Penn Medicine News Blog Posts by Olivia Fermano

Officially our nation’s first hospital, Pennsylvania Hospital has been a stalwart pillar of its surrounding Philadelphia community since its founding in 1751. No wonder than, with over two and a half centuries of history and continuous service behind it, the hospital inspires its employees to “give back” to the community.

“When I was still in school I was very involved in community outreach,” said Alyssa Vaysman, PharmD, Outpatient Pharmacy supervisor at Pennsylvania Hospital. “It’s something that I’ve really been missing. At the end of the day, I got into health care to help people and I got into community and outpatient pharmacy because I love interacting with patients.”

Alyssa Vaysman, PharmD, Outpatient Pharmacy supervisor and Carmela Bynum, Pharmacy technician at Pennsylvania Hospital

It was through her interacting with patients that Alyssa recognized a very real, very specific need in the older adult population. “Prior to working at Pennsylvania Hospital I worked for CVS, participating in annual flu shot clinics at various assisted living facilities and nursing homes. We were there to talk with residents about the importance of getting a flu vaccine but they always had other questions about their medications – how to take them, side effects, etc.,” said Alyssa.  “But we were so busy giving out flu shots that we weren’t able to answer all of their questions.” With her current position at the Hospital, Alyssa realized she now has the opportunity to work with the community as she’s always wanted. “This gave me the idea to contact a local facility and set up a venue to address the needs of our older adult community and apply for grant funding.”

What do the songs “Stayin’ Alive” by the Bee Gees and “Another One Bites the Dust” by Queen have in common? And – what could they possibly have to do with health care or saving lives? Well, as it so happens, both songs have a steady rhythm of 100 beats per minute. The “hands only” method of CPR, as now set forth by the American Heart Association, requires continuous chest compressions of 100 per minute. This means both tunes can provide the perfect soundtrack for administering life-saving CPR. This was just one of many things a dozen students from the William L. Sayre High School learned at a cardiopulmonary resuscitation class hosted for free by Penn Medicine at its Clinical Simulation Center.

It should be noted here that the Lead CPR Instructor Chet Zaremski, did not recommend singing “Another One Bites the Dust” aloud as that’s a sure way to upset cardiac arrest victims and bystanders alike.

On a clear February Saturday morning, the students were first given a tour of Penn’s Simulation Center and then received detailed CPR instruction and guidance from Zaremski and Gregg Lipschik, MD, director of Life Support Training and Special Programs at the Clinical Simulation Center. Students, each equipped with his or her own resuscitation mannequin and equipment, learned the complete process of CPR, including how to: identify if a person is in cardiac arrest; perform “hands only” CPR compressions; perform compressions with mouth-to-mouth resuscitation – with a mask and without; and use an Automated External Defibrillator.

To celebrate February as American Heart Month, the News Blog is highlighting some of the latest heart-centric news and stories from all areas of Penn Medicine.

At first pass, lariat seems like just a hifalutin' word for the more down-to-earth, lasso – a long, noosed rope. For most, either word will bring to mind images of cowboys and rodeos, not human hearts. However, thanks to a new technology making its way onto the medical scene, lariat has a new meaning and is helping to treat the most common of cardiac arrhythmias, atrial fibrillation.

Let’s take a few steps back though, before we make the leap from rodeo ring to hospital.

New Heart Procedure to Treat Atrial Fibrillation Atrial fibrillation (AFib) is an irregular heartbeat that feels like a fluttering or quivering of the heart that affects close to three million Americans. According to the National Heart, Lung and Blood Institute, when AFib occurs, rapid, disorganized electrical signals cause the heart’s two upper chambers to fibrillate, or contract very quickly and irregularly.

AFib causes blood to pool in the upper chambers of the heart. This keeps the heart from pumping blood completely into the heart’s two lower chambers. While for some, the symptoms of AFib can feel very frightening, others have no signs at all. But symptomatic or not, make no mistake about it: AFib is not a simple “heart flutter” and certainly not something to ignore. The biggest threat from atrial fibrillation is the threat of blood clots and stroke.

