InPractice APRIL 2014 Women s and Children s Services Care for a Lifetime of Health and Wellness
Women s and Children s Services Supporting Women Throughout Their Lives ON THE COVER: Joseph Morris, MD; Briana Walton, MD; Michael Lantz, MD; and Teresa Diaz-Montes, MD, MPH Women s and Children s Services at Anne Arundel Medical Center offers a wide spectrum of options that encompasses testing, treatment and care for women of all ages. Our services range from well care to treating complex conditions, healthy deliveries to high-risk obstetrics, and routine to advanced breast and gynecologic care. The Clatanoff Pavilion at Anne Arundel Medical Center More Choices for Women Henry Sobel, MD, chair of Women s and Children s Services at Anne Arundel Medical Center, stresses that the center is focused on providing patients with safe, high-quality, familycentered care. Our program has grown because of the breadth and depth of services we offer for our region, he says. Henry Sobel, MD Major Birthing Center More than 5,300 babies the second highest in the state are born here each year. Women come from as far as the Eastern Shore and Southern Maryland, remarks Dr. Sobel. Our experienced nursing team works hand-in-hand with private obstetricians, maternal-fetal medicine specialists and board-certified hospitalists to provide continuous care. Patients can also be cared for by certified nurse midwives in a freestanding birthing center on campus or in the hospital. Other advanced services include 24/7 dedicated OB anesthesia services and a Level III neonatal intensive care unit, one of the highest levels of care for the sickest babies. e NICU has exclusively private rooms, where neonatologists care for preemies and high-risk infants. We track our quality metrics against both state and national data and our outcomes are excellent, adds Dr. Sobel. Reducing the Rate of Contraindicated Elective Deliveries e number of mothers with healthy pregnancies electing to have their babies before 39 weeks gestation has been rising. is trend is concerning. In accordance with the American College of Obstetricians and Gynecologists and the Society for Maternal Fetal Medicine, we recommend delaying deliveries until at least 39 weeks when not medically necessary. e last few weeks and days of pregnancy are critical for the development of a baby s brain, lungs and liver. For more information, visit askaamc.org/choosingwisely. Minimally Invasive Gynecology We pride ourselves on the advances we ve made in minimally invasive gynecologic surgery, Dr. Sobel states. We have recently added Dr. Teresa Diaz-Montes, who has brought laparoscopic and robotic capabilities to our Gynecologic Oncology Collaborative, led by Medical Director Dr. Neil Rosenshein. David Todd, MD, an interventional radiologist, performs uterine fibroid embolization. Richard Marvel, MD, leads the minimally invasive gynecology and pelvic pain program. Briana Walton, MD, leads the urogynecology program, which is now offered in three locations. We re committed to growing our services to provide women across our region with high-quality care through each stage in life. For more information about Women s and Children s Services at Anne Arundel Medical Center, visit askaamc.org/womens. 2 A AMC I N PRACTICE APR I L 2014
Birth and Baby: Midwifery to NICU The Birth and Baby Team at Anne Arundel Medical Center offers an extensive range of services for expectant mothers, new parents and babies, including all-private rooms designed with women s needs in mind. Pregnant women have the option of Betsey Snow, RN delivering at the Clatanoff Pavilion or at Bay Area Midwifery located on AAMC s campus. Betsey Snow, RN, senior nursing director of Women s and Children s Services, says, Our personalized, familycentered childbirth model promotes mother-baby bonding. In addition to our board-certified obstetricians and outstanding nursing team, we offer certified nurse midwives and boardcertified lactation consultants. The 86-bed Women s and Children s Center in the Clatanoff Pavilion is undergoing renovations to provide a welcoming experience filled with light and familycentered conveniences. Midwifery Bay Area Midwifery is a state-licensed and nationally accredited birth center. Staffed by five certified nurse midwives, Bay Area offers a full scope of services, from well-woman to low-risk pregnancy care. Its free-standing Jennifer Caniglio, CNM center delivers more than 500 infants each year, with the back-up of expert perinatologists and hospital birthing facilities when unanticipated emergencies occur. To refer a patient or for more information, call 410-573-1094 or visit bayareamidwifery.com. Level III NICU Anne Arundel Medical Center provides life-supporting care to more than 500 premature and critically ill infants each year. Suzanne Rindfleisch, DO, neonatologistperinatologist, says, We provide comprehensive care to infants of all gestations and birth weights who are premature or with medical illness. We offer a range of Suzanne Rindfleisch, DO pediatric surgical and medical subspecialties, plus advanced nursing and respiratory care. Women come from many miles away to deliver at AAMC because of the ability to keep their babies close in the event the infant needs this specialized level of care. Center for Maternal Fetal Medicine For women with diabetes and other certain medical conditions, healthy pregnancy outcomes are significantly improved by seeking specialized care prior to conception. Michael Lantz, MD, medical co-director of the Center for Maternal and Fetal Medicine, notes, We offer a comprehensive program to optimize the preconception health of women Michael Lantz, MD with diabetes. Patients with good control of their blood glucose levels prior to pregnancy have a lower risk for miscarriage and