Renovated Orthopedic Department Looks Good and Delivers Positive Outcomes
Holy Spirit’s newly renovated orthopedic unit is a well-kept secret that is meant to be shared far and wide, according to William Polacheck, M.D. The hospital’s Chief of Orthopedics wants the community to know that the sixth floor dedicated unit offers private rooms, boasts low rates of infection and re-admission, and provides a comprehensive pain management program that uses less narcotics, while delivering more comfort and fewer complications.“Holy Spirit’s orthopedic unit is a beautiful facility,” he says. “They have done a lot to improve the patient experience, including providing dedicated orthopedic nursing.”The 23 patient rooms (most are private) are spacious, bright and feature large windows, private bathrooms, and 32-inch flat screen TVs.“The rooms are large enough to accommodate orthopedic equipment and visitors and still allow for the patient to move around easily,” says Jynae Foulk, RN, MSN, CLNC, Orthopedic Service Line Manager.Possibly more important than the renovated unit, are the Orthopedic department’s low infection rates. In 2008 the rate of infection for both total knee and total hip procedures was about one for every 100 procedures performed.“Our numbers in Orthopedics have been great for years and nobody knows that,” says Dr. Polacheck. “We need to get it out in the community that our [infection] rates are excellent by any standards.”The department’s successes began with an experienced team of physicians, including surgeons and anesthesiologists, who have practiced with Holy Spirit for many years. Jesse Hoover, MD, whose anesthesia group provides comprehensive pain management, meets with patients prior to surgery and explains their options for anesthesia, including the use of different anesthesia techniques and medications, which make a tremendous difference in both post operative pain and nausea.“We focus on anesthesia from many directions,” says Dr. Hoover. “Instead of relying on a large amount of one drug, we give smaller amounts of several drugs that work together to provide greater pain control and less post operative nausea, which is something patients really appreciate.”The department also offers an optional educational program known as the Total Joint Experience. The class is led by Nancy Hoffman, RN, who walks patients through everything they can expect with joint replacement surgery, prior to entering the hospital.“The nurse leading the class discusses routine procedures, pain control, equipment, even what to expect from a nursing assessment,” explains Lisa Lewis, MSN, RN, NEA-BC, Vice President, Patient Care Services. “The session makes it possible for patients to prepare things at home prior to surgery and think about what will help them with the healing process.”They also view a video that features Holy Spirit therapists discussing the role physical and occupational therapy will play in their recovery. The video also helps to relieve anxiety prior to surgery, according to Chris Bodle, MSPT,Clinical Manager of Inpatient Therapy Services.“Many times, the patients will see the same face [in the video] that they will see after surgery,” he says. “They know what to expect and folks seem to progress better.”
“We do a lot of procedures where we go through the abdomen to the front of the lumbar spine and then turn the patient and do a reconstruction on the back of the spine,” explains Dr. Wolf.
That continuity of care also is prevalent in the therapy services provided after surgery, both at thebedside and in the satellite clinic on the orthopedic floor. The therapy staff rotates every eight weeksthrough the satellite clinic.“We get good continuity of care and develop relationships with the physicians,” adds Bodle.Patients who undergo joint replacement surgery receive physical therapy twice a day, seven days a week. Care begins at the bedside, but as soon as appropriate, the patient moves to the clinic to work on activities such as stairs and balance exercises.“The occupational therapists work with patients in the satellite clinic as well,” he adds. “There the patients can simulate their home routine.”Seeing total joint replacement patients every day means function improves more quickly and patients return home sooner, according to Bodle.“Once a patient is sent home, Comfort Care Home Health picks up the care until they progress to where we can see them in one of our many outpatient rehab clinics in the community.”All of the Orthopedic services and amenities came out of the work of an advisory committee formed to increase communication between hospital administration, orthopedic surgeons, nursing, therapy and other clinicians.“It gives us very strong clinical and administrative collaboration,” explains Lewis. “It really is an interdisciplinary way to look at the quality and outcomes of our program and continually improve.”