“Patients with atrial fibrillation are six times more at risk of having a stroke and 15 to 20 percent of all strokes a year are related to AFib,” said Daniel J. McCormick, DO, FACC, FSCAI, an interventional cardiologist at Pennsylvania Hospital. “This is not only significant from a direct health care standpoint, but a societal one as well since stroke is one of the biggest drivers of disability and health care costs in the U.S.”

It’s that time of year again. All across the U.S. folks will gather together on Sunday, not to worship, but to watch the 47^th Super Bowl and – thanks to an increasing popularity due to “cute overload” – Animal Planet’s Puppy Bowl 9. Some even started the festivities early here in Philly at today’s Wing Bowl 21. While millions will scarf down junk food and alcohol in mass quantities this weekend, folks at the Joan Karnell Cancer Center (JKCC) at Pennsylvania Hospital celebrated earlier in the week with much healthier food choices at its first ever “Souper Bowl.”

Relay for Life Walk Chair, Michelle Rumbaugh and cancer survivor and JKCC volunteer Pam Barr are shown here setting up for the Center’s first Souper Bowl.

In an effort to cut through the constant communications clutter – websites, e-newsletters, targeted text messages and mailings, plus a plethora of pregnancy and parenting magazines – that bombards women during pregnancy and during early motherhood, Pennsylvania Hospital is taking a fresh approach to help educate and inform staff and expectant mothers about the process and benefits of successful breast feeding.  

Shown from L to R in the foreground are Daniel Feinberg, MD, chief medical officer, Jack Ludmir, MD, chair of Obstetrics and Gynecology; Michael Buckley, MD, executive director, and Mary Del Guidice, RN, MSN, BS, CENP, chief nursing officer, at Pennsylvania Hospital at the ribbon cutting marking the installation of “Ten Steps to Successful Breastfeeding.”

“Ten Steps to Successful Breastfeeding” were recently installed along the corridor floors of the Labor and Delivery and Maternity Units at the Hospital, making it literally and figuratively a “low” tech, yet clear and readily accessible public health messaging campaign. Funded by a state grant, the graphics create a visually fun pathway of footprints through the units. Each pathway is comprised of ten sets of footprints. Each individual footprint is dedicated to one of the ten steps – in English on the left and Spanish on the right.

With each passing year the month of November loses more and more respect. On paper it looks good – All Saint’s, All Soul’s, Veteran’s and Election Day come right in a row within the first two weeks. But poor Thanksgiving. For several centuries it rose through the ranks as one of the most distinctly “American” and popular of celebrations, becoming the most travelled holiday in the U.S.   

Free from religious association, Thanksgiving holds huge cross-cultural appeal. Sadly, what was the unofficial demarcation line between the fall and winter holiday seasons is becoming swamped out by Christmas and Black Friday insanity. Thanks to a persistently poor economy and expanding retail store hours, Thanksgiving doesn’t even get a full day to celebrate anymore.

Things don’t look much better for November in the non-retail arena either. Any health observances held during the 11^th month are totally overshadowed by the Big Pink:  October and Breast Cancer Awareness month. Seriously... how many people realize or care that the Annual Great American Smoke Out has come and gone? I don’t want to pick on October. The blow-up in breast cancer awareness and research funding over the past 30 year is incredibly inspiring. But can we please give Pancreatic Cancer Awareness Month some love?

Ah, the fabulous colors of fall. A time when those of us inhabiting the more northern parts of the hemisphere are treated to a natural environment rich in russet, gold and burgundy hues. Then, come October: PINK.

There are all the little ribbons, t-shirts and caps. There’s pink neon lights atop Philadelphia’s tallest skyscrapers. And for one whole month every season, pro football players – those hardened gladiators of the gridiron – are sporting hot pink footwear and gloves. (No pale pink for those guys!) Did you know there is even a whole website solely dedicated to turning “the internet Pink for October in an effort to help bring attention to Breast Cancer Awareness Month”?           

Thanks to the original efforts of the Susan G. Komen for the Cure® and millions of other dedicated and generous folks, pink is now as synonymous with the month of October as a jack-o-lantern, a truly universal symbol of Breast Cancer Awareness Month.

