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					                                                                                                                             Winter 2012

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
                                                                                                          Page 2
                                                                                                          Because You Asked: Rheumatoid

                                                                                                          Page 3
                                                                                                          Newly Renovated Infusion Center

                                                                                                          Page 4
                                                                          Photo by     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

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     environment.

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
                                                                                      Welcome New
 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 to watch an Ask-A-Doctor video
                                                                                      Family Medicine
 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     findadoc
the placenta is completely detached,

Stay Connected to Your Family and Friends
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                                            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.
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                                                                                      Start your CarePages profile today
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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
the question.

“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       
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.
                                                                                         at 202-342-2400.
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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Pancreatic Cancer                                                       
                                                                                  Please submit your comments to:
As the fourth leading cause of cancer                                             Karen Alcorn, Editor
death in the United States, pancreatic                                            202-444-4658
                                                                                  or via email:
cancer is difficult to diagnose and treat.
That’s why MedStar Georgetown                                                     MedStar Georgetown University Hospital
                                                                                  Administration • 3800 Reservoir Road, NW
provides advanced diagnostics,                                                    Washington, DC 20007-2113
innovative treatment options and
promising new therapies to help people                                            Richard Goldberg, MD               S. Joseph Bruno
                                                                                  President                          Chairman of the Board
fight pancreatic disease.
                                                                                  Kenneth A. Samet, FACHE
                                                                                  President and CEO, MedStar Health
Join us at the PurpleStride Walk to help advance research, support patients
                                                                                  Editors                            Managing Editor
and create hope for those affected by pancreatic cancer.                          Karen Alcorn                       Benjamin Waxman
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PurpleStride Walk                                                                 Writers
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For more information, to register or to make a donation, visit   Laura Sobelman
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