Heroes Among Us: Part 2
Heroes2ArticlePic05
Even after being there and witnessing the devastation firsthand it is still hard to fathom the depth of loss and grief. In the two weeks that I was there I learned more than I ever thought I would about Haiti and myself. The images and stories are haunting. As we passed through the marketplace of Port au Prince on our way back to the airport there were signs of life returning to “normal.” I couldn’t help but think that it was all a facade of the true underlying corruption and suffering of this tiny land.There were 271 patients living in tents and each was permitted to have one family member live with them. Inevitably, the number of family members was usually more than one, so at any given time there were about 600 displaced people living in the tents. I was assigned tent row 10 and was responsible for the nursing care of 36 patients. The injuries were varied but most included external fixation, infections, grafts, failed grafts and amputations along with some internal medicine patients. As you can imagine, Post Traumatic Stress Disorder, in varying degrees, was very common.I was lucky enough to be included as a nurse volunteer representing Operation Smile at a field hospital in Fond Parisien, Haiti, a village forty five miles east of Port-au Prince.My friend, Robin Kingston, a pediatric nurse practitioner at Hershey Medical Center, and I lived, worked, cried, laughed and prayed at the camp located on the Love a Child Orphange grounds for twelve days. The hospital was founded just days after the earthquake of January 12 in a joint venture by the Dominican Republic, Harvard Humanitarian Initiative, Operation Smile and Love a Child.
Heroes2ArticlePic03
There were volunteer health care workers from around the world, each one of us working out of our comfort zones professionally and personally. The heat was oppressive, the sun unrelenting, until the evening when a refreshing breeze would usher in perfect sleeping conditions for our weary bones. We slept on the ground in sleeping bags in ample sized Eddie Bauer tents. Our showers were cold bucket showers behind tarps while looking up at the most beautiful night sky I have ever seen. We were provided one hot meal daily that was beans, rice and special sauce of the day, which usually included sardines!Before the quake, life in Haiti was more difficult than any of us could ever imagine. Now, they face an even more uncertain future buoyed by their unwavering faith and tenacious spirit. It was an honor and my pleasure to serve the gracious, resilient, lovely citizens of Haiti. I hope to return one day. Please pray for Haiti and its people.
Heroes Among Us: Part 1
heros-among-us-1-inset
The ecological difference between Haiti and the Dominican Republic is starkly visible from 32,000 feet.The Dominican Republic on the eastern half of the island the two Caribbean countries share, is beautifully green. It’s neighbor to the west, Haiti, is brown, thanks to clear cut forests and decimated ecosystem.This was the first thing Dr. Jack Frankeny and his wife, Beverly, noticed. The Greenwood Twp. Juniata County, couple landed in Haiti’s capital, Port-au-Prince, on April 9 to serve as surgical volunteers. The closer they got to Carrefour, a Port-au-Prince suburb where the Adventist hospital was located, the more they saw the effect of the January 12 earthquake.“We’d get closer and closer and closer and closer, and we’d start to see the shanties and the tent camps,” Jack explained. “ We noticed a lot of blank faces; traumatized, vacant stares.”From April 9 through 16, the Frankenys helped Haitians with surgical issues,which ran the gamut from tumors to arthritis to amputations. Half of those the Frankenys assisted were victims of the earthquake, and the other half were people who never before had access to medical care.After the earthquake, the Haitian government offered free treatments to anyone in need, not just those injured by the quake. Some would come into the hospital and pretend to be a victim in order to receive care. The Frankenys did everything to reassure those in need that they would receive care.”You could just tell based on their appearance [that some weren’t affected by the earthquake],” Jack said. “All you could do was reassure them that they were going to receive care.”Jack is an orthopedic surgeon at the Orthopedic Institute of Pennsylvania. He first learned of the World Surgical Foundation, the Harrisburg-based group the Frankenys traveled with, through a colleague, Dr. Dom Alvear, the group’s founder.
HeroesArticlePic04
When Jack approached Beverly, an orthopedic nurse, about going to Haiti, she put aside her reservations and was all for it. “We had done small donations, but I prefer to be hands-on,” she said.They had three weeks to prepare for the trip and arrange for someone to take care of their hobby farm. Several inoculations later, they were ready to go.Despite the hardships the couple saw, there were moments of happiness. Beverly’s camera became a favorite of the Haitian children, who enjoyed having their photos taken.”You would take the photo, and they would want to see it. Once they saw it, their faces lit up,” Beverly said.Many of those photos made their way to Beverly’s blog, ImagesofHaiti.Blogspot.com, and each tells a story—some sad, some of hope. One of the photos was of new life.”Jack delivered his first baby,” Beverly said. It wasn’t something the doctor expected, but Jack said, “We did whatever was required.”The conditions weren’t optimal. In surgery, an attendant would use an electric fly swatter to keep insects away. Implements, gloves, gowns and other supplies often were recycled due to depletion fears.It bothers the Frankenys that they had to leave without being able to follow up to make sure some of the surgeries were a success, but they would be able to follow up with doctors there.The trip to Haiti made the couple grateful for what they had. “Nothing could justify unhappiness” after what they were privy to witnessing.”They’re nice people,” Jack said. “They are a positive, loving people—it’s innocence in hell.”
