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					                           G   R   E   E   N   W   I   C   H   H   O   S   P   I   T   A   L   ’   S
Summer 20 06 | Volume 34




                           FOCUS
                           M           A       G           A       Z       I           N           E




                Greenwich
                Hospital:
                a surgical
                center of
                excellence
Greenwich
  Hospital:
a surgical
 center of
excellence
 President’s Message

 Dear Friends,

   No one looks forward to undergoing surgery. Yet many people do find         Summer 2006 + Volume 34
    comfort in knowing that the surgical care they need – whether it’s a
     planned procedure or an emergency situation – is available right         F O C U S M A G A Z I N E is

      here, close to home.                                                    published by the Public Relations
                                                                              Department of Greenwich Hospital.
             Greenwich Hospital’s reputation as a surgical center of
        excellence is drawing thousands of residents from Connecticut         George Pawlush
                                                                              EDITOR IN CHIEF
        and New York. We provide the highest standards of clinical care,
                                                                              Robin Loughman
         patient safety and customer service. People also appreciate our
                                                                              SENIOR EDITOR

         holistic approach that tends to the physical and emotional needs
                                                                              Cathy Ranieri
          of patients and their loved ones.                                   PRODUCTION MANAGER

             In this issue of Focus, you’ll learn about the many surgical
                                                                              Magaly Olivero
          specialties available at Greenwich Hospital, including orthope-     SENIOR WRITER


          dics, neurology, oncology, urology, vascular, gynecology,           Heather Porter
          ophthalmology, general surgery and more. Advances in surgical       Patti Yacavone
                                                                              EDITORIAL ASSISTANTS
           and anesthetic techniques have led to less invasive procedures
                                                                              Teri Caruthers
           and quicker recoveries. In fact, nearly two-thirds of all of the
                                                                              CIRCULATION SUPPORT

           surgical procedures at Greenwich Hospital are done on an
           outpatient basis, with many patients recuperating at home just     FOCUS EDITORIAL BOARD

          a few hours after surgery.                                          A. Michael Marino, MD
                                                                              SENIOR VICE PRESIDENT,
             You’ll also meet members of the surgical team – surgeons,
                                                                              MEDICAL SERVICES
          anesthesiologists, nurses, certified surgical technologists,
                                                                              Frederick E. Siefert, MD
          rehabilitation therapists and many others who bring a superior      CHIEF OF STAFF

         level of skill and compassion to their work each and every day.
                                                                              Stuart W. McCalley, MD
         These individuals work together to provide patients with the best    DIRECTOR OF MEDICINE


        surgical outcomes in the best possible environment.
             As you’ll discover in the following pages, our broad spectrum
       of experts and resources enables Greenwich Hospital to make
       every surgical experience as smooth as possible – before, during
      and after surgery.

                                                                              The Q Design Group Limited
                                                                              GRAPHIC DESIGN, WESTON, CT



                                                                              Steven Rossi Photography
                                                                              PHOTOGRAPHY, NORWALK, CT
 Frank A. Corvino
President and Chief Executive Officer
Greenwich Hospital Offers Advanced Surgical Solutions              6


  Patients Come First with Specialized Nursing Care                8


    Same-Day Surgery On The Rise                                   9


      Imaging Tools Create Surgical Road Map                       10


       Anesthesia Options Augment Surgical Safety                  11


        Patients Find Relief with Pain Management                  12


         Integrative Medicine Heals Body and Soul                  13


         Greenwich Hospital Takes Lead in Patient Safety           14


          General Surgeons Provide Critical Expertise              15


          New Intraocular Lenses Restore Full Range Vision         17


          Sinus Sufferers Breathe Easier with Simple Procedure     18


          Innovative Orthopedic Proceduress Keep Patients Active   19


          Rehabilitation Begins Early for Orthopedic Patients      20


          Spinal Fusions Get Patients Back on Track                21


          Less Invasive Techniques Enhance Gynecological Health    22


         Plastic Surgeons Emphasize Safety and Ethical Standards   23


         Greenwich Hospital Plays Key Role in Research             24


        Laparoscopic Techniques Ease Kidney Cancer Surgery         25


       Early Detection of Breast Cancer Leads to Better Survival   26


      Oral and Maxillofacial Surgeons Provide Specialty Care       27


    Greenwich Hospital’s Anesthesiology & Surgical Staffs          28
Greenwich Hospital Offers Advanced Surgical Solutions




T
                 he prospect of surgery didn’t concern John
                 Squillace, who entered the operating room
                 listening to his favorite classical guitarist on
                 his headphones. There was little time to
                 worry as he focused on the music. “That’s the
                 last thing I remember as I drifted off to
                 sleep,” says Squillace, who underwent two
                 total knee replacements. “I was relaxed
because I knew I was getting the best medical attention in a
place where people also cared about my frame of mind. My
hospital experience couldn’t have gone better.”
    Squillace is among the growing number of Connecticut
and New York residents choosing Greenwich Hospital for its
superb surgeons and nurses, modern facilities and holistic
approach to meeting the medical and emotional needs of
surgical patients. The hospital handles close to 8,500 surgical
procedures a year, with about two-thirds of all surgery
performed on an outpatient basis. Hospital officials expect the
growth to continue as more patients and surgeons realize the
benefits of Greenwich Hospital.
        “We want to make every stage of the surgical experience as       by their commitment to provide personalized patient care,”
    smooth as possible for patients by offering resources to help        says Gina Gladstein, MD, the hospital’s section head
    them before, during and after surgery,” says Anne Ertel, MSN,        of ophthalmology and a surgeon with Greenwich
    RN, program director for surgical services at Greenwich              Ophthalmology Associates.
    Hospital. “We want to provide patients with the best surgical             Patient support services are available to help patients
    outcomes in the best possible environment throughout their           throughout the surgical experience, explains Sandra Barnes,
    hospital visit and beyond.”                                          MS, RN, CPAN, nurse manager for the ambulatory surgery
                                                                         unit and the post anesthesia care unit. “These resources range
                                                                         from the Pre-Admission Assessment Center and patient
    Providing excellence on all fronts                                   education classes to prepare people for surgery; to integrative
                          s a surgical center of excellence, Greenwich   medicine techniques to help patients handle stress; to discharge




    A
                          Hospital provides advanced care with a         planning to get patients back home safely and quickly,” she
                          multidisciplinary team of board-certified       says. “We have it all.”
                          surgeons, anesthesiologists, pain manage-
                          ment specialists and specialty nurses with
                          the highest standards for safety, clinical     Keeping up with changing times
                          performance and patient satisfaction.                                  dvances in surgical procedures –




                                                                         “A
                          Skilled surgeons cover a broad range of                                including minimally invasive surgery,
                          specialties and subspecialties, including                              laparoscopic surgery and other types of
    orthopedics, ophthalmology, urology, gynecology, vascular,                                   endoscopic surgery – have revolution-
    neurosurgery, general surgery, oncology and more. “Surgeons                                  ized the field,” explains Philip
    are skilled in the latest techniques, including minimally inva-                              McWhorter, MD, the hospital’s director
    sive surgery, microsurgery and endoscopic surgery,” says Ertel.                              of surgery. “The field has become
         Hospital surgeons practice in a modern medical facility                                 increasingly more specialized, with
    with state-of-the-art operating rooms equipped with                                          surgeons focusing on specialty and
    computerized surgical navigational tools and the latest                                      subspecialty areas,” he says.
    technology to treat medical conditions across a wide spectrum                                     As a general surgeon for three
    of specialties, says John Crowe, MD, the hospital’s director of                              decades, McWhorter has witnessed
    orthopedics and an orthopedic surgeon with Orthopaedic &                                     dramatic changes in surgery, both at the
    Neurosurgery Specialists. Plus sophisticated radiological tools      hospital and in private practice. “Minimally invasive surgery
    enable surgeons to develop comprehensive treatment plans             allows physicians to perform complex procedures using tiny
    for patients. “Greenwich Hospital provides surgeons with             instruments and small incisions. Patients experience less pain
    superior technology so we can offer patients the most advanced       and heal more quickly because there is less muscle trauma,” he
    treatments,” he adds. “It’s a challenge to keep up with fast-        says. A gall bladder operation, for example, once involved an
    changing technology across so many surgical specialties. But         abdominal incision of four to six inches. “Today, surgeons can
    Greenwich Hospital is committed to staying abreast of the            perform the same procedure laparoscopically with four
    latest advances.”                                                    miniscule incisions.”
         The hospital’s nursing and operating room staff includes             Maintaining a facility and team that can skillfully respond
    highly skilled professionals with decades of experience, many        to the increasing specialization of surgery will remain a top
    with advanced certification in surgical specialties, critical care,   priority at Greenwich Hospital well into the future. “Our
    anesthesia and other areas. “The nursing care at Greenwich           mission,” says Ertel, “is to provide patients with the specialized
    Hospital is outstanding. Their clinical skills are only surpassed    surgical care they need right in their own community.”




7
Patients Come First With Specialized Nursing Care


                        s manager of the operating room, Kim        resource technologists and specialty coordinators who assist




A
                        Viadero, RN, CNOR, stays on the             surgeons, maintain the specialized equipment and keep abreast
                        move, making sure the surgical              of new developments in their field.
                        procedures scheduled for the day are             “Staying up to date is critically important if we are going
                        proceeding smoothly and accommo-            to continue offering the best in patient care,” says Ruth C.
                        dating those unexpected cases that          Hawkins, CST, a specialty resource technologist for vascular
                        inevitably arise. Like the conductor of     and general surgery. “It’s good to have one person who can
                        an orchestra, she knows the best results    serve as a resource for the physician and for staff members with
occur when the team of highly skilled professionals works in        questions about a particular surgical specialty.”
unison to create a healing environment for patients.
      “We’re here to make people’s lives better, no matter what
kind of surgery they’re having,” says Viadero. “We want to pro-     Creating a healing environment
vide patients with the best possible surgical outcomes, while       Although every team member is clinically adept, it’s the per-
doing everything we can to address their individual concerns so     sonal bond between caregivers and patients that sets
they feel at ease.”                                                 Greenwich Hospital apart from other facilities, says Doris
     Viadero is part of a highly skilled and specialized team of    Dubail, RN, CNOR, RNFA. “Greenwich Hospital fosters
surgical assistants, certified surgical nurses, clinical resource    healing by creating an environment where patients feel
experts, post anesthesia care nurses and nurse anesthetists who     special,” says Dubail, who has been part of the hospital’s
believe in bringing something personal to every encounter with      surgical team for 25 years. “Our surgeons and nursing staff go
patients. This commitment has led Greenwich Hospital to be          the extra mile to give patients the one-on-one attention they
a consistent leader nationwide for patient satisfaction thanks to   deserve. They put the needs of patients first.”
a cadre of healthcare professionals who are dedicated to service         As a specialty coordinator and surgical assistant, Dubail’s
excellence.                                                         duties include assisting surgeons during procedures and staying
     “You can’t find better nursing care in the tri-state area,”     informed about technological developments in orthopedics
says Stephen Carolan, MD, director of the hospital’s obstetrics     and ophthalmology. But the most rewarding aspect of her job,
and gynecology department. “The nurses are professionally           she says, involves talking with patients during those final
knowledgeable and provide patients with personal attention          moments before they enter the operating room. “I enjoy reas-
before and after surgery. As physicians, we know our patients       suring patients that they are in a safe environment and in the
are in good hands, getting the best possible care from the hos-     hands of exceptional physicians and nurses who are focused on
pital’s specialized nurses. Everything is in place to optimize      making sure their surgery goes well,” she says. “Patients know
patient care and everyone is working toward that goal.”             they are getting the best possible care.”