So what has all this “pink awareness” gotten us?

It’s hard to fathom, but to this day one startling Civil War statistic stands:  approximately 625,000 American men – the equivalent of 6 million men today – were killed in action or died of disease between April 12, 1861 and April 9, 1865. That’s more than in World War I, World War II, the Korean War and Vietnam War combined.

Pennsylvania Hospital for the Insane, circa, 1860

With defeat of the Southern Confederacy, the Civil War – referred to during its time (depending upon what side you were on) as the War of Southern Rebellion or War of Northern Aggression – resulted in three new amendments to the U.S. Constitution, the abolishment of slavery and the preservation and subsequent redefinition of the  U.S. as a single nation. These are the usual take-away points we glean from the history books. But what of the survivors? The physically and mentally maimed veterans and collaterally damaged civilian victims of the Civil War era?

No stranger to American history, Pennsylvania Hospital (PAH) – the nation's first hospital, founded in 1751 by Benjamin Franklin and Dr. Thomas Bond – is currently hosting two free, historical exhibits which offer a retrospective look into the effects the Civil War had on the bodies and minds of Americans.

Life is full of embarrassing moments. Who among us hasn’t suffered the mild mortification of unknowingly walking around with toilet paper trailing from a shoe? Or an unzipped fly? How many of us know what it’s like to emerge from an underwater dive only to discover that part of our bathing suit didn’t emerge with us? And while these cringe-causing moments leave us red in the face, they usually end up as sources of amusement – not lasting, life-altering burdens.

Unless we have firsthand experience, can any of us truly understand the pain and embarrassment of something like bowel incontinence? Most of us can’t even say “bowel” or “fecal incontinence” without wincing, let alone fathom what it would be like to actually have it. Adding insult to injury is the fact that –as the Journal of the American Medical Association reported, puts it: “Silence masks the prevalence of fecal incontinence,” making it very difficult to pin down accurate estimates of sufferers.

Bowel or fecal incontinence, is a symptom of a condition or disease resulting in the inability to control bowel movements. It occurs when rectal and anal muscles and nerves are damaged as a result of such conditions and diseases as:  complications during childbirth, inflammatory bowel disease, irritable bowel syndrome, pelvic surgery, neurological disorders, nerve or muscle damage, spinal trauma and radiation therapy in the pelvic area to treat cancer. It strikes in a full range of degrees, from the leakage of small amounts of fecal matter when passing gas, to complete loss of bowel and rectal control.

Free Wig Salon at Pennsylvania Hospital

Hair. It’s big. And I’m not just talking about the 1980’s.

Hair is our only built-in body adornment, capable of infinite versatility – if you have it.

Often referred to as one’s “crowning glory,” the significance of hair spans centuries. It was the source of Samson’s strength in the Bible and the only body part to have a still-running musical and its own subsequent movie. (For all you nit-pickers out there, My Left Foot was never made into a musical.) Still don’t think hair is big? Then stop to think about all the exorbitant amounts spent annually around the world on the maintenance, enhancement and restoration of hair.

For as big as hair is, there’s only one thing bigger – losing it. While it’s become acceptable – fashionable even – for men to go for the Mr. Clean look instead of suffering the time-elapsed humiliation of an ever-retreating hairline, it is just not the same for women. What could be worse for a woman’s self esteem than losing her hair? How about having cancer, the treatment for which causes hair loss?

“For a woman, losing her hair to cancer treatments can be very traumatic,” said Debi Page Ferrarello, RN, MS, IBCLC, director of Family Education at Pennsylvania Hospital. “However, with the advancements in therapies today, doctors are able to tell a woman when she can expect her hair to start falling out. So she doesn’t have to wait until she loses her hair to seek help. She can now come into our Solutions for Women boutique and get fitted for a free wig before she actually needs it.”

Just announced this summer, women who experience hair loss as a result of cancer treatment can get help at Solutions for Women at Pennsylvania Hospital. Working with the Joan Karnell Cancer Center at Pennsylvania Hospital,   Solutions, a unique boutique featuring specialty women's health, cancer, maternity and breastfeeding support products, is now a provider of the American Cancer Society’s (ACC) Free Wig Salon Program. The goal of this relatively new program is to provide wigs to any cancer patient who would like one – and for free.  Solutions is the only site in Center City offering this service and one of only two sites in all of Philadelphia.

