MyGeorgetownMD A MedStar Georgetown University Hospital Publication
Active Lifestyle Preserved With
Innovative Ankle Replacement Surgery
By Lynn Cantwell
David Kearing, MD, battled for years Northeast. Each recommended ankle
with post-traumatic ankle arthritis fusion surgery, which connects the
caused by years of repeated sports- bottom of the shinbone to the top of
related ankle sprains, one of which the foot. Although those who have this
included a dislocation. He had two surgery no longer experience pain
operations to address the arthritis, and from arthritis, they can no longer move
he had taken so much over-the- their feet up or down. This option
counter pain medication that he began would not work for David.
to develop an ulcer.
David knew that ankle fusion would Photo by Marianne Worley
However, David’s ankle pain limit his active life. As an avid skier and G Mary Leigh Phillips’ cystic fibrosis put her
at high risk during pregnancy, but MedStar
continued, and it affected his home cyclist, he wanted to examine other Georgetown helped deliver “miracle” baby,
and work lives. “I couldn’t walk on the options, and he performed some Jack.
beach with my family during online research. His search led him
vacations,” he explains. “Even a
middle-of-the-night trip to the
to the fall 2009 issue of the
MyGeorgetownMD newsletter and an High-Risk Obstetrics
bathroom was excruciating.” On his
job, the situation was just as
article about a soccer dad who had an
ankle replacement using the STAR™ Team Helps Mom
challenging. “As an ER physician, I
need to be able to move around, and I
device. STAR stands for Scandinavian
Total Ankle Replacement, because it
With Cystic Fibrosis
was just hobbling,” he says. was designed by a famous
Scandinavian surgeon. The three-
Deliver a Healthy
Ultimately, David’s arthritis reached its piece device moves much like a natural Baby Boy By Leslie Whitlinger
end stage, his joint having deteriorated ankle.
to the point that he could no longer For years, doctors warned Mary Leigh
tolerate the pain. After reading the article, David called Phillips against getting pregnant. Her
Paul Cooper, MD, orthopaedic constellation of conditions—the result
David sought several opinions from surgeon and director of the Foot and of cystic fibrosis (CF)—and the
foot and ankle specialists in the continued on page six medicines needed to tame them
could threaten the health and even
the life of an unborn baby.
continued on page seven
IN THIS ISSUE
Because You Asked: Rheumatoid
Newly Renovated Infusion Center
Photo by sportsgraphics.com Treating Pregnancy Emergencies
G Dr. David Kearing’s new ankle gave him the flexibility and stability to participate in
Boston’s Head of the Charles Regatta a mere nine months following his surgery. Page 5
Connect With Your Family
Because You Asked: Rheumatoid Arthritis—Not Your
Grandmother’s Rheumatism By Lynn Cantwell
Medical Reviewer: Sean Whelton, MD, Associate Professor, Medicine, and Attending Physician, Division of Rheumatology and Internal Medicine,
MedStar Georgetown University Hospital
“Because You Asked” focuses on topics suggested by our readers. If you want to suggest a topic for future issues of this
newsletter, please email suggestions to email@example.com.
Rheumatism. At some point, each of stiffness and even deformity in the experience swelling and discomfort
us has heard the term used by our joints. RA is caused when the body’s throughout their bodies. As a result,
parents, grandparents or even immune system, which is supposed to many people feel tired and become
Granny Clampett from television’s protect us from harm, malfunctions inactive, leading to obesity and
The Beverly Hillbillies. However, and attacks our joints. If left related conditions, such as heart
rheumatism, the catchall term for untreated, RA will ultimately destroy disease and diabetes. Further, being
joint pain, and the actual disease the joints and cause permanent overweight puts excess stress on the
rheumatoid arthritis, are not the disability. knees and hips, making it even more
same. difficult to move around.
Joints can lose cartilage and calcium,
Rheumatoid arthritis (RA) is a chronic as well as become dysfunctional and There is no cure for RA. However,
condition that causes pain, swelling, not work well. People with RA can also those with the disorder are no longer
subjected to the lifetime of pain and
Arthritis: What a Pain! joint deterioration that our
grandparents experienced. In the last
There are four main categories of arthritic conditions that cause joint pain, several years, treatments have
swelling and stiffness. All of them have different causes and treatment become much more sophisticated
medications. and effective. In fact, when the
disorder is caught early, RA sufferers
1. Mechanical arthritis
can lead active, pain-free lives.