Meeting the challenge
As surgical specialties have developed, so has the need for
hospitals to adapt by offering a diversified team of profession-
als who can stay abreast of new medical trends and technology,
explains Anne Ertel, MSN, RN, program director for surgical
services at Greenwich Hospital. The team includes specialty



                                                                                                                                       8
                                                    Same-Day Surgery On The Rise

Ambulatory surgery has become the norm              patient rooms and a post anesthesia care unit. “Patients get a
  for treating many conditions – from               welcoming feeling when they arrive here because they receive
    repairing a shoulder with arthroscopic          personalized care,” says Sandra Barnes, MS, RN, CPAN, nurse
      surgery, to replacing cataracts with          manager for pre-admission assessment center, ambulatory
        intraocular lenses, to eliminating          surgery unit and post anesthesia care units. “Our staff goes out
         polyps during sinus surgery.               of its way to help patients going through what could be one of
                      “Nearly two-thirds of all     the most difficult times in their lives.”
            surgeries performed at Greenwich             Many patients know what to expect by the time the day of
             Hospital are done on an outpa-         surgery arrives because they have visited the Greenwich
              tient basis thanks to minimally       Hospital Pre-Admission Assessment Center, located in the
               invasive techniques, fast-acting     Olive and Thomas J. Watson Jr., Pavilion. At the center,
                anesthetics and pain relief         patients can ask questions about the surgical process, including
                 options that allow most            recovery at home. “We want to make sure everything goes
                  patients to return home safely    smoothly before, during and after surgery,” says Barnes.
                  just hours after surgery,” says   “Patient satisfaction is a major goal. We try to accommodate
                  Anne Ertel, MSN, RN,              their individual needs.”
                   program director for surgical         At the Ambulatory Surgery Center, patients stay in private
                   services.                        rooms where they can discuss their case with the surgeon, nurse
                         “There’s not much we       and anesthesiologist in confidence, says Margaret Lazlo, RN,
                   can’t do on an outpatient        CNOR. “People appreciate the hospital’s efforts to maintain
                   basis,” says Richard Brauer,     patient confidentiality,” she says. “We recognize the impor-
                   MD, the hospital’s section       tance of respecting a patient’s right to privacy.”
                   head of otolaryngology and            While most patients return to their private room after
                   an ear, nose and throat spe-     surgery, some may go to the post anesthesia care unit as part
                   cialist who routinely treats     of their recovery, explains Priscilla Colet, RN, BSN, CAPA.
                   patients at the hospital’s       “We are very protective of our patients,” says Colet. “We are
                  Ambulatory Surgery Center.        constantly anticipating their medical needs to make sure they
                  “We have a modern surgical        recover in a safe manner as they move from unconsciousness to
                 facility with superb surgeons,     consciousness. We work closely with the doctors and other
                 anesthesiologists and nurses. In   nurses to insure patients receive the highest quality of care in a
                the past, people stayed in the      safe, nurturing environment.”
               hospital because the procedures           Most same-day surgery patients are back home in time
              were invasive and they were           to watch an afternoon movie. “We make sure patients have
             affected by the anesthesia. But        everything they need before they go home,” emphasizes
           that’s not true anymore. Even kids       Barnes. “But if they need our expertise once they are home,
          who get their tonsils removed go          we’re just a phone call away.”
         home after a few hours.”
             Located on the second floor of
      the Helmsley Medical Building, the
    Ambulatory Surgery Center features
  state-of-the-art operating rooms, private
    Imaging Tools Create Surgical Road Map

   Powerful imaging devices that allow sur-          radiological tools provide surgeons with critical data.
     geons to look inside the body without                 “These sophisticated devices can detect disease in its early
      making an incision have impacted the           stages, before symptoms appear, thereby alerting a surgeon of
       field of surgery.                              an existing problem,” says Mullen. Other radiological tools are
                “Radiology and surgery are fun-      used to confirm suspected disease or to determine if the disease
          damentally intertwined at almost           has spread. “Physicians use this information to decide whether
          every level,” says David Mullen, MD,       surgery is an option when developing treatment plans for their
           director of radiology at Greenwich        patients,” he adds.
            Hospital. “Radiology gives surgeons           Nuclear medicine tests, such as bone scans, can detect the
             a picture or a road map of where        spread of cancer, which may impact treatment. Meanwhile,
             they need to go and what they need      PET can detect the presence of a tumor in areas that appear
              to do.”                                normal on other imaging tests. “A patient with a lung nodule
                   Greenwich Hospital – the first     may undergo surgery. But if imaging tests determine that the
               Fairfield County facility to provide   disease has spread, then chemotherapy may be a better option,”
               advanced diagnostic imaging with      explains Mullen.
               a 64-slice CT scanner – offers a           Richard Brauer, MD, section head of otolaryngology and a
               comprehensive array of services at    surgeon with Associates of Otolaryngology, PC uses CT and
               the main hospital and at the          MRI images to differentiate between soft tissue and bone in the
               Greenwich Hospital Diagnostic         nasal cavity. Plus patients scheduled for nasal surgery get a CT
               Center in Stamford. These outpa-      scan to check for chronic sinus problems, a common condition
               tient services include x-ray,         that would otherwise go undetected. “The diagnostic
               ultrasound, computed tomogra-         technology available at Greenwich Hospital is absolutely
               phy, magnetic resonance imaging       phenomenal. These tools are invaluable for diagnosing and
               (MRI), nuclear medicine, positron     treating disorders,” he says. “CT scanning capabilities are so
               emission tomography (PET) and         extensive that enhanced images can pinpoint the problem area,
              interventional radiology. The 64-      allowing surgeons to know exactly where to go and how deep
              slice CT scanner represents a new      to probe.”
             generation of technology capable of          As an orthopedic surgeon and director of othropedics,
             performing whole body scans in ten      John Crowe, MD, uses many imaging tools to plan his strate-
            seconds and identifying cardiac          gy for surgery, whether it’s the knee, hip, shoulder or other
            disease that other less advanced         area, “We may identify a fracture with an x-ray or CT scan and
           scanners miss.                            then use MRI to clearly delineate any soft tissue injuries that
                Nearly every surgical specialty –    you couldn’t previously see,” says Crowe, a surgeon with
         neurosurgery, orthopedics, oncology,        Orthopaedic & Neurosurgery Specialists. “These same images
        urology, general surgery and more –          can be displayed and enhanced in the operating room to assist
       relies on information gathered by imag-       the surgeon during the procedure.”
      ing tools to develop the most appropriate           Mullen expects advances in radiology will continue
    treatment plan for a patient. From screen-       enhancing surgery. “The rapidly evolving field of radiology,”
  ing for disease to delineating an injury to        he says, “will enable surgeons to provide the highest level of
pinpointing the exact location of a tumor,           surgical care.”
     Anesthesia Options Augment Surgical Safety


                            dvances in anesthesiology have made            techniques that better control postoperative nausea and pain




     A
                            surgery, whether a routine tonsillectomy       leave patients with fewer side effects.”
                            or a complex spinal fusion, safer than ever         Anesthesia options include general anesthesia, regional
                            before.                                        anesthesia and monitored anesthesia, explains Alfonso
                                 “Short-acting anesthetic drugs,           Tagliavia, MD, an anesthesiologist. “Major surgery usually
                            specialized anesthetic techniques and          requires general anesthesia, which provides total loss of
                            sophisticated monitoring devices have          consciousness. Regional anesthesia or regional blocks involve
                            made the surgical experience safer for         the injection of a local anesthetic near a cluster of nerves to
     patients,” says Gary E. Kalan, MD, director of the hospital’s         numb a large region of the body. Spinals and epidurals, for
     anesthesiology department. “Anesthesiologists have always             example, can numb a patient from the chest down,” he says.
     been in the forefront of patient safety.”                             “Monitored anesthesia care, also known as conscious sedation,
          At Greenwich Hospital, a team of board-certified anesthe-         uses medications to make patients drowsy and relieve pain.”
     siologists and certified registered nurse anesthetists are                 Administering anesthesia, however, represents just one
     intimately involved with a patient’s care throughout the              aspect of care, notes Tagliavia. “The anesthesiologist is respon-
     surgical experience. Areas of expertise include cardiovascular,       sible for taking care of the entire patient, making sure that all
     critical care, neurosurgical, obstetrical and pediatric anesthesia.   the organs and systems are functioning properly during a sur-
          “Anesthesiologists meet with patients to review options,         gical procedure,” he says. Sophisticated intraoperative moni-
     which vary depending on the type of surgery and the patient’s         toring keeps tabs on all bodily functions and ensures patients
     medical history and personal preferences,” Kalan says. “Talking       remain in proper anesthetic state during surgery. “We are the
     with anesthesiologists before surgery can help alleviate any          internists who care for patients under anesthesia,” he says.
     concerns.”                                                                 As a registered nurse with a master’s degree in anesthesia,
          Dramatic changes in anesthesia, along with the develop-          Grace Briccetti, CRNA, plays a crucial role in maintaining a
     ment of minimally invasive surgical techniques, means                 patient’s physical and mental condition during surgery. “It’s
     physicians are performing more procedures on an outpatient            important to connect with patients emotionally. You want
     basis. “Years ago, surgical patients would stay in the hospital       patients who are drifting off to sleep to feel confident that
     because of side effects from the anesthetic drugs,” says Kalan.       everything is going to be fine,” says Briccetti. “Our role is to
     “But now we have fast-acting medications that metabolize              keep patients safe throughout surgery, whether it’s a 15-minute
     quickly, allowing many patients to return home just a few             procedure or a six-hour operation. We are the guardians of
     hours after surgery. Plus new classes of drugs and new                their well-being.”