All of Society Needs to Support Breastfeeding for Everyone to Reap the Maximum Benefits

Medical journals, magazines, websites… they’re all touting the same message, something nature has known all along: breastfeeding is beneficial for both babies and mothers. The message is getting through - but not always to everyone who needs to hear it. In addition to mothers-to-be, other factions of modern society must also get on board with breastfeeding for everyone to the receive maximum benefits, especially employers.

Of course, it’s only fair to mention here that some women cannot breastfeed, no matter how hard they try. Studies have shown that about two percent of all women can't produce enough milk, regardless of their physical or emotional condition while others may lactate poorly because of incorrect latch or breastfeeding issues for which they were unable to access the right help. Previous surgery, such as lumpectomy or breast-reduction can also inhibit lactation. However, for women who can breastfeed, it really does benefit all involved.

Work Projects Administration Poster Collection (Library of Congress)
WPA Federal Arts Project, 1938

First the basics:  Babies breastfed for at least their first six months have less gastric distress such as spitting up and diarrhea. More impressive is that they have fewer ear, respiratory tract and urinary tract infections, plus fewer allergies, a lower risk of diabetes and higher IQ scores. According to the American Academy of Pediatrics, breastfeeding also offers some protection from Sudden Infant Death Syndrome (SIDS) and obesity.

Breastfeeding moms see benefits too. They snap back in shape faster after giving birth. Their risk of breast and ovarian cancer is reduced along with their risk of osteoporosis, hip fractures, cardiovascular disease and metabolic syndrome, according to the Centers for Disease Control (CDC).

In addition to health benefits for mom and baby, breastfeeding is economical (regarding time and money), convenient and environmentally friendly. It’s employer friendly too. Bottom line: women who breastfeed and work for an accommodating employer are more productive. Because of the health benefits for both mother and child, breastfeeding women miss less work days as both are sick less often.

It’s about time we starting treating cancer patients as survivors – even when they’re still in the midst of treatment.

Every year hundreds of hospitals, cancer centers and communities throughout the US and across the world join in a Celebration of Life for National Cancer Survivors Day^®. This year the official 25^th Annual National Cancer Survivors Day was recognized on June 3rd.  

In years past, this event was “survivorship-centric,” focusing only on people who had completed their active treatment. Not that there’s anything wrong with that. Surviving a diagnosis of and treatment for cancer should be celebrated – as much and as often as possible. However, previous Survivors Day celebrations didn’t seem to leave room for all the brave souls in the midst of treatment, struggling to maintain their strength and hold their lives together. Happily, the National Cancer Survivors Day Foundation (NCSDF) is facing this issue as part of a national initiative. This year, participants were asked to “unite in a symbolic event to show the world that life after a cancer diagnosis can be meaningful and productive.” Indeed!

Plus, the NCSDF clearly redefined the definition of a cancer survivor to help the world work towards a much needed shift in mindset. The NCSDF defines a “survivor” as anyone living with a history of cancer – from the moment of diagnosis through the rest of their life.

While most communities and institutions celebrated for a day, the Joan Karnell Cancer Center (JKCC) at Pennsylvania Hospital went to extraordinary lengths to proudly showcase and celebrate their large, active, vibrant and productive cancer survivor population, from the newly diagnosed to those decades past treatment.

For the past ten years at PAH, the JKCC celebrated National Cancer Survivors Day at a Celebration of Life event attended by patients, caregivers, physicians, nurses, staff, family and friends. This year, the celebration shifted to a weeklong series of events from June 11th to 15th, which focused on cancer patients currently undergoing treatment in the inpatient and outpatient areas of the hospital.

I remember the first time I heard of preeclampsia . Despite the fact that I’ve worked my whole adult career in hospitals and health care, I didn’t first learn about preeclampsia on the job. In truth, I read about it years ago – and rather graphically – in the John Irving  novel, The Cider House Rules. (FYI, readers:  you will not find a scene about preeclampsia in the movie version starring Toby Maguire and Charlize Theron. That, along with much more, was edited out of the book for the screenplay.)