certain birth defects, including open spina bifida and congenital heart disease. A maternal-fetal medicine specialist and a certified diabetic educator work with patients to address all aspects of their preconception and post-conception health. To refer a patient, call 410-224-4442. OB Hospitalists Expectant mothers have access to highly skilled, round-the-clock care from experienced, board-certified OB hospitalists. Having these hospitalists on staff improves response time, communication and coordination among the care team and enables us to provide more comprehensive care. They collaborate with patients OB-GYNs to provide the best care, Joe Morris, MD keeping him or her informed of the patient s medical condition and progress. They are also available to consult or assist with any emergencies. Classes for the Whole Family For patients who are pregnant or planning to become pregnant, AAMC sponsors a host of maternity classes and support groups at a variety of times and locations. Programs include: > Birth classes > Breastfeeding classes > Family education > Newborn care classes > Prenatal yoga > Breastfeeding support groups Patients can sign up for classes by visiting AAMCevents.org or calling 443-481-5555. 3 A AMC I N PRACTICE APR I L 2014
Urogynecology Pelvic Health e Women s Center for Pelvic Health at Anne Arundel Medical Center is a team of three female board-certified urogynecologists and two specialized nurse practitioners who treat complex pelvic issues at offices in Annapolis, Bowie and Odenton. We offer a full array of urogynecologic care, including conditions such as bowel and urinary incontinence, uterine fibroids, urogenital fistulas, and pelvic organ prolapse, says Briana Walton, MD, director of female pelvic medicine and reconstructive surgery. We pride ourselves on taking the necessary time for new patient consults, listening carefully because we Briana Walton, MD need to understand the impact on the woman s quality of life, not just what we see during an exam. Urogynecology only recently became a board-certified subspecialty, requiring fellowship training in female pelvic medicine and reconstructive surgery, clinical practice experience, case collection and a rigorous exam. Kay Hoskey, MD, urogynecologist, adds, Collaboration is critical. We work as a team, holding weekly pre-operative conferences. Our nurse practitioners co-manage patients and we meet quarterly with pelvic floor physical therapists to Kay Hoskey, MD coordinate care. Minimally Invasive Pelvic Prolapse Surgery Today, patients who fail conservative measures to manage pelvic prolapse can take advantage of far less invasive surgical options. Yong Zheng, MD, urogynecologist, notes, We o en see patients who have had some type of treatment or Yong Zheng, MD procedure but are still experiencing issues. We determine their goals, whether it s comfort, less pain or a better sex life. We then offer the most appropriate non-surgical or surgical options to meet those goals. Dr. Walton explains, Some 75 percent of patients are appropriate for a vaginal minimally invasive surgery approach, and the remainder receive laparoscopic or robotic sacrocolpopexy. e best approach depends on the patient s lifestyle and activity level. We ve used the robot since 2006 and our complication rates are extremely low. For more information, visit askaamc.org/pelvichealth or call 443-481-1199. Mara Holton, MD Newer Treatments for Overactive Bladder Overactive bladder (OAB) treatments have changed significantly, says urologist Mara Holton, MD, of Anne Arundel Urology. I tailor treatment to the patient s lifestyle and preference, often combining allopathic and holistic approaches such as acupuncture. This is especially important because long-term medication compliance rates are often less than 25 percent in a patient population where polypharmacy is already an issue. While pelvic floor physical therapy, behavioral modifications and medications provide good outcomes for 70 to 80 percent of patients, those who fail conservative methods can benefit from percutaneous tibial nerve stimulation (PTNS) or BOTOX injections into the bladder. For more information, call 410-266-8049. 4 A AMC I N PRACTICE APR I L 2014
Women s Rehabilitation Services We offer physical and occupational therapy to treat a wide variety of women s medical issues. Specialized services include rehab for women recovering from surgery and those with pelvic health issues. In 2014, Anne Arundel Medical Center s comprehensive cancer rehabilitation program became STAR-certified (Survivorship Training and Rehab Program), a designation given to programs that emphasize evidence-based best practices. For more information, visit askaamc.org/cancerrehab. Lymphedema Center Women who have had lymph nodes surgically removed are at risk for lymphedema. Early treatment can address this problem before it becomes disabling. Physical therapists and lymphedema specialists provide patient education and a series of exercises to strengthen the muscles, regain range of motion and provide a gentle skin stretch. Additional therapeutic approaches may include aerobic activity to increase tolerance, multi-layered bandaging that includes fitting for compression garments, manual lymphatic drainage and intermittent compression pumps. To refer a patient, call 443-481-3805. Rehab for Pelvic Conditions Specialized physical therapy can help address multiple pelvic problems, including urge and stress urinary incontinence and fecal incontinence, pelvic pain, constipation, interstitial cystitis, osteoporosis, and pre- and postpartum pain. Customized programs may include education, pelvic floor biofeedback, manual techniques, electrical stimulation, targeted pelvic exercises, and behavior modification. Patients receive individualized treatment