11
Patients Find Relief with Pain Management

                       nce considered an inevitable part of          explains. Meeting with patients to discuss their pain




O
                       surgery, pain has become a condition          management options during their hospital stay and recovery at
                       that specialists can safely and effectively   home can help alleviate stress and manage pain, he says.
                       manage to help patients hit the road of            Physicians control pain with medications such as
                       recovery faster.                              analgesics and anti-inflammatory drugs; local anesthetics that
                             “The sooner patients are up and         block the nerves that transmit pain signals to the brain; and
                       moving, the sooner they recover,” says        opioids, which are often used for acute discomfort. “The
                       Cassandra Tribble, MD, an anesthesiolo-       medications used depend on the patient’s personal preference
gist and interventional pain management specialist at the            and the type of pain a patient is experiencing,” says Sygall.
Sackler Center for Pain Management at Greenwich Hospital.            Medications can be administered in many ways, depending on
“Patients free from pain are more motivated to become mobile,        the patient’s needs. For instance, medications given through
which advances post-surgical recovery and decreases the time         an intravenous device or by an epidural into the spine are
of rehabilitation. They get better quicker.”                         fast-acting and can offer relief for more than 24 hours.
     When necessary, Greenwich Hospital offers surgical                   Medication can help people experiencing chronic pain due
patients round-the-clock, specialized pain management care           to a medical condition before or after surgery, explains Steven
that begins before surgery and extends through their hospital        Bennett, DO, of Greenwich Pain Consulting Services, Inc.
stay and beyond to recovery at home. “We are part of the             “Medication can provide substantial relief for those that have
patient’s care team throughout the entire process,” notes            chronic pain from cancer or other illnesses,” he says. Bennett
Tribble. “Our goal is to work with patients to develop the best      works with surgeons to manage pain using a variety of medica-
pain management plan for their needs.”                               tions. “People with chronic pain may need to change their
     Pain specialists constantly monitor the patient’s discom-       medication regimen during the period of their surgery,” says
fort level so adjustments can be made to the treatment plan.         Bennett. “In some situations, a surgical patient may need
“We make sure patients are getting adequate pain relief and are      medication to manage pain after discharge from the hospital.
responding well to the medication,” says Tribble. “Patients are      We assist with the selection of medications and follow-up in
asked to rate their pain on a scale from zero to 10, with zero       the office to make any necessary changes.”
being no pain and 10 being the worst possible pain. We                    Patients experiencing discomfort also have more
encourage patients to speak up because everyone perceives and        opportunities to manage their own pain relief. Devices such as
manages pain differently.”                                           patient controlled anesthetic pumps allow patients to adjust
     Sometimes just thinking about the prospect of pain is           their level of intravenous pain medication by pressing a button,
enough to heighten the pain response, says Paul Sygall, MD, an       with pre-set limits determined by the physician. Says Tribble:
anesthesiologist and interventional pain management special-         “Patients appreciate having control over their pain and being
ist. “Anxiety can create a cascade of hormone changes that           involved in their treatment.”
make pain more pronounced or more likely to occur,” he




                                                                                                                                        12
                             Integrative Medicine Heals Body and Soul

Elizabeth Galt knew having a double mas-                 “The goal is to empower patients to take control of their
  tectomy would radically change her life.         anxiety,” says Johnson, of the integrative medicine techniques.
    But she never suspected the acupunc-           In “Prepare for Surgery, Heal Faster®,” patients meditate and
      ture and meditation she used to              listen to a relaxation tape one to two weeks before surgery.
        enhance the surgical experience            “Next, patients are asked to describe a peaceful place and to
         would dramatically impact her life        visualize the first, second and final stages of recovery,” she says.
          beyond the hospital, as well.            For example, Galt’s “peaceful place” was a Paris café and she
                 Few would expect a woman          visualized herself walking on a beach in St. Barts during the
            battling breast cancer to declare      final phase of recovery. Patients listen to music throughout
             “psychologically I feel great” in a   surgery and the anesthesiologist, who supports the Huddelston
              letter to family and friends         approach, whispers “healing statements” to the patient before,
               shortly after surgery. “The         during and after surgery.
                whole experience was more               Galt admits she approached integrative medicine “with a
                comfortable than it had a right    grain of salt” as someone who “had a biased scientific approach
                 to be,” says Galt, who attrib-    to medicine and a scientific mind.” But her personal experi-
                 utes her quick post-surgical      ences have made her an advocate of the power of combining
                  recovery and positive outlook    conventional medicine with complementary therapies to heal
                  to the use of integrative        the body and soul. “Integrative medicine put me more in
                  medicine techniques.             control physically and emotionally,” she says.
                          “I never expected             She believes the integrative techniques helped decrease the
                   integrative medicine to have    amount of pain medication she needed following surgery. “I
                   the kind of impact it had on    was still listening to my tape after surgery,” recalls Galt, who
                   my own surgical experi-         stopped taking morphine after the first night. She took small
                   ence,” she says. “I certainly   amounts of pain killers the first day and asked for an acupunc-
                   did not expect the impact it    ture pain treatment at the hospital. “The acupuncture really
                   has had on my life since.”      worked for the type of pain I was experiencing. It was
                       Galt participated in        amazing,” she says.
                  Greenwich Hospital’s “Prepare         “Integrative medicine helps you get in touch with your
                 for Surgery, Heal Faster®”        own ability to heal,” says Galt. “By the time I got to the
                 program developed by noted        hospital for surgery, I had no room for anxiety. I was already on
                researcher Peggy Huddelston.       my way to Paris. Today, I feel blessed to be free of cancer.”
                “This program uses a five-step
               approach to prepare for surgery
              with       meditation,     guided
             imagery and other techniques to
            reduce stress and make the surgi-
           cal experience more positive,” says
          Bernadette Johnson, RN, MS,
         CES, program director of the hospi-
       tal’s integrative medicine program.
      Acupuncture, massage, visualization,
    reflexology and stress reduction are
   among the services offered.
Greenwich Hospital Takes Lead in Patient Safety


                       reenwich Hospital has taken additional            Alison Hong, MD, manager of quality management, notes




G
                       steps to remain a leader in patient safety   that Greenwich Hospital already exceeds national benchmarks
                       by voluntarily participating in a program    in various safety areas. “The hospital takes part in continuous
                       that monitors safety in the operating        quality improvement efforts to enhance patient safety through-
                       room.                                        out all medical departments,” says Hong. The hospital exceeds
                            “We are constantly looking for ways     national standards in caring for patients with acute myocardial
                       to build the safest environment possible     infarction, heart failure and pneumonia; central line infection
                       to provide the highest quality of care to    rates; hand hygiene and contact precautions; the consistent
patients,” says Tami Moe, an administrative director in the         use of patient identification verification procedures; and
surgical services division.                                         nosocomial infection rates.
     The hospital is taking part in a program by MCIC                    Greenwich Hospital is also among the more than 3,000
Vermont, Inc., a risk retention group, to develop and imple-        hospitals countrywide taking part in the Institute for
ment system changes that improve patient safety. Enhancing          Healthcare Improvement’s (IHI) 100,000 Lives Campaign.
communication between caregivers is a primary focus of the          Launched in 2004, the campaign is a national effort that
initiative. “Improving communication among staff helps create       focuses on saving lives by implementing proven, evidence-
a better environment of care,” explains Moe.                        based practices and procedures. “The goal of this landmark
     Protocols for avoiding surgical site infections and deep       initiative is to dramatically improve how patients are cared for
vein thrombosis are also being examined to ensure hospital          when they are most at risk for infection, complications and
staff is providing the highest standard of care, she says. “For     adverse outcomes,” says A. Michael Marino, MD, senior vice
example, experience has shown that clipping, rather than shav-      president, medical care administration. “Greenwich Hospital
ing, the hair around the surgical site reduces the number of        has already implemented all six of the practices outlined by
infections,” says Moe.                                              IHI.”
     Being able to identify and treat patients at risk for deep          “Initiatives such as the 100,000 Lives Campaign and the
vein thrombosis before a potential problem occurs is another        MCIC project,” explains Hong, “are examples of the many
key component, she says. Deep vein thrombosis occurs when a         ways Greenwich Hospital strives to continuously improve
blood clot develops in one of the deep veins that lie in groups     patient safety.”
of muscle.




