos. 

While we know we can’t cure everyone, we can care for everyone. We can be companions in their time of need. We can enter into their chaos. We can be mercy for them.

Even if you don’t work in a hospital, you probably have opportunities to be mercy for others everyday. In his 2015 Message for Lent, Pope Francis shares his hope that we take advantage of these opportunities:

“…how greatly I desire that all those places where the Church is present … may become islands of mercy in the midst of the sea of indifference!”

Perhaps you’ve heard the Gospel story about Joseph learning that Mary was pregnant before they got married. This freaked him out. He was ready to divorce her and leave. However, God intervened and Joseph chose to stay with Mary. He willingly entered into the divine chaos of Mary’s life. Joseph was mercy for Mary. 

I would guess that you know people living in some kind of chaos. Whether they are in our parish, workplace, neighborhood or our own family, we can, like Joseph, be mercy for others.

Questions for Reflection:

How can I reject indifference today?

How can I be mercy for others?


Note:  On March 18, the Catholic Church and several Protestant and Orthodox traditions celebrate the Feast of St. Joseph.  St. Joseph is the namesake and patron of St. Joseph Mercy Ann Arbor, Livingston, Oakland, Port Huron and of our fellow Trinity Health ministries in Mishawaka, Ind., Atlanta, Ga., and Southern Pines, NC. 

Re-published with permission from the St. Mary Student Parish.

IMG_0149Michael Miller, Jr. is the Regional Chief Mission Officer at Saint Joseph Mercy Health System. He studied philosophy at Loyola University New Orleans (BA ’01), liturgy at Aquinas Institute of Theology in St. Louis (MA ’07) and is currently studying bioethics at Loyola University Chicago. He moved to Ann Arbor, MI in 2011 with his wife, daughter and dog, and is grateful for their willingness to enter into his chaos.


Redefining Colorectal Cancer Treatment


Surgeons at St. Joseph Mercy Ann Arbor have totally re-engineered the way they treat colorectal cancer— before, during and after surgery–and the results have led to some of the best patient outcomes in the country for a disease that strikes more than 150,000 Americans each year. 

By analyzing the entire process from the patient’s perspective, the team at St. Joe has developed a model for treatment that is setting the na­tional standard for colorectal care. Its main components include:

  • Pioneering use of the minimally invasive da Vinci® Robotic Surgical System for colorectal conditions;
  • The “Enhanced Recovery Initiative,” (ERI); which includes comprehen­sive patient education and more effective pre- and post-surgical protocols.
Robert Cleary, MD

For Robert Cleary, MD, lead physi­cian of da Vinci surgery for colorectal cancer, it is the culmination of a 25- year career that began in general surgical residency at St. Joe and in­cluded a colorectal surgical fellow­ship at Parkland Memorial Hospital in Dallas.

“St. Joe added the da Vinci to our suite of robotic surgical tools in 2006. At the time, it was being used mostly by urologists and gynecologists,” said Dr. Cleary. “I had been fellow­ship trained in laparoscopy, but I was convinced we could use the da Vinci for colorectal conditions, too. With its 3D imaging, greater flexibility and improved dexterity and con­trol, I thought it would be easier than working with a laparoscope.”

ERI has shortened hospital stays by two to three days with no increase in readmission.

Well informed, well prepared patients are able to participate more fully in their own recovery.

2009 was a signature year for the Colon and RectalSurgery service. Dr. Cleary applied through the American Council for Graduate Medical Education to establish a Colon and Rectal Surgery fellowship at St Joe’s. This fellowship to train future colon and rectal surgeons was approved in 2012. The second fellow is currently enrolled in this program that includes robotic training.

Colorectal_1As compared to traditional, open surgery, the da Vinci approach promises less blood loss, smaller scars, shorter hospital stays, lower likelihood of infection or other complications and a faster recovery time. “We also see better clinical outcomes, quicker return to bowel function and normal diet, significantly less pain and faster healing,” he said.

But spectacular as the surgical successes are, what happens before and after surgery is equally important to the overall patient experience. The Enhanced Recovery Initiative (ERI) is a program developed by Dr. Cleary and a host of colleagues in anesthesia, nursing, nutrition, case management and other disciplines.

“We sat around a table and said, ‘ok, we’re going to create an enhanced recovery protocol—much like ones that have been popularized in Sweden,’” he said. “We decided that each of us would research all the literature in our area of expertise and come back every month to discuss our findings.”

The group learned, for example, that the conventional wisdom of no food or drink 12 hours before surgery was not the best approach; that the patients actually did much better if they consumed a high carb sports drink (Gatorade) two hours before the procedure. It decreased nitrogen and protein losses, reduced insulin resistance, helped maintain lean body mass and decreased recovery time and length of stay.