The most common type of mechanical
arthritis is osteoarthritis or aging joints.
Very powerful pain relievers and anti-
Medications used to treat osteoarthritis inflammatory medications are often
are those that reduce pain in the affected used to enable people to remain
joints. active. Over-the-counter medications,
such as acetaminophen and
2. Inflammatory arthritis ibuprofen, as well as steroids that are
Inflammatory arthritis occurs when the injected into the joints, can provide
immune system attacks the joints. The immediate relief while doctors
most common inflammatory arthritis is address the cause of the RA.
rheumatoid arthritis. However, there are
other types of autoimmune-related
Many RA medications weaken certain
arthritis, including juvenile arthritis, lupus and psoriasis. Medications are used to
control the pain and reduce swelling and stiffening, along with other drugs
aspects of the immune system, so it
intended to either suppress the immune system or block its response. is unable or less able to attack the
joints. These immunosuppressive
3. Arthritis caused by mineral or crystal buildup medications are much like the ones
When crystals or minerals build up in the body, they can lead to arthritic used during chemotherapy or those
conditions. The most common of these is gout, which occurs when the body has that help prevent the rejection of
too much uric acid. Doctors treat this type of arthritis with medications to reduce organs during transplants.
both pain and the substance that is building up.
At MedStar Georgetown University
4. Arthritis caused by infection Hospital, many advances are
Some infections can settle in the joints, causing arthritic symptoms, including
available to treat RA, including drugs
painful and swollen joints. The usual culprits are staph, strep and Lyme bacteria.
These infections typically respond to antibiotics. Once the infection is gone, the
that change how the immune system
symptoms go away soon after. works to prevent it from attacking the
joints. Every few months, new drugs
MedStar Georgetown Opens
New Infusion Center for Oncology
Patients by Marianne Worley
MedStar Georgetown University the unit offers what is essentially
Hospital has opened a newly “drive-up” access, which is a great
renovated infusion center for convenience for patients who are
patients who need chemotherapy coming to the hospital to receive
and other infusion services, such as infusion services. Also, the space
blood products, nutrients or boasts open, sunny treatment areas
medications injected directly into with individually controlled lighting
the body through blood vessels, and flat-screen televisions that
muscles or beneath the skin. The patients can adjust.
center was designed to provide
patients with the utmost comfort, as This project was successful thanks in
well as the highest-quality medical part to the generous donations of
care and customer service. private donors who contributed funds
G New, sophisticated treatments are to MedStar Georgetown’s Lombardi
reducing and eliminating pain from
rheumatoid arthritis. Some of the amenities of the new Comprehensive Cancer Center
center are 15 open bays, five private Renovations Project.
rooms and one semiprivate bay. And
and targeted therapies become To schedule an infusion center
available that can be very effective with the availability of valet parking, appointment, call 202-444-4399.
in treating RA.
The goals of the rheumatologists at
MedStar Georgetown are to control
inflammation and keep people who
have RA active. If the disorder
destroys the joints, the hospital’s
rheumatologists and orthopaedic
surgeons work together to help
restore function. Additionally, the
hospital provides a physical
medicine and rehabilitation
program for people who have had
joint replacements or whose pain-
related inactivity has caused them
to become weak.
Today, many people who develop
RA can lead more active lives.
For a rheumatology appointment,
call MedStar Georgetown M.D. Photo by Laura Brickley
at 202-342-2400. G MedStar Georgetown’s infusion experts provide exceptional care in a comfortable
Treating Pregnancy Emergencies
By Brendan Furlong, MD, Chief of Service, Emergency Department, MedStar Georgetown University Hospital
Most pregnancies proceed normally including pelvic inflammatory disease,
and end happily with the birth of a pelvic infections, infertility,
healthy baby. But sometimes, endometriosis, pelvic surgery or a
problems occur that can pose a previous ectopic pregnancy.
serious threat to baby and mother.
Pregnancy complications, such as an Symptoms: Abnormal vaginal
ectopic pregnancy or miscarriage, can bleeding, abdominal or pelvic pain,
occur early during the first trimester. shoulder pain when major hemorrhage
Others, such as preeclampsia and has occurred, weakness, dizziness or
placental abruption, occur later in fainting.
pregnancy—usually during the last
trimester, days before an anticipated To confirm the diagnosis: Blood
delivery or even one to two weeks tests, pelvic exam, ultrasound and a
after delivery. Such complications general assessment of the patient’s
require emergency treatment to help condition.
ensure the health of mother and child.