Preeclampsia is a form of high blood pressure brought on by pregnancy and occurs after the 20^th week of pregnancy. It is also known as toxemia. In some women, a more severe form of the illness, eclampsia    develop, causing seizures or convulsions. It’s a leading cause of premature births, and the only sure treatment is delivery of the baby. If that doesn’t happen, the condition can take the life of both mother and her unborn child.

That’s what the pregnant woman at the orphanage giving birth in The Cider House Rules had. In the story, she was in labor, flailing and jack-knifing on the table in the midst of a full-blown seizure. It freaked me out. And I remember thinking after the lead character Homer saves the day – and thus the eclampsic woman’s life, “Geez…bad enough the poor woman had to sneak off to give birth to an unwanted child whom she was going to abandon at the orphanage. Did she really need to have such an emotionally gut-wrenching experience made all the worse by this, this “preeclampsia?” At the time, it seemed like “down-on-one’s-luck overkill” for a lone character. I would come to learn later, though, that Irving didn’t really add any unnecessary drama to the story. Pre-eclampsia was and reemains actually quite common with consequences quite dramatic. No creative literary license was taken. Irving was apparently right on the money with the realism.

I didn’t hear a thing about preeclampsia until almost ten years later – and at that time is was through work, when I began working with obstetricians. But how come I hadn’t heard about preeclampsia for a whole decade, a time when I’d been surrounded by pregnant relatives, friends and co-workers? I remember some of them having to have emergency c-sections because of high blood pressure…but was this preeclampsia?

Why wasn’t anyone talking about this?

To celebrate February as American Heart Month, the News Blog is highlighting some of the latest heart-centric news and stories from all parts of Penn Medicine.

Hot flashes. Night sweats. Sleep disturbances. Mood swings. Irregular and racing hearts. These are all signs of menopause setting in, the time in a woman’s life when her ovaries cease to function signaling the end her fertility years, her menstrual cycle and a drop in naturally produced hormones.

Often aptly referred to as “the change of life,” the period during which some women suffer the many unpleasant symptoms associated with menopause is actually a transitional phase called perimenopause, which can begin from as young as 40 and last until a woman’s early 60s. A woman is considered perimenopausal until one full year after her last menstrual period. After this year has passed, a women can then declare herself as “gone through menopause” and is considered postmenopausal the rest of her life. 

 As if the possibility of menopausal symptoms setting in as early as age 40 isn’t unsettling enough, check out these disturbing facts: a woman’s risk for heart disease automatically increases at age 40, and heart disease is the leading cause of death in women over 40, particularly those in the midst of menopause. Why? Because the decrease in estrogen caused by menopause has multiple negative effects on the female cardiovascular system including: changes in the walls of arteries and blood vessels which makes plaque and blood clots more likely to form; increased fibrinogen levels which make blood clots more likely to form and narrow the arteries; a decrease in HDL – or “good cholesterol” – and an increase in LDL or “bad cholesterol.”

To celebrate February as American Heart Month, the News Blog is highlighting some of the latest heart-centric news and stories from all parts of Penn Medicine.

The flowers and cards have all been delivered. The chocolates were devoured and Cupid can now take his annual break. But just because Valentine’s Day has come and gone doesn’t mean the time for hearts is over. There’s still some days left of American Heart Month and while the public is bombarded with commercials and news stories about the topic, no one – especially women – should think they’ve heard all there is to know about heart disease.

Heart disease is the number one killer of women. Yet after scores of public education programs and public service campaigns the message still hasn’t sunk in. “For decades, heart disease was considered a man’s disease,” said Nazanin Moghbeli, MD, MPH, FACC, the director of the Women's Cardiovascular Center at Pennsylvania Hospital. “Previous heart disease research and public awareness efforts only focused on cardiovascular disease in men. But we know differently today. Today we’re faced with the sobering fact that a woman suffers a heart attack every minute in the United States. Not only do we need further research and continuing education, we must focus on teaching women the important differences in the symptoms and risk factors of heart disease.”