in private rooms. Call 443-481-1140 for more information. How to Manage Patients with Breast Nodularity, Breast Density on Mammography and Other Issues Knowing when to refer a patient for further evaluation can be challenging, especially when the physician has received a report noting dense breasts or a high level of breast nodularity. Lorraine Tafra, MD, medical director of the Anne Arundel Medical Center Breast Center, offers some advice. Every patient is different and has a different level of breast nodularity, she says. As many as 10 percent of women will present with severe nodularity, which makes it difficult to have a high degree of confidence in your exam. Dr. Tafra continues, We recommend physicians err on the side of caution and refer patients who have nodular breasts or a difficult exam. To ease the patient s anxiety, they can say Your exam is challenging and I d feel better having a breast expert evaluate your breasts. It is particularly challenging for primary care physicians faced with a report that now must state (based on regulations passed by the State of Maryland) if patients have dense breasts on mammography. Deciding the patient needs further imaging with ultrasound, diagnostic mammography, an MRI, a high-risk consultation, or nothing is relatively complex and requires a thorough review of the actual mammograms, history, as well as a discussion of the pros and cons of next steps. To meet this need, The Breast Center plans to develop a high breast density clinic later this year to make it easier for patients and physicians to resolve these issues. These high density clinic appointments will be relatively short, follow a standardized protocol, and will provide the needed personalized education patients need to make an informed decision, Dr. Tafra notes. Dense Breast Law Challenges and Mammography Controversy The Breast Center staff also can assist when patients ask questions after being Breast surgeon Lorraine Tafra, MD, confers with breast imaging radiologist Daina Pack, MD. notified that they have dense breasts. The new Maryland law requires radiologists to notify patients with dense breasts. The controversy swirling around mammograms for women ages 40 to 49 has added to the challenge of managing breast care in this age group. Dr. Tafra observes, While it s a highly emotional issue, the data is clear that screening mammography is supported in women aged 50 and older. For the younger age group there are pros and cons and the discussion needs to be tailored to the individual patient. Managing Nipple Discharge Issues Dr. Tafra states, Patients with nipple discharge can also present a dilemma for primary care physicians. Non-bloody discharge that is present only when squeezing the nipple and discharge from multiple ducts are not concerning. Spontaneous or bloody discharge, and discharge from a single duct (which may indicate benign intraductal papilloma) however, require further evaluation and typically need surgical intervention. Fortunately, only 10 to 15 percent of these surgeries will show a malignant lesion. To refer a patient to The Breast Center, call 443-481-5300. For a patient-friendly brochure on breast density, visit annearundeldiagnostics.com/breastdensity. 5 A AMC I N PRACTICE APR I L 2014
Nonprofit Org. U.S. Postage PAID Annapolis, MD Permit No. 179 2001 Medical Parkway, Annapolis, MD 21401 Anne Arundel Medical Center (AAMC), a regional health system headquartered in Annapolis, MD, serves an area of more than 1 million people. In addition to a 57-acre Annapolis campus, AAMC has outpatient pavilions in Bowie, Kent Island, Odenton, and Waugh Chapel. InPractice delivers information designed to help you manage your medical practice and enhance patient care. For more information on AAMC services, visit askaamc.org. Gynecologic Oncology The Gynecologic Oncology Collaborative at Anne Arundel Medical Center has an experienced gynecologic oncology surgical team to care for women with cancerous and pre-cancerous genital tract malignancies. The program is led by gynecologic oncology surgeon Neil Rosenshein, MD, who was recently joined by Teresa Diaz-Montes, MD, ensuring a comprehensive surgical program. Dr. Diaz-Montes says, We offer robotic and laparoscopic surgery to women needing Neil Rosenshein, MD minimally invasive gynecologic oncology surgery so they no longer need to travel from Annapolis to other centers. We offer robotic surgery and prophylactic surgery for appropriate women with BRCA 1 and 2 gene mutations. Other options available to patients include intraperitoneal chemotherapy, treatment for pelvic cancer that has spread into the Teresa Diaz-Montes, MD abdomen, and high-dose rate (HDR) brachytherapy, which delivers highly targeted radiation to the tumor. In addition, Anne Arundel Medical Center offers genetic counseling services. For more information, contact Judeth Davis, RN, nurse navigator, at 443-510-0324 (mobile), 443-481-3308 (office) or email jdavis1@aahs.org. Continuing Medical Education Anne Arundel Medical Center offers physicians and other providers CME opportunities with in-person and online presentations at askaamc.org/cme. To register, email msooac@aahs.org. WHAT S NEW WITH INFLAMMATORY BOWEL DISEASE? April 16, 6pm AAMC Doordan Institute, 7th Floor Belcher Pavilion Presented by Mark Lazarev, MD, Assistant Professor of Medicine, Johns Hopkins Hospital, Division of Gastroenterology and Hepatology 1CAT1CME t SAVE THE DATE Contemporary Screening and Management in Women s Cancers November 1, All-Day Event AAMC Doordan Institute, 7th Floor Belcher Pavilion Featuring Stephen Cattaneo, MD, thoracic surgeon; Teresa Diaz-Montes, MD, gynecologic oncologist; Neil Rosenshein, MD, gynecologic oncologist; and Lorraine Tafra, MD, breast surgeon. 6 A AMC I N PRACTICE APR I L 2014