                                                                                                                                       14
General Surgeons Provide Critical Expertise

There’s no such thing as a typical day for             the essence,” says Brown. “The most common surgical
  Philip McWhorter, MD, a general surgeon              emergencies involve the appendix, gall bladder or other parts of
   for three decades who also serves as                the abdomen. Just one phone call will bring a surgeon to the
     the hospital’s director of surgery.               emergency room within minutes. They have many years of
              General surgeons fill a critical role     experience and offer indispensable consultative services. We
        at Greenwich Hospital, whether                 couldn’t function without the backup of our surgeons.”
         they’re performing complex surgical                General surgeons are often called to the emergency
          procedures, assessing a patient in the       department to assess and observe patients who are experiencing
           emergency department, or assisting          fever and abdominal pain, explains Brown. “They have great
            surgical specialists to develop treat-     expertise in this area,” he says. “They can determine whether
             ment plans for patients.                  or not a patient needs surgery and be ready to handle the
                   In an age of increasing surgical    procedure if the patient requires surgery quickly.”
              specialization, McWhorter takes               Patients with medical problems involving various organs
              pride in his training as a general       or body systems often turn to general surgeons for assessment
               surgeon, capable of handling            and care. “We often take care of the sickest patients because we
               diverse surgical situations. “I enjoy   have broad training in multiple areas,” says McWhorter. “This
                my work because it doesn’t fall        unique knowledge base makes general surgeons essential to the
                into the confines of one particular     daily operation of a hospital.”
                specialty,” he says.                        General surgeons also assist surgical specialists, often
                      The     hospital’s    general    working as a team in the operating room. In some cases, the
                 surgeons, he adds, are “master        general surgeon may expose the surgical area so the specialist
                 surgeons” experienced in mini-        can proceed. “Specialty surgeons have needs that the general
                 mally invasive surgery who            surgeon can meet,” explains McWhorter. In other instances,
                 welcome challenging cases.            such as breast cancer surgery, the general surgeon works with a
                 These highly skilled, board-          plastic surgeon, who begins the reconstruction process once
                 certified surgeons perform a wide      the breast has been removed.
                 variety of surgical procedures,            “We’re fortunate at Greenwich Hospital to have access to
                including laparoscopic appendec-       such qualified general surgeons,” says Joel Rein, MD, section
                tomy, cholecystectomy and hernia       head of plastic surgery who has worked with general surgeons
                repair, bariatric surgery, plus        for years. “They are an invaluable resource to physicians and
               abdominal, cancer, thyroid,             patients, alike.”
               thoracic and vascular surgery.
                    Kevin Brown, MD, director of
              emergency medicine at Greenwich
             Hospital, says his staff relies on the    Innovations in Vascular Surgery
             expertise of all surgical specialists
            when treating patients who come to         Vascular surgeons use minimally invasive techniques to
           the emergency department. But               treat abdominal aortic aneurysms which are potentially life-
          general surgeons, he says, are often         threatening conditions if left untreated, says Kenneth
         the “first responders to the emergency         Schwartz, MD, a vascular surgeon at Greenwich Hospital.
        room,” offering crucial surgical and                “Aneurysms are a health risk because they can burst or
       assessment skills to the situation.             rupture, causing severe internal bleeding that can lead to
              “We rely on surgeons around the          death,” he says. “Fortunately, aneurysms can be treated with
    clock. You never know when the next                highly effective and safe treatments when the condition is
  ambulance or car will bring a patient in             diagnosed early.”
 critical surgical condition where time is of              The aorta, which is the largest artery in the body, carries
blood away from the heart through the chest            for another medical condition,” says Schwartz. The good news
 and abdomen. An abdominal aortic                      is that ultrasound can now be used to screen for aneurysms.
   aneurysm develops when a weakened area              “Adults over age 65 with high blood pressure should be
    of the aorta expands or bulges. Risk fac-          screened for aneurysms and many insurance companies are
     tors for aneurysms include hardening of           beginning to cover screenings.”
      the arteries, high blood pressure,                    Sophisticated radiological tools such as duplex ultrasound,
       increasing age and smoking.                     magnetic resonance angiography and computed tomography
                Until      recently,    physicians     angiography enable physicians to diagnose aneurysms using
         repaired most abdominal aneurysms             minimally invasive or noninvasive techniques.
          with open surgery that involved                    “The ability to more easily diagnose the condition and
           large incisions, a week-long hospital       improved surgical techniques with graft materials are greatly
            stay and three weeks of recupera-          benefiting patients who have aneurysms,” he says.
             tion, explains Schwartz. “Some
             patients still require this tradition-
              al approach because of the shape
              and location of the aneurysm or
                                                       Advances in Thoracic Surgery
               the person’s medical condition.”
                    Today, however, surgeons rely      Thoracic surgeons treat lung cancer, esophageal cancer,
               on a less invasive technique —          tumors of the chest wall, emphysema, esophageal swallow-
                known as endovascular stent graft      ing problems, gastroesophageal reflux and more, says
                – which uses a fabric tube to rein-    Hyman Miller, MD, a thoracic surgeon at Greenwich
                force the weakened spot. “This is      Hospital.
                a painless procedure involving              “In some cases, thoracic surgeons are using minimally
                two small incisions on either side     invasive techniques to treat cancer and perform procedures
                of the groin,” says Schwartz.          such as removing small tumors of the lung and biopsies of
                “Patients stay overnight at the        the lung for inflammatory lung disease,” says Miller. “Video
                hospital and are back to normal        assisted thoracic surgery allows surgeons to perform these
               activities in a few days.”              procedures with small incisions.”
                    During this procedure, sur-             People with lung cancer may benefit from minimally
               geons thread the compressed stent       invasive surgery, says Paul Waters, MD, a thoracic surgeon at
              graft through the blood vessels to       the hospital. “Years ago, surgically treating lung cancer
              the site of the aneurysm. The stent      required a full-size chest operation with a large incision,” he
             graft expands to fit snugly against        says. “Now we can remove a cancerous spot on the lung using
             the walls of the artery, sealing tight-   limited access incisions of three, half-inch incisions.”
            ly with the artery above and below              Surgeons also use video assisted thoracic surgery to treat
          the aneurysm. “The stent graft               cancer patients who develop fluid around the lungs, says
          allows blood to pass through the             Miller. In the past, surgeons used a chest tube to periodically
         weakened artery without pushing               drain the fluid. “Now we can drain the fluid and apply
        against the bulge,” he says.                   medicine via thoroscopy that cements the lung to the chest
               Aneurysms are difficult to detect        wall, which prevents fluid from accumulating again,” he says.
      because no symptoms exist until they                  The advantages of minimally invasive thoracic surgery are
     burst. “Most people don’t know they               plentiful. “These procedures,” says Miller, “often result in less
    have an aneurysm until they have a test            pain, shorter hospital stays and a quicker recovery.”
     New Intraocular Lenses Restore Full Range Vision

                                 any people consider poor vision a       performed by ophthalmologists. A cataract is a protein




     M
                                 natural part of aging. Yet ophthal-     clouding of the eye’s natural lens that leads to blurred vision.
                                 mologists today have the expertise      During surgery, the surgeon removes and replaces the clouded
                                 and technology to perform many          lens with a clear, plastic intraocular lens. Specialized equipment
                                 relatively painless procedures that     known as a phacoemulsifier machine “crushes the cataract into
                                 restore vision.                         small pieces,” which enables the surgeon to extract the cataract
                                         “Greenwich Hospital is          through a microincision that requires no stitches, she says.
                                 committed to providing the highest            “Years ago, cataract surgery was an invasive procedure that
     standard of eye care available,” says Gina Gladstein, MD,           involved a large incision, multiple sutures and a three-day
     section head of the hospital’s ophthalmology department.            hospital stay. Today, cataract surgery is a 15-minute outpatient
     Ophthalmologists are board-certified surgeons who specialize         procedure that is performed with local anesthesia and is
     in the diagnosis and treatment of eye disorders, including          virtually painless,” notes Gladstein. “Patients are seeing well
     cataracts, retina diseases, glaucoma, macular degeneration, and     the next day and the total rehabilitation period takes three to
     vision correction and other conditions.                             five days. It’s very exciting for patients.”
          “We have state-of-the-art technology, including the finest           As with cataracts, the risk of developing glaucoma
     operating microscopes and the latest cataract surgery               increases with age. Surgical options also have improved for
     equipment. We also provide patients with the highest quality        people with glaucoma, which occurs when excess eye fluid
     intraocular lenses on the market,” she says. “Having this           causes intraocular pressure to reach dangerous levels and
     technology enables our ophthalmologists to provide patients         damages the optic nerve. This condition can lead to decreased
     with top-notch care.”                                               peripheral vision and eventually blindness. “While no cure
          One of the most exciting advances in the field is the           exists,” she says, “surgery can stop the progression of glaucoma
     development of multi-focal intraocular lenses, a new genera-        by creating a false passageway that allows fluid to flow from
     tion of implants that provide cataract surgery patients with the    inside the eye to the tissue outside the eye.”
     ability to see near and far. “In the past, cataract patients were        An increasingly aging population means more people are
     fitted with a lens that enabled them to see at a distance. But       at a greater risk of developing eye disorders in their lifetime.
     they still had to wear reading glasses,” explains Gladstein.        Fortunately, the options for treating eye conditions are
     “These new intraocular lenses offer patients a full range of        plentiful. “As a surgeon,” she says, “it’s rewarding because you
     vision from near to far, eliminating the need for glasses.”         are impacting the lives of people in such a positive way.”
          Cataract surgery is among the most common procedures




17
 Sinus Sufferers Breathe Easier with Simple Procedure

                           any people suffering from stuffy          of the endoscope projects an image onto a monitor. “We get a




M
                           noses, congestion and pressure            direct view of the area, which makes it easier for surgeons to
                           headaches associated with sinus           use miniature instruments to remove abnormal structures with
                           problems could easily find relief with     minimal tissue trauma,” he says.
                           a minimally invasive surgical proce-           The enhanced capabilities of imaging tests such as com-
                           dure.                                     puted tomography and magnetic resonance imaging help ENT
                                “Endoscopic sinus surgery is a       specialists develop a strategy for surgery. “Imaging tools can
                           safe, effective, and virtually painless   help physicians differentiate between soft tissue and bone,” he
treatment for people with acute sinusitis who no longer              says. “These three-dimensional images allow physicians to see
respond to medication,” says Richard Brauer, MD, section             the problem area from any angle.” CT scans also are used to
head of otolaryngology at Greenwich Hospital. “This outpa-           identify previously undetected sinus problems. “Some people
tient procedure involves minimal cutting and discomfort,             with deviated septums weren’t getting better after surgery
enabling patients to go home a few hours after surgery.”             because they had developed a chronic sinus problem as a result
     Otolaryngologists are surgeons who treat disorders of the       of the deviated septum,” explains Brauer. “Now any patient
ear, nose, throat and related structures of the head and neck.       undergoing a nose procedure gets a CT scan to determine if an
They see patients of all ages with symptoms ranging from             underlying sinus problem exists.”
chronic ear infections and sinusitis to tonsillitis and sleep             Other valuable resources are computerized navigational
apnea. “All of our ear, nose and throat (ENT) specialists are        tools that provide critical information to surgeons while they
well trained in the latest procedures,” notes Brauer, “and the       perform a procedure. “It’s like having a global positioning sys-
hospital is always purchasing the newest and best technology.”       tem for the nose and sinuses,” says Brauer. “The danger with
     Minimally invasive surgical techniques, sophisticated           sinus surgery is that you are operating close to the eye and the
imaging devices and computerized navigational surgical tools         brain. This technology provides real time information that lets
have changed the nature of sinus surgery, explains Brauer. Years     surgeons know when they are getting close to a structure.
ago, surgeons reached the sinus with an invasive procedure           Greenwich Hospital is doing everything possible to make
through the cheek. Now surgeons insert an endoscope through          surgery safer than ever before.”
the nasal passage, requiring no incision. A camera on the end