Treatment: Patients who have not
Understanding risks and recognizing suffered a ruptured ectopic pregnancy
Photo by Laura Brickley
symptoms can be the first step to a will often receive medication. Some
speedy diagnosis and successful patients may require surgery, usually a G Brendan Furlong, MD, helps women and
newborns when crises arise.
treatment. minimally invasive laparoscopic
procedure to possibly remove a
portion of the fallopian tube. Other Symptoms: Headaches and vision
patients will undergo open surgery in problems that may be related to high
which a larger incision is needed. blood pressure, rapid weight gain,
swelling of the hands and face, upper
Preeclampsia abdominal pain and seizures, if the
What is it? Preeclampsia is described condition has progressed to
as a combination of high blood eclampsia.
pressure, protein in the urine and
swelling in the legs, hands and/or To confirm the diagnosis: Blood
face. This serious condition usually tests, blood pressure testing and urine
occurs in the second half of studies.
pregnancy (even sometimes within
the first few weeks after delivery) and Treatment: When a woman has
can affect multiple organs, including preeclampsia, delivering the baby is
the liver and kidneys. When the the best way to protect both mother
condition progresses to include and child. When preeclampsia occurs
Ectopic Pregnancy seizures, it is called eclampsia. at an early stage of pregnancy, i.e.,
What is it? Ectopic pregnancy occurs early in the third trimester, every effort
within the first three months of Who is at risk? While the cause of is made to delay delivery, giving the
pregnancy when a fertilized egg grows preeclampsia is still unclear, some fetus more time to develop. Physicians
outside the uterus, most commonly in women appear to be at a higher risk. will closely monitor the woman in the
the fallopian tube. This abnormality Some risk factors include first full-term hospital and often prescribe
can cause the fallopian tube to rupture, pregnancy; history of underlying medication to decrease blood
which can lead to internal bleeding. medical conditions, such as high blood pressure, prevent seizures and
pressure, diabetes, lupus or renal ultimately delay delivery of a very
Who is at risk? Women with disease; previous preeclampsia; premature infant.
abnormal fallopian tubes are at higher carrying more than one fetus; obesity;
risk. This irregularity can occur as the and mother’s age—both the very young Placental Abruption
result of a number of conditions, and those who are older than 35. What is it? Placental abruption is a
condition in which the placenta
Advanced Neonatal Care = Confidence for Expecting Moms
MedStar Georgetown’s Neonatal Intensive Care Unit (NICU) is the region’s most
advanced center for the treatment of sick and/or premature infants. Its team of
expert physicians and nurses combines compassionate care with the most
advanced treatment options to help ensure better outcomes for seriously ill
newborns. From the transport of critically ill infants to and from MedStar We are pleased to introduce
Georgetown 24/7 to support services for parents and siblings, MedStar doctors who have recently joined
Georgetown’s NICU provides comprehensive services to treat the smallest, most
fragile babies. the MedStar Georgetown team.
Visit georgetownuniversityhospital.org/nicu to watch an Ask-A-Doctor video
featuring Siva Subramanian, MD, chief, Division of Neonatology. He answers
commonly asked questions about the NICU. Erica L. McClaskey, MD
Vincent Winkler Prins, MD
detaches prematurely from the wall of doctors will deliver the baby
the uterus, causing bleeding and immediately. Breast Surgery
reduction of oxygen and nutrients to Bridget A. Oppong, MD
the fetus. Every patient is unique, and
symptoms of these complications
Who is at risk? Women who smoke, and others will vary from person to Hematology-Oncology
have high blood pressure, have person. It is always a good idea for a Chaitra S. Ujjani, MD
suffered traumatic injuries, are carrying woman to call her physician or make
twins or have a history of placental a trip to a hospital emergency room Pediatric Infectious Disease
abruption. if she experiences anything that
seems unusual. And because these Susan K. Wollersheim, MD
Symptoms: Vaginal bleeding late in conditions may result in premature
pregnancy, abdominal pain and births, as well as blood loss and Vascular Surgery
tenderness. organ failure for mothers, it’s best to Susanna H. Shin, MD
be treated at a hospital with
To confirm the diagnosis: Physical advanced specialty services for
examination, ultrasound and blood both mother and child.
tests. To schedule an appointment with a
To schedule a high-risk pregnancy MedStar Georgetown physician,
Treatment: When the placenta is appointment, call call MedStar Georgetown M.D.