Running & Health Over 40
PicArticlePic01
It’s not a sprint; it’s a marathonThat age-old adage is underscored when listening to mid-state runners older than 40 who regularly participate in the region’s toughest races.Some can tell their running pace has slowed. Others admit they need more time to bounce back after a race than they did at a younger age. And yet others go full-steam ahead after crossing the finish line – enjoying dinner, doing laundry and even packing for vacation right after they compete.All run with a passion but pay particular attention to the needs and limits of their changing bodies.”My brain keeps saying go faster but my body says hell no,” laughed Hap Miller, who has participated in 33 of 35 Harrisburg – area marathons and still shoots to run one race each year. “The minute I stop then I’m going to feel old. Running helps you hold on to that younger feeling.” That age-old adage is underscored when listening to mid-state runners older than 40 who regularly participate in the region’s toughest races.Perhaps there’s truth to that. “People say I look a lot younger. They are surprised to hear I’m 64,” he said. Miller has competed in 27 other races, including nine Boston Marathons.”I now average about an hour slower than 20 years ago, but I like to get under four hours. I hope to get back (to Boston) within the next year or two,” said the Carlisle retiree. “I can’t put it off too much longer.”As Miller and other Harrisburg-area marathons adjust their running goals during their later years, they remain humble about their accomplishments, reverent about the positive changes that the sport has brought them and determined to keep running as that benchmark 40th birthday fades in the distance.Body changesRunners typically peak in their performance between age 25 an 35, said Matt Silvis, a primary care sports medicine physician with Penn State Milton S. Hershey Medical Center. “After that, you are looking at someone who no longer is going to perform at the same level.”Muscles and tendons tighten with age. Adults older than 40 start to lose bone mass and will see cartilage change in their joints. On top of that, runners often ignore nagging injuries, compounding the consequences. “It starts to add up,” Silvis said. “It can affect your performance and heighten your risk of having injuries.”Silvis cited a recent study showing that those over 40 had more muscle, hamstring, quad and calf strains than those under 40. Up to 90 percent of people preparing for a marathon will suffer training injuries that cause them to miss part of their training, he said.That’s no surprise to the folks pounding the pavement.”I get a little stiffer than what I used to,” said Marjorie Lebo, 47 of New Cumberland. “I take my fair share of Advil. I’m definitely a little slower, but I’m OK with that. …All of us are darn lucky to be running.”Lebo, a certified registered nurse practitioner at Hershey Medical Center, has been running for 30 years, with 27 marathons – including 11 in Harrisburg – under her belt. While lifting free weights combats her time loss and maintains core strength, she has adjusted her training over time. She used to run five to six days a week; now it’s four. Other runners say they’ve made changes, too. Miller cut back on weekly miles and scheduled more brisk walking.Silvis stressed that the over-40 crowed must stretch regularly, maintain good flexibility and even take off a week. “I’d rather be 90 percent in shape than 100 percent injured,” said William Demote, 55, of Hummelstown, who started marathon running 10 years ago.But why run when it can be so tough?It’s so addictiveJim Hon, 44 of Dillsburg regularly runs 80 miles a week, logging 80,000 miles over the years.”If I were a car, I’d be trading myself in right now,” joked Hon, who has racked up 78 marathons in 27 years and runs eight to 10 a year. “My doctor always told me there are only so many marathons that any one person has in his body, and I’ve already blown that curve.”Hon started running in high school to lose weight. “I fell in love with it. It totally became an addiction and part of my life.’ He hoped to compete 50 marathons before he turned 40; he did so within a month of that birthday. “So I thought, let’s see if I can double that in the next 10 years” (100 marathons before 50), he said.Hon and his wife often plan winter vacations around marathons, in scenic warm-weather climes like California’s Big Sur Marathon, billed as “Running truly has been a blessing.”Everyone began running for different reasons. With Honchar, it was weight. Miller listed weight and smoking. It served as a moms’ social activity for Elizabeth DeSousa, 45, of West Hanover Twp., until she decided to leave a legacy of sorts.Area medical professionals and marathoners offer these tips to lead you to the finish line for the first time:Get a full physical.Consider pre-training counseling with a pro who deals with runners, like sports medicine physicians.Consult www.runnersworld.com for beginner training programs.Seek quality running shoes at local shoe stores that work with runners.Build up