                                                                                                                                        18
Innovative Orthopedic Procedures Keep Patients Active

 Younger adults determined to stay on          inches. “These minimally invasive procedures cause less muscle
  the move as they age are among the           trauma, leave smaller scars and result in shorter hospital stays
  growing number of people undergo-            and speedier recoveries for many patients,” says Crowe.
   ing innovative orthopedic proce-                 Breakthroughs continue in arthroscopy, which provides
    dures at Greenwich Hospital.               relief for medical conditions that once required invasive
             “People today are more active.    surgery. Arthroscopy allows orthopedic surgeons to diagnose
       They demand solutions to their          and treat problems using an instrument called an arthroscope.
       medical problems because they           The scope has a camera that transmits images to a monitor,
       don’t want to restrict their physical   providing surgeons with a clear view of the problem area.
        activity,” says John Crowe, MD,        “During this outpatient procedure, surgeons can remove or
        director of orthopedics at             repair damaged tissue by inserting tiny surgical instruments
         Greenwich        Hospital.    The     through small incisions,” says Crowe. “More procedures are
         orthopedic team treats diverse        being done with arthroscopy and some procedures, such as
         conditions from sports injuries to    rotator cuff repairs, are being done exclusively with
          arthritis to complex fractures to    arthroscopy.”
          revision surgeries involving the          Experts expect the number of total hip and knee replace-
          shoulder, knee, hip, hand, wrist,    ments performed at Greenwich Hospital and across the
          foot and ankle.                      country to increase as the population ages and baby boomers
                “Our surgeons have exten-      enter their sixties. Once performed primarily on patients over
          sive training and experience in      65, younger adults whose active lifestyle has led to the early
          the most advanced techniques         onset of arthritis or other problems are seeking total joint
          including arthroscopy, joint         replacements, says Crowe. “Joint replacement techniques have
          replacement, minimally invasive      evolved to include less invasive, safer techniques and new
          surgery, computer-assisted sur-      materials that may help increase the longevity of artificial
         gery and other procedures,” he        joints,” he says. “Materials such as ceramic and metal-on-metal
         notes. “We’re fortunate to have       may offer improved wear properties that could safely extend
         such a broad range of orthopedic      the life of artificial joints beyond two decades.”
        specialists and subspecialists at           The hospital’s orthopedic team also includes surgeons
        Greenwich Hospital.”                   trained in computer-assisted surgery, which has the potential
              Today, patients with orthope-    for improving the accuracy of many orthopedic procedures,
       dic conditions have access to           including joint replacements. “This technique uses computer-
       many treatment options, including       ized surgical navigation to create a visual map of the area,”
      advanced minimally invasive surgi-
      cal techniques that allow physicians
     to perform complex procedures using
    tiny instruments and small incisions.
   Hip and knee procedures that a decade
  ago required incisions of 12 inches or
 more, for example, can now be accom-
plished with incisions of three to five
explains Crowe. “By using a computer, surgeons can fine tune           anxiety during and after their hospital stay. “Patients who have
the proper alignment and rotation of the implant, providing           gone through the class know what to expect, which reduces the
patients with opportunities for better long term results.”            fear of the unknown. They’re more relaxed and this helps the
     “It’s amazing,” says Doris DuBail, RN, CNOR, RNFA, of            recuperation process,” she says.
the dramatic changes in orthopedic surgery during her 25-year              During the class, orthopedic nurses, physical therapists,
career. “Patients who have undergone complex orthopedic pro-          social workers and discharge planners explain the surgical and
cedures are out of bed the night of surgery. The rehabilitation       recuperation process, including information on rehabilitation,
process begins immediately and that makes a big difference in         pain management, home care and more. People who cannot
getting patients back to their normal activities as quickly as        attend the class can rely on a video and an all-inclusive infor-
possible.”                                                            mational folder designed by the hospital.
          Anna Cerra, RN, DNP, nurse manager for surgery and               Cerra says patients appreciate “the personal touch” offered
orthopedics, says orthopedic patients who attend the hospital’s       by hospital staff. “Patients experience a sense of relief,” she says,
pre-operative total joint class before surgery experience less        “knowing we’ve tended to every aspect of their care.”




 Rehabilitation Begins Early for Orthopedic Patients

                     atients who undergo total knee or hip                  While at Greenwich Hospital, patients work with a




P
                     replacements at Greenwich Hospital can            physical therapist twice a day to learn therapeutic exercises they
                     expect to begin their rehabilitation process      can do alone and with the therapist. “The physical therapist
                     the day after surgery.                            sees patients in their room or they use the satellite gym located
                           “Our main goal is to get patients up        on the orthopedic floor,” says Kosak. “We make things conven-
                     and moving as soon as possible to improve         ient for the patient.” Some patients may see an occupational
                     their functional mobility,” explains Marc         therapist if they need adaptive equipment for dressing and
                     Kosak, administrative director for the            grooming.
 hospital’s physical medicine department. “The quicker patients             In addition to mobility skills, therapists place a “heavy
 get out of bed, the quicker the recovery process begins.”             emphasis” on bending and straightening the knee for patients
      A physical therapist meets with patients the day after sur-      who have undergone a total knee replacement, says Kosak.
 gery to evaluate their strength, range of motion and ability to       “These patients use a continuous passive motion machine that
 move around and get out of bed. “We want patients as mobile           is constantly flexing and extending the knee,” he says. Patients
 and functional as possible before they leave the hospital to go       with total hip replacements receive extensive education on how
 onto the next phase of their rehabilitation,” says Kosak.             to safely move their body and leg without dislocating their hip.
      Patients usually stay at the hospital up to four days, during         Kosak believes the hospital’s “focused team approach”
 which they discuss the next phase of recuperation with a dis-         among physicians, nurses, therapists and discharge planners
 charge planner. “Some patients go to an acute rehabilitation          greatly benefits patients. “Everyone on the team communicates
 center or a sub-acute rehabilitation center, depending on their       effectively, which enables us to design the best, individualized
 situation,” says Kosak. “Other patients choose to get physical        care plan for each patient.”
 therapy on an outpatient basis or in their home.”




                                                                                                                                              20
Spinal Fusions Get Patients Back on Track

As a longtime surgical nurse, Marie           bone morphogenetic protein and the use of sophisticated
Pham, RN, BSN, CNOR, still marvels at         computer-assisted, image-guided surgery have accelerated the
 the tiny incisions surgeons make to          development of minimally invasive spine surgery, says Camel.
  perform complex spine surgery.                    “Patients with spinal fusion may be out of the hospital in
         “You can’t imagine the amount of     as few as two days and, in some cases, may be back on the
   work done inside the body by looking       tennis court or golf range within six weeks,” says Camel. “That
    at the small bandage on the patient’s     was unheard of years ago, when patients who underwent spine
    back when the surgery is completed,”      surgery faced many months of rehabilitation.”
     says Pham. “You’d never guess there           Unlike traditional open surgery, spinal fusions are
     were screws and hardware inside by       performed using minimally invasive techniques by making a
      looking at that small incision.”        tiny incision (about an inch) and gently spreading the muscle
            Refinements in minimally          without cutting. The surgeon fuses or joins adjacent vertebrae
       invasive surgery have dramatically     using bone graft (or a substitute) and instrumentation such as
       enhanced spine surgery, in some        titanium screws, rods and cages. A microscope that has a
        cases allowing patients who under-    camera displays an enlarged view of the surgical site onto a
        go spinal fusions to return to nor-   computer monitor to assist physicians during the procedure.
        mal activities within weeks of a      “Patients experience less muscle trauma, blood loss and scar-
        procedure, says Mark Camel, MD,       ring,” says Camel. “Preserving healthy muscle and soft tissue
        the hospital’s section head of        reduces post-operative pain, which leads to shorter hospital
        neurosurgery.      The hospital’s     stays and quicker recoveries.”
        neurosurgeons include fellowship-          Technological advances have also made spine surgery safer.
        trained physicians skilled in         “The use of intraoperative monitoring, which tracks nerve
        advanced spine and brain surgery      activity in real time even when a patient is under anesthesia,
        techniques. “These techniques         minimizes the risk of nerve damage during spine surgery,”
        allow us to perform technically       explains Camel. A computerized navigational system that
        more demanding surgery safely,”       tracks the movement and location of surgical instruments in
        he says, “using better imaging and    relation to delicate structures in the spine further enhances
       computer-aided technology.”            safety. “These tools provide crucial information to surgeons
            Gone are the days when            during a procedure, which allows us to change the surgical
      patients postponed back surgery         approach, if necessary,” he says.
      simply because they couldn’t afford          For patients, rehabilitation begins shortly after surgery.
     to take off weeks and months from        “Patients are extremely happy with the results,” says Camel,
     work, school or home life. “Instead,     “because they see a dramatic improvement in the quality of
    the decision to have a spinal fusion is   their lives.”
    based solely on whether the surgery is
   appropriate and safe for the patient,”
  he says.
       Customized surgical instruments,
 specialized implants to stabilize the
spine, bone graft substitutes such as
    Less Invasive Techniques Enhance Gynecological Health

    Women who develop gynecologi-                     option for treating fibroids. In fact, fibroids are the top reason
      cal conditions that often come                  for hysterectomies,” explains Carolan. “Now we have
       with aging can now choose less                 alternative surgical procedures that can remove the fibroids
        invasive surgical solutions than              while preserving the uterus.” Depending on the size and
         before.                                      location of the fibroid, surgeons can remove the growths using
                  “Minimally-invasive surgical        an open procedure or through a laparoscopic procedure
          techniques, including laparoscopic          involving smaller incisions.
           surgery, mean fewer women need to               Pelvic prolapse is another gynecological condition that can
            undergo open surgery for hysterec-        be treated with more advanced techniques to rebuild the pelvic
            tomy or to treat problems such as         support structures. Many women’s pelvic organs change with
             fibroids. We now also have newer,         age, causing some to experience pelvic pressure, says Carolan.
             less invasive methods to treat           This condition may affect the urethra, bladder, rectum, uterus
              pelvic prolapse and other condi-        and the vagina. “When the tissues that support the pelvis are
              tions,” says Stephen Carolan,           stretched and damaged, the organ these tissues support may
              MD, director of obstetrics and          drop down and press against the wall of the vagina and form a
              gynecology       at      Greenwich      kind of hernia,” he says. Menopausal women and women who
               Hospital. “Women experience            have had vaginal deliveries are at greater risk of experiencing
               less disfiguration and less pain        pelvic prolapse. Symptoms include loss of urine with coughing,
               because there is no large incision     sneezing or exercise.
               in the abdomen, which leads to              Some patients find relief with pelvic prolapse surgery.
               shorter hospital stays, faster heal-   “With a vaginal approach, physicians can surgically repair the
               ing and speedier recuperation.”        prolapse in a more anatomically correct way, which improves
                      At Greenwich Hospital,          urinary, sexual and, in some cases, bowel functions. Patients are
               board-certified gynecologists offer     back to their normal activities within two weeks,” he says.
               a full range of gynecological               Even hysterectomies, which are medically necessary for
               services, including surgical           some women, can be performed laparoscopically, in some
              treatment of diseases of the repro-     instances. “Refinements in laparoscopic surgery,” says Carolan,
              ductive system. “Women are good         “will continue to provide women with less invasive surgical
              about staying healthy during their      solutions to gynecological problems.”
             childbearing years. But they need
             to stay vigilant about their gyne-
            cological health throughout life,”
            notes Carolan. “Our surgeons are
           well equipped to handle the wide
          variety of gynecological surgical
          needs that may arise with aging.
         Women today have many options.”
              Among these options is myomec-
        tomy or the surgical removal of uterine
      fibroids while sparing the uterus.
     Fibroids are abnormal, non-cancerous
   growths that develop on or in the wall of
  the uterus. Women with fibroids often
 experience heavy bleeding and cramping.
“Until recently, hysterectomy was the preferred
       Plastic Surgeons Emphasize Safety and Ethical Standards


                             he art of plastic surgery – whether it’s     field because it crosses many other specialties,” notes Rein.