MedStar Georgetown M.D. at at 202-342-2400.
partially detached, patients are
hospitalized and closely monitored. If georgetownuniversityhospital.org/obgyn findadoc
the placenta is completely detached,
Stay Connected to Your Family and Friends
MedStar Georgetown University post photos, recognize staff and
Hospital is pleased to offer connect to other patients.
CarePages—a free online community
where patients, as well as close From birth announcements to
friends or family members, can stay surgical recovery updates, MedStar
in touch throughout treatment. Georgetown patients are using
With this service, you can create CarePages to stay connected to
personalized and private Web loved ones.
pages to share health-related
Start your CarePages profile today
triumphs, hopes, encouragements
and challenges. This secure tool georgetownuniversityhospital.org/
allows users to receive messages, carepages
Active Lifestyle Preserved With Innovative Surgery continued from page one
Ankle Center at MedStar Georgetown
Facts about STAR™
University Hospital. Dr. Cooper had
performed the soccer dad’s ankle STAR has many benefits compared to ankle fusion:
replacement—the first in the United
States following the approval of the STAR Ankle Replacement
Surgery Ankle Fusion Surgery
STAR device by the Food and Drug
Administration in 2009. Durability/Duration of Repair 10–15 years Lifetime
In September 2010, Dr. Cooper Average Recovery Time Two weeks in a splint 12 weeks in a cast followed by a
performed David’s STAR surgery. walking boot through the initial
Walking boot with daily physical
David was in and out of the hospital in rehabilitation period
therapy for two to 12 weeks
one day and able to walk within two
Ankle brace until no longer needed
weeks. Three months later, he was
on skis. Patient Mobility Able to move foot up and down Unable to lift or lower foot from
and continue with most activity the ankle
Had David had an ankle fusion, he
would have spent longer in the Average Hospital Stay 23 hours or less 24–48 hours
hospital and been in a cast for 12 (same-day surgery)
weeks. Also, since he would not have
Treatment Flexibility If an ankle replacement fails, Once an ankle is fused, it cannot
been able to move his foot up and
the ankle can be fused at a later be replaced
down, skiing would have been out of time
“To be able to offer this latest has performed more than 600 ankle cycle. In severe cases, we end up
generation of ankle replacement to our replacements, of which about 160 fusing other bones in the foot and
patients is nothing short of were with the new STAR device. ankle, and within five to ten years, we
revolutionary,” says Dr. Cooper, who have fused so many bones that nothing
His results with the device have been moves.”
overwhelmingly positive. Patients
spend less time in the hospital, recover In addition to the STAR surgery, which
more quickly and are able to remain has been used in Europe for more than
active because they have better 20 years, there are various other
movement in the joint than an ankle surgical and nonsurgical treatment
fusion would allow. Dr. Cooper options for ankle arthritis. “Many
anticipates that demand for the people can avoid ankle replacement or
procedure will continue to grow fusion if we see them early enough.
because more people who are ages 65 Often, there are medical and more
or younger are experiencing end- conservative surgical solutions we can
stage ankle disease or osteoarthritis. use to keep patients pain free and
Such conditions are caused by mobile before their arthritis reaches
recurring athletic injuries or significant the end stage,” says Dr. Cooper.
traumas, like those associated with car “When we become involved with
accidents. patients earlier, we can offer them a
wider range of treatment options and,
“When you are in your 40s, 50s or even often, better outcomes without
older and accustomed to being active, needing to replace the ankle.”
the inability to move your foot due to
ankle fusion is not acceptable,” says Dr. For an ankle replacement consultation,
Cooper. Additionally, the joints that call MedStar Georgetown M.D.
Photo courtesy of Kim Kearing surround the fused ankle can become at 202-342-2400.