“It’s obvious that women should be aware of the risks of heart disease and recognize the signs of a heart attack. Yet women also need to realize they can take action. If they know the risks factors of heart disease and can minimize or eliminate them, they can greatly improve their chances of preventing cardiovascular disease,” Dr. Moghbeli says “When it comes to risk factors of heart disease for women, I like to break them down into two categories:  the usual suspects and the not-so-usual suspects.”

To celebrate February as American Heart Month, the News Blog is highlighting some of the latest heart-centric news and stories from all parts of Penn Medicine.

February is all about hearts…from Valentine’s Day to American Heart Month. However, while one is a reference to a romantic and commercial holiday, the other is a more serious matter. One that women in particular need to pay close attention to: the prevention, causes, symptoms and treatment of heart disease.

Heart disease remains the number one cause of death in the US for both men and women. Heart disease, in all its forms, is responsible for over 400,000 deaths a year among women – more than all forms of cancer combined. And although new research on the importance of heart-healthy diets, exercise and quitting smoking have decreased heart disease rates among men in the past 30 years, the rate for women hasn’t budged, according to a new report from the National Insitute of Nursing.

Helping to battle such depressing statistics and improve the heart health of women in the greater Philadelphia region is Nazanin Moghbeli, MD, MPH, FACC, the director of the Women’s Cardiovascular Center at Pennsylvania Hospital. In a series of posts this month, Dr. Moghbeli will address the most important questions and issues to help women become more  heart smart.

Funny thing how celebrities and sport stars can dictate what’s considered fashionable in everything from wardrobes to medical treatments. Over the past year, there has been debate on whether or not platelet-rich-plasma-therapy (PRPT) is an effective, viable treatment for orthopaedic injuries, a topic most recently voiced in the New York Times Well Blog, “Does Platelet Rich Plasma Therapy Really work?” PRPT has made the news and put the bug in many-an-ear as a viable successful sports injury-buster when professional athletes like Philadelphia Eagle and NFC pro-bowler Jon Dorenbos and Troy Polamalu from the Pittsburgh Steelers are reported as receiving the somewhat experimental treatments. But now, in the words of The New York Times, “rather belatedly, science is showing up to spoil the fun.”

Well, where the science is showing that PRPT is losing in the sports arena, it’s also showing where it’s winning in operating room. Samir Mehta, MD, chief of the the Orthopaedic Trauma and Fracture Service at the Hospital of the University of Pennsylvania and assistant professor of Orthopaedic Surgery at the University of Pennsylvania School of Medicine has been successfully using PRPT to treat traumatic bone loss – and some very severe cases - by augmenting commercially available bone grafts in patients like a tri-athlete, veteran competitor of Iron-women competitions whose shoulder was completely shattered after being hit by an automobile, and a motorcycle policeman who, after losing control of his bike completely shattered his tibia, and a mother of two who was struck by a truck resulting in massive bone loss in both her femurs.

The treatment involves injecting portions of the patient’s own specially processed blood directly into the injured areas with bone grafting. The injection acts like a catalyst in the body to get it to instinctively repair bone and surrounding tissue.

So why do we hear so little about the demonstrated successes of PRPT for healing bones and only its failures for other sports injuries? The facts are generally unclear to the public so to help shed some light on the issue Dr. Mehta outlines the following fast facts:

• PRPT is only FDA-approved as a bone graft extender – all other uses, including those touted in the media being used by pro athletes – is “off-label” use.
• As the science has shown so far, there is limited anecdotal success in off label use.
• Many basic science (animal) studies so far are supportive of fracture healing with PRP. 
• There has been anecdotal success in using PRPT in recalcitrant (long-bone) fracture healing and used judiciously, especially in patients who have failed other biologic augments, to incite fracture healing.

To read more about Dr. Mehta - who just recently was announced as one of the 2011 "Top 40 Under 40" award winners by the Philadelphia Business Journal - and his successful use of PRPT, check him out in a recent issue of SJ Magazine:  SJ Magazine.net/2011