     T
                             reconstructing a breast destroyed by         “Our expertise with tissue management and reconstruction is
                             cancer or contouring the body with a         crucial for rebuilding parts of the body.”
                             cosmetic procedure – is continuously              Advances in breast reconstruction are benefiting women
                             evolving.                                    diagnosed with beast cancer who undergo a mastectomy.
                                  But one factor remains constant:        “Breast reconstruction can dramatically improve a woman’s
                             The need to provide patients with a          appearance, self-confidence and quality of life,” says Rein.
                             superior medical facility that includes      Women who have a mastectomy can have a new breast made
                             skilled surgeons and nurses committed        either from an implant or their own tissue. Plastic surgeons
     to patient safety and privacy.                                       work with oncology surgeons in the operating room to begin
           “Greenwich Hospital offers patients a wide range of            the reconstruction process as soon as the breast is removed.
     board-certified specialists and subspecialists dedicated to pro-      “Greenwich Hospital is unique because it has developed such a
     viding the highest standards of patient safety and surgical          strong breast cancer division. Breast surgeons and plastic
     excellence,” says Joel Rein, MD, the hospital’s section head of      surgeons work as a team from day one to make sure the patient
     plastic surgery. “Greenwich Hospital is a tremendous resource        has the best outcome,” says Rein.
     offering women and men broad coverage in the field of plastic              More people are seeking cosmetic surgery to enhance their
     surgery.”                                                            appearance and boost self-esteem. “Cosmetic surgery is more
          Maintaining patient confidentiality is also a top priority of    accepted now,” notes Rein. “People talk about it.” Procedures
     the hospital team, says Nina Saylor, RN, an operating room           include face lifts, breast augmentations, liposuction,
     nurse who assists plastic surgeons. Patients have private rooms      rhinoplasty and eyelid surgery. “Although women account for
     and their names do not appear on operating room rosters.             most cases, more men are choosing cosmetic surgery to stay
     “Their anonymity is preserved,” she says. “Patients receive          competitive in their careers.”
     personalized, compassionate care that respects their right to             Although many are eager to try the latest cosmetic surgery
     privacy.”                                                            procedures, Rein advises patients to choose “techniques that
          Plastic surgeons are experienced in reconstructive and          have been shown to be truly safe and effective over time.” Most
     cosmetic surgery, treating patients with major medical               importantly, patients should undergo cosmetic surgery in a
     challenges to those wanting elective procedures to enhance           medical facility with board-certified professionals. “Our
     their appearance. Reconstructive surgery involves the rebuild-       patients have complete use of state-of-the-art operating rooms,
     ing of parts of the body damaged by trauma or disease.               with top-notch surgeons, anesthesiologists and nurses who
     Cosmetic surgery refers to numerous body contouring                  follow national guidelines for safety,” he adds.
     procedures such as liposuction, face lifts and more.                      Rein expects plastic surgery subspecialties will continue
          As specialists in reconstructive surgery, plastic surgeons      evolving as microsurgery techniques become more sophisticat-
     collaborate with other surgical specialists, including orthopedic    ed. No matter what medical advances the future brings, notes
     surgeons, general surgeons, and otolaryngologists. Advances in       Rein, “Greenwich Hospital’s plastic surgeons will continue to
     microsurgery and instrumentation mean patients have more             maintain the highest standards of ethics and safety.”
     options involving fewer incisions. “Plastic surgery is an eclectic




23
Greenwich Hospital Plays Key Role in Research

                    esearch taking place at Greenwich Hospital      neurosurgeons nationwide. The final results of this study will




R
                    is shedding light on the treatment of spinal    be released later this year.
                    cord conditions and the cognitive implica-           Another study examines the potential role of carotid artery
                    tions of carotid artery surgery.                surgery in improving cognitive function. People have carotid
                         The research endeavors are spearhead-      artery surgery to remove plaque from the carotid arteries in the
                    ed by Zoher Ghogawala, MD, a Greenwich          neck, a procedure that reduces the risk for stroke. “This
                    Hospital neurosurgeon who is clinical           multi-center pilot study will look at whether increasing blood
                    assistant professor of neurosurgery at Yale     flow to the brain after carotid artery surgery improves cognitive
                    School of Medicine and has a private            functioning,” explains Ghogawala. The study will assess cogni-
practice at Greenwich Neurosurgery. “Research benefits              tive functioning and measure blood flow to the brain before
patients and physicians by providing valuable data on who will      and after surgery. Collaborating with centers that perform
benefit from a particular procedure,” he says. “Sharing             carotid stenting should allow comparisons between these
knowledge through research helps physicians with this               procedures in terms of cognitive function after carotid
complex decision making process.”                                   revascularization.
     Ghogawala is leading a national team in an unprecedent-             Ghogawala is laying the groundwork for a third research
ed study to compare two procedures for treating lumbar spinal       project that will examine how best to treat spinal cord injuries
stenosis. The study involves patients at five medical centers,       in patients who have spinal cord compression. “Right now
including Greenwich Hospital. Lumbar stenosis is a narrowing        there is controversy over whether to treat this condition with
of the spinal canal that leads to back and leg pain.                anterior decompression and fusion through the throat or pos-
      “The study is the first randomized, prospective trial          terior decompression, with or without fusion, through the
designed to determine which patients should undergo fusion          back of the neck,” he says. The trial involves eight centers
surgery, which aims to improve stability by placing rods and        nationwide.
screws between vertebrae,” he says. All patients are treated with        “Our involvement with research shows that Greenwich
decompression surgery, which removes bones compressing the          Hospital is committed to the future of medicine,” says
nerves. But half of the patients also receive fusion surgery.       Ghogawala, who noted that the generosity of the Greenwich
As part of the study, investigators established a “spinal experts   community has made research at the hospital a reality.
network” for patients to get second opinions from eight




                                                                                                                                       24
Laparoscopic Techniques Ease Kidney Cancer Surgery

While a diagnosis of kidney cancer can           the urine, back pain, a mass in the abdomen, fatigue, weight
 be devastating, improved minimally              loss, fever, and swelling in the ankles and legs.
  invasive surgical techniques to treat               If kidney cancer is found, urologists work with the
   the disease can put patients on the           hospital’s oncology team to determine whether surgeons
    path to recovery sooner.                     should remove the tumor (partial nephrectomy) or remove the
              “Surgery can provide kidney        entire tumor-bearing kidney (a radical nephrectomy). “This
      cancer patients with an effective way      decision is based on the size and location of the tumor,” he
       to eliminate the cancer and preserve      says. Some patients have the tumor removed using laparoscop-
        the kidney’s ability to function nor-    ic surgery with small incisions. “The advantages of this
         mally,” says Jeffrey Ranta, MD,         procedure include less post-operative pain, a shorter hospital
         section head of the hospital’s urol-    stay and a faster recovery.”
          ogy department. “For many                   The surgical treatment of kidney cancer represents just
          patients, surgery is the only treat-   one aspect of the comprehensive oncological surgical services
          ment necessary to eradicate the        available at Greenwich Hospital, says Nicholas Stroumbakis,
           cancer.”                              MD, director of surgical oncology.
                Urologists are board-certified         “Our surgeons represent a broad range of specialists who
           physicians who specialize in the      are an integral part of the cancer care team,” he says. “Surgeons
            diagnosis and treatment of condi-    attend tumor board and tumor conference meetings in
            tions involving the urinary tract    collaboration with other members of the cancer care team
            and reproductive system. They        to ensure an accurate diagnosis and consider all appropriate
            treat conditions as common as        treatment options.”
            kidney stones and as complex as           “The goal,” he adds, “is to provide cancer patients with
            cancer. “Our urologic surgeons       timely, comprehensive and compassionate treatment.”
            are experienced in all surgical
            approaches, including laparo-
           scopic surgery and other less inva-
           sive techniques that can greatly
           reduce the recovery time for
          patients,” he says.
                The kidneys are bean-shaped
         organs that filter impurities from
         the blood and process these wastes
        to form urine. The most common
       type of kidney cancer is called renal
      cell carcinoma, which accounts for
      more than nine out of 10 cases. This
     tumor usually grows as a single mass
    within the kidney.
            “Many people don’t realize they
  have kidney cancer until they undergo
 testing for another medical condition,”
notes Ranta. Symptoms include blood in
 Early Detection of Breast Cancer Leads to Better Survival

   Improved methods of early detection,             radiologist on-site who discusses the findings of diagnostic
    coupled with advances in surgical               mammograms with women face-to-face so we can immediate-
     procedures, are providing a growing            ly begin exploring treatment options. Women, and less
     number of women with breast cancer             frequently men, appreciate receiving this personalized,
      improvements in survival with fewer           comprehensive care.”
       long-term side effects.                           Greenwich Hospital is also one of the few cancer centers
               “The majority of patients            in the area to offer magnetic resonance imaging-guided needle
        diagnosed with breast cancer at             biopsy. “This is cutting-edge technology,” she says. “Magnetic
         Greenwich Hospital have stage 0 or         resonance imaging allows physicians to see suspicious areas that
          stage 1 disease. Almost every one of      may not be visible with mammography or ultrasound.”
          these patients will be cured,” says            The center’s multidisciplinary approach is a key advantage.
           Barbara Ward, MD, medical director       “We can easily communicate with members of the cancer care
           of the Breast Center at Greenwich        team, ranging from medical oncologists, radiation oncologists
            Hospital.                               and pathologists to plastic surgeons who are involved in the
                  “When appropriate, a lumpec-      breast reconstruction process,” says Ward.
            tomy to remove only the breast                “Women who need surgery can have the procedure done
             lump and some surrounding tissue       in a timely fashion at the hospital,” she says. Although more
             is the procedure of choice for these   women are undergoing lumpectomy, explains Ward, mastecto-
             smaller, contained cancers‚” she       my remains a necessary treatment option for women whose
             adds. “Plus the routine use of         cancer is in more than one area of the breast and for those who
             sentinel node surgery, which makes     have a greater risk for breast cancer due to genetic testing
             it possible to remove fewer lymph      results.
             nodes from the armpit for staging           As the center’s nurse coordinator, Jan Larkin, RN, BSN,
             purposes, results in less pain and     works closely with patients and their families, providing
             long-term swelling issues.”            practical and emotional support by answering questions,
                  Located in the Sherman and        facilitating care and connecting people to available hospital
            Gloria H. Cohen Pavilion, the           and community resources. Larkin is on hand the day of surgery
            Breast Center provides women with       and remains a crucial contact for patients throughout the
            easy access to a comprehensive          treatment process and beyond.
           spectrum of medical and support                “I coordinate every aspect of their care, including helping
           services, from screenings and            them through the surgical procedure and arranging appoint-
          diagnosis to treatment, counseling        ments for chemotherapy and radiation therapy, if necessary,”
          and education. The interdisciplinary      says Larkin. “My role is to provide support in any way they or
         team includes highly skilled breast        their loved ones need it.”
        surgeons with decades of experience,             Women and men who have completed treatment for
       including Ward, a nationally recognized      breast cancer can also take advantage of the Nutrition and
       breast surgeon, and recent arrival Laura     Exercise Therapy (NEXT) program. This new wellness pro-
      Lazarus, MD, a general surgeon who            gram allows patients to access the expertise of a nutritionist and
     completed a breast fellowship at               exercise therapist at Greenwich Hospital’s Healthy Living
     Northwestern University Medical School.        Center. Participants can attend the center for three months at
           “We have a state-of-the-art center       no cost; after that, they have the option of joining.
  with the latest digital mammography and                 “This program allows our patients to focus on the positive
 ultrasound capabilities to accurately diagnose     by taking control of their health and their lives,” says Larkin.
breast cancer,” says Ward. “We have a
     Oral and Maxillofacial Surgeons Provide Specialty Care