“We also learned about better ways to do bowel prep, anesthetics and pain management, and we found treatments that reduced the incidence of post-surgical blood clots as well as nausea and vomiting,” he said. Other enhance­ments included better fluid management that speeds up the return to normal bowel function, early removal of urinarycatheters and a quicker return to post-operative feeding and mobilization.

ERI, which went live in February of 2012, has shortened hospital stays by two to three days with no increasein readmission.

Key to the success of the program is patient education that begins with the first office visit. After speaking with the physician, patients are given an information kit that includes hard copy handouts and a DVD with a 15-minute Power­Point presentation that detail the disease process, treatment options, risks and benefits, milestones and expectations. Well informed, well prepared patients are able to participate better in their own recovery.

Dr. Cleary believes the combination of da Vinci robotic surgery and the Enhanced Recovery Initiative make St. Joe’s colorectal program the most progressive in the region. “Along with our fellowship program, it has put us in prime time and gained us a reputation as a state-of-the-art center,” he added.

Finding Results

Dr. Cleary is setting his sights on the outpatient experience. “We want to bring the same scrutiny to the patients’ healing process once they’ve gone home,” he said. In addition, St. Joe is working with the Michigan Surgical Quality Collaborative, a consortium of 67 hospitals across the state, to share its findings and replicate its successes statewide.

Join the Conversation on Community Wellness

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Saint Joseph Mercy Health System is off to an exciting start to a healthier 2015 with the launch of the “Join Me” initiative. To date, more than 3,500 people have visited the Join Me website to learn more about our commitment to improving the health of the communities we serve. Social media advanced our message to a wider audience via Facebook and Twitter.

We’re now recruiting community “wellness ambassadors” to help spark real change through collaboration and activities. To that end, health reporter Lila Lazarus and I – along with local leaders – are launching a series of one hour Lunch & Learn events at every SJMHS hospital in our region. We will not be promoting services or pushing agendas, but rather engaging the community in a grass roots conversation about health topics that are important to them.  Colleague and physician conversations will occur at upcoming leadership meetings. Based on input and engagement, we will be open to other internal and external meetings in the future.

You can visit www.stjoeshealth.org/joinme to register for an event closest to your home.

Community Engagement Series:

March 24, 2015              St. Joseph Mercy Chelsea         1:30 p.m.         

April 7, 2015                  St. Mary Mercy Livonia              Noon               

April 20, 2015                St. Joseph Mercy Livingston      Noon               

April 24, 2015                St. Joseph Mercy Ann Arbor      Noon       

April 27, 2015                St. Joseph Mercy Oakland          Noon

“Since the launch of this community initiative, I’ve met people who have made remarkable changes in their lives helping others do the same,” said Rob Casalou, President and CEO of Saint Joseph Mercy Health System. “Together we can help this initiative catch fire.”

Coming to Brighton: Return of the Super Colon

The lobby of St. Joseph Mercy Brighton will be filled with a giant inflatable colon on March 17, from 10 a.m. – 2 p.m. The interactive event raises awareness of regular screenings during National Colorectal Cancer Awareness Month.

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The Science of Stress on the Heart

Stress in all of its many forms can be harmful to your heart. Whether its relationship problems or the pressures at work, the body tends to shift into a primitive protective gear called “fight or flight.”

Mark Bernstein, MD, a cardiovascular disease specialist at Michigan Heart, offers tips for identifying stress and how to find healthy avenues to avoid its negative physical effects.

In scientific terms, stressful events or feelings trigger a part of the brain called the locus coeruleus, which processes sensory input and can increase or decrease awareness of surroundings through its autonomic nervous system.

The hypothalamic/pituitary/adrenal axis will cause hormones to be excreted that will aid in the “fight or flight” response.  CRF is secreted by the hypothalamus, which in turn secrets ACTH, which will in turn secrete cortisol, which increases the availability of sugar to the body.

The adrenal gland will also secrete epinephrine, which will increase heart rate and increase blood supply to the muscles and shuts down digestion and sexual system until stress is relieved.

For a short time these responses are appropriate and beneficial, however, if present for a prolonged time the can lead to increased blood sugar, elevated blood pressure, fluid retention, activated platelets (which can lead to heart attacks) and decreased immune response, which can lead chronically stressed people to be more prone to illness.

Why is stress bad for the body?
When dealing with relationship issues and the pressures of work, the body shifts into a primitive protective gear called “fight or flight.” The brain stimulates sugar production in the body, increases the heart rate and shuts down the digestive system and sexual system until stress is relieved. These defensive measures offer short-term relief but prolonged stress drives up the risk of heart attack and lead to chronic illnesses.