G David Kearing, MD, was back on skis just increasingly stressed, which can lead georgetownuniversityhospital.org/
three months after his ankle replacement to arthritis. “It can become a vicious footandankle
High-Risk Obstetrics Team Helps Mom continued from page one
Then the 29-year-old discovered she medicine, began supervising Mary “Knowing how much was at stake, we
was, unexpectedly, expecting. Leigh’s care. anticipated every possible problem,”
“I was totally terrified,” she says. “So says Dr. Myers.
many things could go wrong. Some CF “In a normal pregnancy, hormones can
medications can cause birth defects. stress the mother’s ability to control “Fortunately, everything went as
And if my husband were a carrier, our glucose as the body works to deliver planned until late in the pregnancy,
baby would have a 50/50 chance of necessary fuel to the developing when the baby’s growth slowed
being born with the disease.” baby,” Dr. Landy says. “The growing down,” Dr. Landy says. Mary Leigh was
uterus also makes breathing admitted for bed rest and close
Unpreventable and incurable, CF is the increasingly difficult as it pushes observation, as more reinforcements—
most common life-shortening, against the lungs. Mary Leigh had both a cardiologist, wound specialist and
inherited disease among Caucasians in diabetes and trouble breathing before neonatologist—were called in to
the United States today, affecting she even became pregnant. As a prepare for a C-section. Husband and
about 30,000 people. With CF, the result, pregnancy put her and her baby wife steeled themselves for the next
body produces thick, sticky mucus that at higher risk for a variety of new or steps.
causes breathing difficulties for all and worsening problems.”
a unique form of diabetes for many, “We were told that the baby would
including Mary Leigh. The disease also probably be underweight, have
I’m just so amazed by the care
can affect the body’s ability to break elevated sugar levels and have to go to
down food and absorb nutrients, while I received...from the whole the NICU,” Mary Leigh says. “But
increasing vulnerability to pancreatitis, Georgetown team. against all odds, he was fine.”
pneumonia and lung infections.
Managing CF requires balancing ~ Mary Leigh Phillips, obstetrics/ Delivered at 36 weeks, baby Jack
medications, respiratory therapy, diet gynecology patient and new mom weighed five pounds and went home
and exercise to keep nutrition up, with his grateful parents a few days
blood sugar down and oxygen levels In fact, only about 100 live births are after birth. At the same time, Mary
adequate. recorded to American women with CF Leigh became the first woman with CF
each year. Dr. Landy was determined to deliver a healthy baby in Dr. Landy’s
Despite being vigilant about her health to help Mary Leigh become one of the 25-year career and, she suspects, the
and physical fitness—even completing success stories. first at MedStar Georgetown, ever.
several half marathons and small
triathlons—Mary Leigh knew that Dr. Landy mobilized a multidisciplinary “Jack is living proof of the power of a
pregnancy with CF would be team of MedStar Georgetown multidisciplinary team approach to
challenging for both her and her child. specialists—including Natasa Janicic, care,” Dr. Landy concludes. “Together
MD, PhD, endocrinologist; Anne with Mary Leigh’s attitude and physical
So she, an economic consultant, and O’Donnell, MD, chief, Division of fitness—and Brian’s support and
her husband, attorney Brian Morrison, Pulmonary, Critical Care and Sleep involvement—we reached a happy
used their analytical skills to research Medicine; and Joseph Myers, MD, outcome.”
the best place for comprehensive high- director, Obstetric Anesthesia.
risk maternal and neonatal care. They Adds Mary Leigh, “I’m just so amazed
found the total package at MedStar With Mary Leigh and Brian as active by the care I received from Dr. Landy
Georgetown University Hospital, with partners, the team went to work. Dr. and the whole Georgetown team,
its wealth of specialists, collaborative O’Donnell monitored Mary Leigh for including the fantastic nurses, prenatal
approach to patient care and top-rated increased mucus, which could raise the educators and lactation consultants.
Neonatal Intensive Care Unit (NICU). odds of developing lung infections As a matter of fact, I’m now getting all
and pneumonia and reduce oxygen to my specialty and follow-up care there.
Brian underwent testing with Laura both mother and baby. Dr. Janicic kept I feel like a walking medical miracle,
Krass, a genetic counselor at MedStar Mary Leigh’s growing need for extra and Jack’s my miracle baby.”
Georgetown, to make sure he was not nutrition delicately balanced with her
a carrier. In the meantime, Helain J. blood sugar level. And Dr. Myers For a high-risk pregnancy appointment,
Landy, MD, chair, Department of developed backup plans that weighed call MedStar Georgetown M.D.
Obstetrics and Gynecology, and an the effects of anesthesia on Mary
expert in high-risk maternal-fetal Leigh’s compromised lung function.
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