your mile counts slowly, over four months to a year depending on your comfort level. Initially set goals at a few miles a week and include time to walk.Start with shorter races and work up to a marathon.Get involved in a running club (such as Harrisburg Area Road Runners Club) for weekly runs, support and pointers. Seewww.harrc.org for details.Eat sensibly and stay hydrated.Vary running routes to maintain interest and prevent injuries from running the same grades, ruts and bumps repeatedly.Take a day off each week from running.Getting older, Changing goalsWhile SeSousa and Honchar have yet to notice the aging process, chances are their running goals will change as they grow older.”I went from just finishing to qualifying for the Boston marathon – and today I’m back to crossing the finish line,” said Andrew O’Donnell, 62, of Hummelstown, who has run about 46 marathons since 1978, including three in Boston. “It’s back to the future.””You have to slow down as you get older,” he added. “I made a conscious decision years ago not to run for a time any more but just for the pleasure of crossing the finish line.”DeMuth started marathon running with the goal of qualifying for Boston, he said, He missed it his first time by eight minutes. “At the time it was like climbing a mountain those last few minutes,” said Demuth, who has run Boston three times and wants to qualify again. “It is physically harder. Our bodies can’t generate the speed we did years before.””I wish age didn’t make a difference, ” he lamented. “Once you hit 50, for most of us our performance will slowly decrease because our tissue changes. The biggest change is that you have to listen to your body.”Bodies speak loudly. “I learned from practical experience,” said Demuth, an orthopedic surgeon with Orthopedic Institute of Pennsylvania. “I did too much, and got injured.”Road to recoveryRecovery after a race is as individual as the runner, but growing older can change that routine, too.”The old body is sore a lot longer,” Miller said. “Sometimes it’s only a day or two recovery when you’re young. When you’re older it’s considerably longer. You lose flexibility, the soreness lingers. it’s inevitable; 26 miles of anything is taxing.”DeSousa envisions her recovery plan while running. “Once I’m through the chutes, I shower, have a margarita and steak dinner. I think about that as I run – go to that margarita in front of me.”Leaving youth behindAlthough runners compete in age groups during events, they’re all on the same course at the same time. Honchar gets a kick out of passing those half his age. “You give a nice smile and a “Hey how are you doing?” and you look like you’ve just run your first mile. They look at you like, “You’ve got to be kidding me.’ It’s a nice payback,” he said.Lebo said she would check her competition’s progress years ago. Now, she’s competing against herself to qualify for Boston, she said. “I’m far less competitive. I can be more encouraging now to other runners than I was 25 years ago.”DeMuth “just loves to be up there running,” but, he admitted, “If everyone around me looks younger than me, then that’s a pretty good day.”Finish lineRegardless of the individual goals and the hurdles overcome, crossing the finish line retains tremendous impact for marathoners.”It’s an incredible feeling of accomplishment, elation and joy,” Honchar said. “You have a feeling that you can’t be more alive at that point.”In the last few Harrisburg marathons, Lebo’s sons have run the final mile with her for moral support. “It’s such a good feeling of accomplishment, knowing you’ve got so much going on in your life and you’ve able to do this,” she said. “Knowing my kids are going to be there, I wouldn’t want to not show up. Oh, the embarrassment that would be.”While family support is crucial, marathon running is very individualized sport. “I don’t want anyone to think that running a marathon is a family event,” said O’Donnell, a part-time annuitant for the state Public Utility Commission. “Try to imagine a family coming to watch for four hours in the pouring rain. It’s important to have support but don’t expect participation.”Those adverse conditions can make the finish sweeter. “The harder it is, the move you’re going to be glad to cross the finish line” O’Dennell added.Reaping rewards after a raceLebo has channeled her love of the sport into helping others. Through the Harrisburg Area Road Runners Club, she serves as a race director, setting up 5K runs for Domestic Violence Services of Cumberland and Perry County. She has done the same to raise funds for colon cancer prevention with Hershey Medical Center.The marathoner’s confidence has carried into Honchar’s professional and personal life. “It has helped me manage emotions and really have a lot of self-esteem,” he said. “It’s let me really be thankful for every day I’m alive.””It has literally changed my life,” DeMuth concurred. “I have an intense sense of accomplishment for doing it. If you had goals that seemed insurmountable, the discipline… is instrumental in reaching those goals. It carries over into other things.”