     O
                              ral and maxillofacial surgeons at         “Years ago, we would put the bones together with wires,” he
                              Greenwich Hospital are specially          says. “Now metal plates are screwed across the fracture line to
                              trained to treat many conditions,         stabilize the surgical correction. Patients don’t need to have
                              including corrections of jaw deformi-     their jaws wired.”
                              ties, facial and mouth lacerations             Minimally invasive techniques involving arthroscopy may
                              caused by trauma, jaw and mouth           be used to treat people who have problems with their
                              tumors, and impacted teeth and            temporomandibular joint or TMJ. This small joint is located in
                              implants.                                 front of the ear where the skull and lower jaw meet, allowing
          “Our surgeons have access to state-of-the-art dental equip-   the lower jaw to move and function. “Arthroscopy involves the
     ment and are skilled in the latest bone plating and minimally      use of miniature telescoping instruments to diagnose and
     invasive surgical techniques,” says Robert Aslanian, DDS,          repair the joint, which minimizes trauma to the area,” he says.
     section head of oral surgery at Greenwich Hospital. The team            At times, pediatric dentists may operate on children,
     includes oral and maxillofacial surgeons, pediatric dentists,      adolescents and young adults with special needs who require
     periodontists and restorative dentists.                            general anesthesia for extensive dental restoration. Likewise,
          Oral surgeons sometimes work with orthopedic surgeons         periodontists (dentists who specialize in the treatment of
     for operations that require bone grafting, explains Aslanian.      gums) may work in a surgical setting because the patient has
     “During this procedure, surgeons remove bone from the hip to       another medical condition which requires close monitoring.
     use when correcting a defective jaw,” he says. “The goal is to          Oral surgeons treat patients who come to the emergency
     improve the jaw’s function and restore the patient’s facial        department and care for patients who, although hospitalized
     appearance.”                                                       for another medical condition, also have oral or dental issues.
          Surgeons are also skilled in bone plating techniques used     “We’re available to assist patients and physicians wherever we’re
     to treat patients who have experienced multiple fractures.         needed,” he says.




27
                        Greenwich Hospital’s
                         Anesthesiology & Surgical Staffs


                        Anesthesiology                  Surgical Specialists of       The Westchester
                        Greenwich Anesthesiology        Greenwich, PC                 Medical Group
                        Associates, PC                  77 Lafayette Place            14 Rye Ridge Plaza
                        5 Perryridge Road               Greenwich, CT 06830           Rye Brook, NY 10573
                        Greenwich, CT 06830             (203) 863-4300                (914) 253-4192
                        (203) 863-3390                  Philip J. McWhorter, MD       Stephen F. Carolan, MD
                        Hanief M. Abrahams, MD          Bruce M. Molinelli, MD        Patricia B. Close, MD
                        Frederick W. Axelrod, MD        Athanassios Petrotos, MD      Ranjan K. Dasgupta, MD
                        David B. Bernstein, MD                                        Vanessa A. Grano, MD
                        Francisco J. Brea, MD           The Westchester               Elizabeth M. Legatt, MD
                        John L. Clark, MD               Medical Group                 210 Westchester Avenue
                        Terence L. Cochran, MD          210 Westchester Avenue        White Plains, NY 10604
                        Gary E. Kalan, MD               White Plains, NY 10604        (914) 682-0732
                        Michael Levin, MD               (914) 682-6403                Virginia C. Daly, MD
                        Elizabeth R. Ryan, MD           Caleb K. Charny, MD           Mia M. Wright, MD
                        Heena Sultan, MD                Evan K. Krakovitz, MD
                        Paul B. Sygall, MD                                            Gad Lavy, MD
                        Alfonso A. Tagliavia, MD                                      1275 Summer Street
                        Cassandra L. Tribble, MD        Gynecology-Obstetrics         Stamford, CT 06905
                                                        Brookside Greenwich           (203) 325-3200
                        General Surgery                 Obstetrics & Gynecology
                        Christina A. Del Pin, MD        Associates, PC                Greenwich Fertility &
                        77 Lafayette Place              159 West Putnam Avenue        IVF Center
                        Greenwich, CT 06830             Greenwich, CT 06830           55 Holly Hill Lane
                        (203) 863-3782                  (203) 869-7080                Greenwich, CT 06830
                                                        Angela N. Aslami, MD          (203) 863-2990
                        Steven Burger, MD               Donna Coletti, MD             Alan S. Berkeley, MD
                        1874 Pelham Parkway South       S. Wear Culvahouse, MD        Lisa M. Kump Checchio, MD
                        Bronx, NY 10461                 Leslie A. Donovan, MD         Nicole Noyes, MD
                        (718) 824-4300                  Gaetane C. Francis, MD        Barry R. Witt, MD
                                                        Audrey F. Miller, MD
                        Sansern Hastanan, MD            Ben D. Ramaley, MD            Greenwich Gynecology, LLC
                        157 Windermere Drive            Carla J. Williams, MD         1 Perryridge Road
                        Yonkers, NY 10710                                             Greenwich, CT 06830
                        (914) 961-1714                  Putnam Gynecology &           (203) 869-8353
                                                        Obstetrics of Greenwich, PC   Donna J. Hagberg, MD
                        Breast Care Services of         500 West Putnam Avenue        Edward Jacobson, MD
                        Greenwich, LLC                  Greenwich, CT 06830
                        77 Lafayette Place, Suite 302   (203) 622-0303                Reiss & Migotsky, MD
                        Greenwich, CT 06830             Dzwinka C. Carroll, MD        150 Purchase St.
                        (203) 863-4250                  Morris C. Finkelstein, MD     Rye, NY 10580
     To view our                                        Elizabeth A. Molinelli, MD    (914) 967-3113
                        Barbara A. Ward, MD
doctors’ credentials,
                        Laura Lazarus, MD               Linda M. Reid, MD             John Migotsky, MD
visit our website at
                                                        Michael D. Schechter, MD      Ronald J. Reiss, MD
www.greenhosp.org



 For a referral to a
Greenwich Hospital
  physician, call
    888 357-2409

                                                                                                                  28
Masahide D. Kanayama, MD     Neurological Surgeons          I. Rand Rodgers, MD            Robert A. Aslanian, DDS
2 1/2 Dearfield Drive         of Stamford                    229 East 79th Street           Michele S. Bergen-Shapiro,
Greenwich, CT 06831          70 Mill River Street           New York, NY 10021             DMD, MD
(203) 422-0477               Stamford, CT 06902             (212) 249-7600                 49 Lake Avenue
                             (203) 324-3504                                                Greenwich, CT 06830
Caterina Violi, MD, PC       Carl Dila, MD                  New York Cornea, PLLC          (203) 661-4231
2 1/2 Dearfield Drive         Charles C. Rosenstein, MD      110 Brook Street
Greenwich, CT 06831                                         Scarsdale, NY 10583                    .
                                                                                           Walter F Bloes, DMD
(203) 861-9586               Orthopaedic and Neurosurgery   (914) 723-1641                 1171 East Putnam Avenue
Caterina Violi, MD           Specialists, PC                George Florakis, MD            Riverside, CT 06878
Rebecca A. Kleban, MD        6 Greenwich Office Park                                        (203) 698-1414
                             Greenwich, CT 06831            Philip J. Piro, MD
         .
Herbert F Gretz, III, MD     (203) 869-1145                 70 Mill River Street           Greenwich Oral &
5 East 89th St.              Paul J. Apostolides, MD        Stamford, CT 06902             Maxillofacial Surgery, PC
New York, NY 10029           Mark H. Camel, MD              (203) 325-4481                 23 Maple Avenue
(212) 241-1111               Amory J. Fiore, MD                                            Greenwich, CT 06830
(Gynecologic Oncology)       32 Strawberry Hill Court       Richard Weber, MD              (203) 661-5858
                             Stamford, CT 06902             1275 Summer Street             Steven M. Brody, DDS
Yale Gynecologic Oncology    (203) 487-0363                 Stamford, CT 06905             Joseph F. Wallace, DDS
800 Howard Avenue            Scott L. Simon, MD             (203) 353-1857
Yale Physicians Building                                                                   Stuart R. Epstein, DDS
New Haven, CT 06519                                         John S. Ettenson, MD           4 Dearfield Drive
(203) 785-4014               Ophthalmology                  2 Rye Ridge Plaza              Greenwich, CT 06831
Peter Schwartz, MD           Greenwich Ophthalmology        Rye Brook, NY 10573            (203) 661-3733
                             Associates, PC                 Telephone: (914) 253-8208
Yale Gyncologic Oncology     4 Dearfield Drive                                              Vito B. Federici, DMD
800 Howard Avenue            Greenwich, CT 06831            Ameet K. Goyal, MD             49 Lake Avenue
New Haven, CT 06519          (203) 869-3082                 167 Purchase Street            Greenwich, CT 06830
(203) 785-6301               Richard D. Banyard, MD         Rye, NY 10580                  (203) 661-5555
Thomas J. Rutherford, MD     Christienne F. Coates, MD      (914) 921-6966
                             Donna L. Densel, MD                                           Angelo Milazzo, DDS
Reproductive Medicine        Gina F. Gladstein, MD          Rutkowski & Greenberg MD, PC   1212 E Putnam Avenue
Associates of Connecticut    Suresh Mandava, MD             2 Rye Ridge Plaza              Riverside, CT 06878
10 Glover Avenue             William S. Potter III, MD      Rye Brook, NY 10573            (203) 698-0794
Norwalk, CT 06850                                           (914) 253-6502
Telephone: (203) 750-7400    Greenwich Eye Specialist       Steven C. Greenberg, MD        Richard D. Miller, DDS
Mark Leondires, MD           49 Lake Avenue                                                500 West Putnam Avenue
                             Greenwich, CT 06830                                           Greenwich, CT 06830
                             (203) 869-4446                 Oral Surgery                   (203) 869-2510
Neurosurgery                 Alexis E. Finlay, MD           Robert L. Ailleo, DMD
Greenwich Neurosurgery, PC                                  453 East Putnam Avenue         Phillip Pacelli, DMD, MD
75 Holly Hill Lane           New England Retina             Cos Cob, CT 06807              166 Cherry Street
Greenwich, CT 06830          Associates                     (203) 869-2552                 New Canaan, CT 06840
(203) 661-3333               2200 Whitney Avenue                                           (203) 972-1581
Katrina S. Firlik, MD        Hamden, CT 06518
Zoher Ghogawala, MD          (203) 288-2020
                             Peter Liggett, MD
                             David Tom, MD
Greenwich Pediatric                 Orthopaedic Associates         Greenwich Otolaryngology,       Mount Sinai School of
Dental Group                        of Stamford                    PC                              Medicine
42 Sherwood Place                   90 Morgan Street               4 Dearfield Drive                5 East 98th Street
Greenwich, CT 06830                 Stamford, CT 06905             Greenwich, CT 06831             New York, NY 10029
(203) 422-5437                      (203) 325-4087                 (203) 629-5500                  (212) 241-0786
Anastasia Zarakiotis, DDS           Joseph M. D’Amico, MD          Steven M. Feldman, MD           Benjamin D. Roye, MD

