Redefining Colorectal Cancer Treatment

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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.
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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.”

The Science of Stress on the Heart

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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 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
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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
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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

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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.”

 

Your Body is a Furnace. Turn it On!

IMG_1836Happy New Year, friends! Here we are in the dead of winter. This time of year can be a real downer for a lot of people. A good way to boost your mood is to get outside and fight the elements!

It’s not easy to tear myself away from a cozy spot next to the fire for an outdoor workout.  I usually have to talk myself into it.  But the benefits are worth it.  And the more I do it, the easier it gets. So can you!

With the right clothing, you don’t have to get cold! Put on breathable, moisture-wicking layers of clothing. Just be sure to protect your most vulnerable body parts: Fingers, toes, ears and nose. Those are the areas most susceptible to frostbite. And no need to shock the body. Warm up before you ever leave. Do some jumping jacks or lunges.    

I always think it’s going to be colder than it really is. And the truth is, you want to feel a slight chill when you get outside. If you don’t, you’re likely overdressed. But after 10-15 minutes of jogging or cross-country skiing, the body starts warming up and you can feel the winter blues disappearing.LilaLazarus_ColumnArt

Here are the top 5 reasons to bundle up and head outdoors.

  1. You Need the Vitamin D
    Unless you’re headed to the islands for vacation, chances are you could use a boost of the sunshine vitamin.  This time of year, feeling a little sunshine on your cheeks, even at below-freezing temperatures, can really lift your spirits and your energy levels.
  2. You’ll Feel Happy!
    If you don’t believe me, just try it yourself. Working out in Michigan in the winter doesn’t come with that heavy humidity we find in the summer. You actually feel lighter outside this time of year. Since your body is working harder in the cold, it’s easier to get that runner’s high as the endorphins start soaring.
  3. It’s a Calorie Cruncher.
    Don’t get me wrong. I know it’s harder to workout outside in the winter. But that’s the beauty of it. Working harder means your burning more calories. It’s the same workout you might do in the summer, but you get more bang for your buck because your body is using more energy just to stay warm. Your body is one powerful furnace. Turn it on!
  4. It’s Heart Healthy
    If you already exercise on a regular basis, taking it into the elements is going to strengthen your heart muscle even more. With added heart strength, you’ll be better prepared for the big workouts come spring and summer.  
  5. You’ll Get Rosy Cheeks
    One of my favorite childhood memories is sledding on the big hill near our house. It was tough dragging that sled to the top. By the time we came back home my cheeks were bright red. Exercising in the frosty air still gives me that same exhilaration – and rosy cheeks, to boot.

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By keeping your body strong and in shape, you can reduce the likelihood of illness, says family doctor Paul Schulz, MD, with St. Joseph Mercy Brighton. “Someone who is in shape tends not to get sick as much,” he says.

But winter workouts aren’t for everyone. If you already have a heart condition or asthma, make sure you talk to your doctor. The cold can tighten your airways. That could limit your oxygen and put extra stress on your heart.

And if you do get sick, the best medicine is to “go by what your mother told you,” says Dr. Schultz. That means getting lots of rest and drinking fluids.

 One last note:  When you’re done exercising outdoors, make sure to hydrate.  The air is so dry during these winter months and you don’t want to get dehydrated. Happy Winter!

Read more Lila’s Health Report posts

 

Exercising while sick: Listen to your body and rest!

There’s a common misconception that exercise can “run” a cold out of the body. While exercise can reduce the likelihood of illness, “germs are germs… they get to everyone,” Dr. Paul Schultz, family and medicine physician at St. Joseph Mercy Brighton, told Livingston Press & Argus writer Abby Welsh.   The best advice is to get lots of rest and drink fluids. He shares more advice in this article, “Exercising while sick may do more harm than good.”

 

 

Join Me on a Journey to Better Health

By Rob CasalouRob Casalou
Regional President and CEO, Saint Joseph Mercy Health System

The start of 2015 marks my first days on the job as regional president and CEO of Saint Joseph Mercy Health System. From my family to yours, I hope the New Year brings you much joy, good health and personal growth. As I begin this journey, my mind is filled with goals and resolutions!

I want to take this opportunity to introduce myself to those who may not know me, and share my vision for a healthier and more vibrant community.

Having worked with SJMHS colleagues and physicians across southeast Michigan over the past six years, I can honestly say the industry’s brightest and most dedicated people work here. Our hospitals are exceptional at treating complex medical conditions, ranking among the best in the country for clinical outcomes and patient safety. We also want to be the best in the country at reducing risk and improving health. Therein lies a great opportunity for us to change lives for the better.

As health care professionals, we know the statistics – obesity and diabetes rates on the rise, life expectancy lowering*. The best way to improve the health of our communities is from the inside out. I have a vision for a healthy and active workforce.

To further our message, Saint Joseph Mercy Health System is embarking on a “Journey to Better Health.” Please think about the goals you can make to improve your own health and become more involved in the communities we serve. With your support and engagement, this journey is going to be remarkable for us all.  I invite you to visit www.stjoeshealth.org/joinme to learn more.

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Watch Video

We have a strong foundation with which to accelerate our efforts. Across SJMHS, there are farmers’ markets, 5Ks, bike rides, classes, wellness events, sports teams, walking groups, Weight Watchers at Work, HMR weight management programs and more. Our hospitals have been tobacco-free longer than any other hospital in the state.

We are leading the way in the communities we serve. Our partnership with Eastern Market in Detroit puts nutritional education and farm-grown produce on the tables of those who need it most. We’ve partnered with the Detroit Red Wings to identify healthier menu options for fans. We’re helping people improve their health through weight loss programs, smoking cessation, wellness events and health screenings. We help athletes rehabilitate from injuries and encourage families to get moving together.

I am honored to have this opportunity to work with all of you. We have much to do to build on our collective strengths of connected hospitals, outpatient centers, physician offices and programs for the poor and underserved. By our example, we will be a transforming healing presence in the lives of those we serve.

It starts with our own health. Take the journey in 2015. Join me.

In good health,

Thank you, riders!

We at Saint Joseph Mercy Health System are proud of the cyclists of Team Joe’s who completed the Wish-a-Mile challenge.  This year’s riders were –

Rosalie Tocco-Bradley, MD
Alex Bradley
Lee Benjamin, MD
Rob Casalou
Ralph Dillier
Nick Graham
Bill Holmes
Ed Jones
Dave McNeil
Sheila Marcus, MD
Tim Mervak, MD
Tom Mihalski
Russ Olmsted
Mike Prisby
Jenny Cotton Pruitt (WAM 50)
Jon Ricard
Scott Sapita
David Steinberg, MD
Jodi Talbott
Rob Urbanowicz
Jenny Mary Wehrly (WAM 50)