How do people react to stress?
People react to stress in different ways. Some people experience physical reactions such as heart palpitations, headaches, ulcers, lack of appetite, overeating, anxiety and depression. These conditions are exacerbated by the use of alcohol, tobacco, drugs and lack of sleep.

What are some ways to reduce the physical effects of stress?
For starters, reducing or eliminating bad behaviors can lower risk of developing heart disease. Anxiety medications are an option but they are not a good long-term solution. There are a variety of ways to help people reach a sense of relaxation and well-being. These techniques include meditation, yoga, Tai Chi, music, reading, religion, exercise, healthy eating, and social interaction.

For more information, visit http://www.michiganheart.com.






All You Need is Love

LilaLazarus_ColumnArtThe Beatles were on to something.  When it comes to protecting your heart, love may be your most potent protective covering.

If you want to reduce stress and anxiety, decrease your blood pressure and total cholesterol, you know the importance of good nutrition, exercise and not smoking.  But did you know the simple act of loving  along with some specific behaviors that go with it, can also empower your heart?  So if you really want to improve your next stress test… turn up your love meter.  Here’s how:

I Want to Hold Your Hand
Grab a hand.  If it’s peace and serenity you’re seeking, people think of yoga or meditation or maybe a hot bath.  Turns out, just holding hands can also have that calming effect.  A study published in the journal Psychological Science showed that a little pressure when holding hands, specifically  a squeeze between the thumb and forefinger, could calm pain and anxiety and promote a feeling of well-being.  The less stress you have, the less likely you are to have an increased heart rate and other factors that can lead to heart disease.

She Loves You
Fall in love!  Oh the wonders of a new relationship!  You know that magical feeling when your heart goes pitter patter.  Your brain is busy releasing a drug cocktail of hormones: Adrenaline, dopamine and norepinephrine. They all help to strengthen your heart beat and get your blood circulating more efficiently.   It’s a workout.  It’s similar to what happens when you jog around the block.   You even feel healthier.  But don’t get me wrong… you still need to exercise.

Love Me Do
Surround yourself with people you love and who love you. It’s a great way to keep your blood pressure down.  A study reported in the journal Psychosomatic Medicine suggested a loving relationships and healthy friendships may be the key to a healthy heart.

Hold Me Tight
Go give someone a squeeze!  I’m a real believer in hug therapy.    I don’t need a study to show it makes a person feel better though there are plenty of studies.  The act of hugging releases the “cuddle hormone” oxytocin.   We also immediately reduce the amount of cortisol, the stress hormone produced in our bodies.   In an experiment at the University of North Carolina, Chapel Hill, people who didn’t have any contact with their partners developed a quickened heart rate of 10 beats per minute  compared to the five beats per minute among participants who were allowed to hug their partners

Bottom line: Love is all you need.  I’m off to hug and kiss and hold hands with my hubby.  It’s good for the heart.

A Matter of the Heart

Dorothea Ross 098

Dorothea was grateful to be celebrating another Thanksgiving with her family, but the day before the holiday she felt chest pain and pressure, which led her straight to the emergency room at St. Joseph Mercy Ann Arbor. She was relieved to hear that her diagnosis was angina, but it revealed an underlying issue.

This wasn’t the first time Dorothea experienced heart problems. She has survived four heart attacks and two open heart bypass surgeries in her lifetime. 

The heart team at St. Joe knew that Dorothea needed an aortic valve replacement but another open heart surgery was too risky for a woman her age who had previous heart surgeries. “I just figured that I didn’t have much time left,” said Dorothea, “but Dr. Arthur Szyniszewski and Dr. Andrew Pruitt gave me another chance at life when they told me about a new procedure they were doing called TAVR.”

Traditional treatment for severe aortic stenosis – a narrowing of the valve that delivers blood to the heart—has been to open the chest, remove the faulty valve and replace it with a new one. For many years there was little that could be done to treat severe aortic stenosis if the patient was unable to undergo open heart surgery due to age and/or the severity of their condition.

But, in 2012, the heart team at St. Joseph Mercy Ann Arbor began performing a new procedure – the transcatheter aortic valve replacement – or TAVR. Watch Video on how TAVR works.

Dorothea carefully weighed the risks and benefits and decided to go for it. “I’ve been blessed with a good life and if the doctors feel it will be successful, then I have no worries,” said Dorothea. “I come to St. Joe for all of my health care needs because of their good reputation and excellent care.”

Originally from Winnipeg, Canada, Dorothea has always been very active. She spends quality time with her good friends, is an avid euchre player and loves parties. She also enjoys spending time with her family and seeing her 14 grandchildren, 12 great grandchildren and five great-great grandchildren.

“Before TAVR I thought my days were numbered. Now, with each day that passes I’m not having any more angina attacks and I feel great. I enjoy my life and I’m happy for the opportunity to lengthen it.”


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