                                    Orthopaedic Surgery &          Ear, Nose, Throat and Allergy
Orthopaedics                        Sports Medicine                Associates, LLP                 Pediatric Surgery
Orthopaedics & Neurosurgery         1290 Summer Street             3000 Westchester Avenue         Leif O. Holgersen, MD
Specialists, PC                     Stamford, CT 06905             Purchase, NY 10577              One Elm Street
6 Greenwich Office Park              (203) 323-7331                 (914) 253-8070                  Tuckahoe, NY 10707
Greenwich, CT 06831                 Frank A. DiFazio, MD           Jeffrey H. Jablon, MD           (914) 337-2455
(203) 869-1145                                                     David B. Lawrence, MD
Michael R. Clain, MD                The Westchester                                                Peter Liebert, MD
John F. Crowe, MD                   Medical Group                  Paul D. Gittelman, MD, PLLC     222 WestchesterAvenue
James G. Cunningham, MD             210 Westchester Avenue         1600 Harrison Avenue            White Plains, NY 10604
Francis A. Ennis, MD                White Plains, NY 10604         Mamaroneck, NY 10543            (914) 428-3533
Steven E. Hindman, MD               (914) 682-6540                 (914) 381-7222
Brian F. Kavanagh, MD               Edward V. Gundy, MD                                            Bronx-Westchester
Seth R. Miller, MD                  Young Don Oh, MD               Habib Jamal, MD                 Pediatric Surgery
David P. Nocek, MD                                                 14 Rye Ridge Plaza              688 White Plains Road
Thomas Rodda, MD                    Edward C. Jones, MD            Rye Brook, NY 10573             Scarsdale, NY 10583
Paul M. Sethi, MD                   535 East 70th Street           (914) 253-4985                  (914) 722-0228
                                    New York, NY 10021                                             William Middlesworth, MD
Rudolph F Taddonio, MD
         .                          (212) 606-1856                 Adam D. Schaffner, MD           Jeffrey L. Zitsman, MD
Scoliosis and Spinal Surgery                                       25 Leroy Place
70 Mill River Road LL3                                             New Rochelle, NY 10805          Columbia Presbyterian
Stamford, CT 06902                  Otolaryngology                 (914) 813-2404                  Medical Center
(203) 327-9844                      Associates of                                                  3959 Broadway
                                    Otolaryngology, PC             Ear, Nose and Throat Faculty    New York, NY 10032
Cristofaro, Nelson & Delbello, PC   49 Lake Avenue                 Practice                        (212) 305-0641
Blind Brook Lane &                  Greenwich, CT 06830            1055 Saw Mill River Road        Robert A. Cowles, MD
Purchase Street                     (203) 869-0177                 Ardsley, NY 10502
Rye, NY 10580                       Richard J. Brauer, MD          (914) 693-7636                  Columbia Presbyterian
(914) 967-8708                                                     Carlo P. Honrado, MD            Medical Center
Robert L. Cristofaro, MD            Greenwich Ear, Nose & Throat                                   3959 Broadway
John M. Nelson, MD                  - Head & Neck Surgery, PC                                      New York, NY 10032
                                    49 Lake Avenue                 Pediatric Orthopaedics          (212) 305-5871
New York Orthopaedic                Greenwich, CT 06830            David P Roye, Jr, MD
                                                                          .                        Jessica J. Kandel, MD
Specialists, PC                     (203) 869-2030                 3959 Broadway
700 White Plains Road,              Steven A. Bramwit, MD          New York, NY 10032
Suite 10                            Michelle S. Marrinan, MD       (212) 305-5475
Scarsdale, NY 10583                 Steven J. Salzer, MD
(203) 629-3484
Scott V. Haig, MD
                                                 To view our doctors’ credentials,
                                            visit our website at www.greenhosp.org


                                              For a referral to a Greenwich Hospital
                                                    physician, call 888 357-2409




     Pediatric Urology                  Henry M. Spinelli, MD          The Westchester              Jonathan A. Waxberg, MD
     Kevin Burbige, MD                  875 Fifth Avenue               Medical Group                35 Hoyt Street
     32 Strawberry Hill Court           New York, NY 10021             210 Westchester Avenue       Stamford, CT 06905
     Stamford, CT 06902                 (212) 570-6235                 White Plains, NY 10604       (203) 324-4866
     (203) 359-4211                                                    (914) 682-6499
                                        F Frederic Khoury, MD
                                         .                             Michael S. Suzman, MD        Greenwich Urological
     Pediatric Urology Associates, PC   22 Rye Ridge Plaza                                          Associates, PC
     19 Bradhurst Avenue                Rye Brook, NY 10573                                         49 Lake Avenue
     Hawthorne, NY 10532                (914) 253-9300                 Thoracic Surgery             Greenwich, CT 06830
     (914) 493-8628                                                    Hyman Miller, MD, PC         (203) 869-1285
     Israel Franco, MD                  Sandra L. Margoles, MD         2 1/2 Dearfield Drive         Jeffrey A. Ranta, MD
     Paul F. Zelkovic, MD               166 West Broad Street          Greenwich, CT 06831          Nicholas Stroumbakis, MD
                                        Stamford, CT 06902             (203) 661-1272               Sandy M. Chin, MD
                                        (203) 358-0770
     Plastic Surgery                                                         .
                                                                       Paul F Waters, MD            The Urology Clinic of
     Keith J. Attkiss, MD               David Passaretti, MD           77 Lafayette Place           Greenwich, PC
     2 1/2 Dearfield Drive               722 Post Road                  Greenwich, CT 06830          31 River Road
     Greenwich, CT 06831                Darien, CT 06820               (203) 863-4341               Cos Cob, CT 06807
     (203) 862-2700                     (203) 656-9999                                              (203) 863-1180
                                                                                                    William C. Brown, MD
     Steven A. Fern, MD                 Rick D. Rosen, MD              Urology
     2 1/2 Dearfield Drive               91 East Avenue                 Carl A. Olsson, MD           The Westchester
     Greenwich, CT 06831                Norwalk, CT 06851              5141 Broadway                Medical Group
     (203) 629-1900                     (203) 899-0000                 New York, NY 10032           210 Westchester Avenue
                                                                       (212) 932-4139               White Plains, NY 10604
     Surgical Specialists of            John E. Sherman, MD                                         (914) 682-6440
     Greenwich, PC                      1016 Fifth Avenue              Rudy T. Andriani, MD         Bryan P. Blair, MD
     77 Lafayette Place                 New York, NY 10028             166 West Broad Street
     Greenwich, CT 06830                (212) 535-2300                 Stamford, CT 06902
     (203) 863-4300                                                    (203) 356-9692               Vascular Surgery
     Robert E. Reber, MD                Jonathan H. Sherwyn, MD                                     Hyman Miller, MD, PC
                                        50 East 79th Street            Urology Associates           2 1/2 Dearfield Drive
     Joel M. Rein, MD                   New York, NY 10021             of Stamford                  Greenwich, CT 06831
     2 1/2 Dearfield Drive               (212) 517-2700                 35 Hoyt Street               (203) 661-1272
     Greenwich, CT 06831                                               Stamford, CT 06905
     (203) 869-9850                     Aesthetic Surgery Center       (203) 324-2268               Robert J. Mulcare, MD
                                        of Connecticut                 Robert H. Lovegrove, MD      3 East 74th Street
     Ian M. Rubins, MD                  722 Post Road                                               New York, NY 10021
     4 Dearfield Drive                   Darien, CT 06820                        .
                                                                       Richard P Santarosa, MD      (212) 744-1515
     Greenwich, CT 06831                (203) 656-9999                 166 West Broad Street #404
     (203) 618-0687                     Frederic A. Newman, MD         Stamford, CT 06902           Vascular Surgical Associates
                                                                       (203) 356-9391               14 Harwood Court
     Harold S. Gewirtz, MD              Fairfield Plastic Surgery, PC                                Scarsdale, NY 10583
     70 Mill River Street               605 West Avenue                Alan Schrager, MD            (914) 723-7737
     Stamford, CT 06902                 Norwalk, CT 06880              1600 Harrison Avenue         George O. Piccorelli, MD
     (203) 325-1381                     (203) 838-8844                 Mamaroneck, NY 10543         Kenneth S. Schwartz, MD
                                        Laurence A. Kirwan, MD         (914) 698-8106               Neil S. Weintraub, MD




31
                                    Those who come to Greenwich Hospital for surgical care
                                       often find comfort in the exquisite paintings found in
                                          patient rooms, hallways and waiting areas throughout
                                            the Helmsley Medical Building and the Watson
                                              Pavilion. These beautiful pieces of art – featuring
                                               landscapes, flowers and other soothing scenes
                                                — are gifts from Leslee and David Rogath of
                                                 Greenwich. Thanks to the generosity of the
                                                  Rogaths, these paintings will provide solace
                                                   and pleasure to patients and their loved ones
                                                    for years to come.

                                                    As the gift of these paintings demonstrate,
                                                    there are many creative and flexible ways to
                                                    support Greenwich Hospital’s mission of
                                                     caring. Opportunities to combine philanthro-
                                                     py with your financial planning abound, from
                                                    donations to the annual fund to planned gifts
                                                    and bequests. The actions you take today
                                                    can have lasting and far-reaching benefits for
                                                   future generations.

                                                  For more information, please contact
                                                 Marita O’Hare, Executive Director of
                                                Development
                                               Greenwich Hospital Development Office
                                              89 Lake Avenue
                                            Greenwich, Connecticut 06830
                                          Telephone: (203) 863-3863




                                                                                              NonProfit
                                                                                                 Org
                                                                                            U.S. Postage
                                                                                             P A I D
5 Perryridge Road                                                                          Permit No.1784
                                                                                            Har tford, CT
Greenwich, Connecticut 06830-4697
203 863-3000

www.greenhosp.org

				
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