Download Sans Serif no indent - Anne Arundel Medical Center

InPractice
APRIL 2014
Women’s and Children’s Services
Care for a Lifetime of Health and Wellness
ON THE COVER:
Joseph Morris, MD; Briana Walton, MD;
Michael Lantz, MD; and
Teresa Diaz-Montes, MD, MPH
Women’s and
Children’s Services
Supporting Women Throughout Their Lives
Women’s and Children’s Services at Anne Arundel Medical
Center offers a wide spectrum of options that encompasses
testing, treatment and care for women of all ages. Our
services range from well care to treating complex conditions,
healthy deliveries to high-risk obstetrics, and routine to
advanced breast and gynecologic care.
The Clatanoff Pavilion at Anne Arundel Medical Center
More Choices for Women
Henry Sobel, MD, chair of Women’s
and Children’s Services at Anne Arundel
Medical Center, stresses that the center is
focused on providing
patients with safe,
high-quality, familycentered care. “Our
program has grown
because of the
breadth and depth of
services we offer for
our region,” he says.
Henry Sobel, MD
Major Birthing Center
More than 5,300 babies—the second
highest in the state—are born here each
year. “Women come from as far as the
Eastern Shore and Southern Maryland,”
remarks Dr. Sobel. “Our experienced
nursing team works hand-in-hand with
private obstetricians, maternal-fetal
medicine specialists and board-certified
hospitalists to provide continuous care.”
Patients can also be cared for by certified
nurse midwives in a freestanding birthing
center on campus or in the hospital.
2 A A MC I N PRACT I CE | AP R I L 2 0 14
Other advanced services include 24/7
dedicated OB anesthesia services and a
Level III neonatal intensive care unit, one
of the highest levels of care for the sickest
babies. e NICU has exclusively private
rooms, where neonatologists care for
preemies and high-risk infants. “We track
our quality metrics against both state and
national data and our outcomes are
excellent,” adds Dr. Sobel.
Reducing the Rate of
Contraindicated Elective Deliveries
e number of mothers with healthy
pregnancies electing to have their babies
before 39 weeks’ gestation has been
rising. is trend is concerning. In
accordance with the American College
of Obstetricians and Gynecologists and
the Society for Maternal Fetal Medicine,
we recommend delaying deliveries until
at least 39 weeks when not medically
necessary. e last few weeks and days of
pregnancy are critical for the development
of a baby’s brain, lungs and liver.
For more information, visit
askAAMC.org/ChoosingWisely.
Minimally Invasive Gynecology
“We pride ourselves on the advances
we’ve made in minimally invasive
gynecologic surgery,” Dr. Sobel
states. “We have recently added
Dr. Teresa Diaz-Montes, who has
brought laparoscopic and robotic
capabilities to our Gynecologic
Oncology Collaborative, led by
Medical Director Dr. Neil Rosenshein.”
David Todd, MD, an interventional
radiologist, performs uterine fibroid
embolization. Richard Marvel, MD,
leads the minimally invasive
gynecology and pelvic pain program.
Briana Walton, MD, leads the
urogynecology program, which is
now offered in three locations.
“We’re committed to growing our
services to provide women across
our region with high-quality care
through each stage in life.” For more information about
Women’s and Children’s Services at
Anne Arundel Medical Center, visit
askAAMC.org/Womens.
Birth and Baby: Midwifery to NICU
The Birth and Baby Team at Anne
Arundel Medical Center offers an
extensive range of services for
expectant
mothers, new
parents and
babies, including
all-private rooms
designed with
women’s needs
in mind. Pregnant
women have
the option of
Betsey Snow, RN
delivering at
the Clatanoff Pavilion or at Bay Area
Midwifery located on AAMC’s campus.
Betsey Snow, RN, senior nursing director
of Women’s and Children’s Services,
says, “Our personalized, familycentered childbirth model promotes
mother-baby bonding. In addition to
our board-certified obstetricians and
outstanding nursing team, we offer
certified nurse midwives and boardcertified lactation consultants.” The
86-bed Women’s and Children’s Center
in the Clatanoff Pavilion is undergoing
renovations to provide a welcoming
experience filled with light and familycentered conveniences.
Midwifery
Bay Area Midwifery is a state-licensed
and nationally accredited birth center.
Staffed by five
certified nurse
midwives, Bay
Area offers a
full scope of
services, from
well-woman
to low-risk
pregnancy care.
Its free-standing
Jennifer Caniglio, CNM
center delivers
more than 500 infants each year, with
the back-up of expert perinatologists
3 A A MC I N PRACT ICE | APR I L 2 014
and hospital birthing facilities when
unanticipated emergencies occur.
To refer a patient or for more
information, call 410-573-1094 or
visit bayareamidwifery.com.
Level III NICU
Anne Arundel Medical Center provides
life-supporting care to more than 500
premature and critically ill infants each
year. Suzanne Rindfleisch, DO,
neonatologistperinatologist,
says, “We provide
comprehensive
care to infants of
all gestations and
birth weights who
are premature or
with medical illness.
We offer a range of
Suzanne Rindfleisch, DO
pediatric surgical
and medical subspecialties, plus advanced
nursing and respiratory care.” Women
come from many miles away to deliver at
AAMC because of the ability to keep their
babies close in the event the infant needs
this specialized level of care.
Center for Maternal Fetal Medicine
For women with diabetes and other certain
medical conditions, healthy pregnancy
outcomes are significantly improved by
seeking specialized care prior to conception.
Michael Lantz, MD,
medical co-director
of the Center for
Maternal and Fetal
Medicine, notes,
“We offer a
comprehensive
program to optimize
the preconception
health of women
Michael Lantz, MD
with diabetes.
Patients with good control of their blood
glucose levels prior to pregnancy have a
lower risk for miscarriage and certain
birth defects, including open spina
bifida and congenital heart disease.”
A maternal-fetal medicine specialist and
a certified diabetic educator work with
patients to address all aspects of their
preconception and post-conception health. To refer a patient, call 410-224-4442.
OB Hospitalists
Expectant mothers have access to
highly skilled, round-the-clock care
from experienced, board-certified OB
hospitalists. Having these hospitalists
on staff improves response time,
communication
and coordination
among the care team
and enables us to
provide more
comprehensive care.
They collaborate
with patients’
OB-GYNs to provide
the best care,
Joe Morris, MD
keeping him
or her informed of the patient’s medical
condition and progress. They are also
available to consult or assist with any
emergencies.
Classes for the Whole Family
For patients who are pregnant or planning
to become pregnant, AAMC sponsors a
host of maternity classes and support
groups at a variety of times and locations.
> Birth classes
> Breastfeeding classes
> Family education
> Newborn care classes
> Prenatal yoga
> Breastfeeding support groups
Programs include:
Patients can sign up for classes by visiting
AAMCevents.org or calling 443-481-5555.
Urogynecology
Pelvic Health
e Women’s Center for Pelvic Health
at Anne Arundel Medical Center is a
team of three female board-certified
urogynecologists and two specialized
nurse practitioners who treat complex
pelvic issues at offices in Annapolis,
Bowie and Odenton. “We offer a full
array of urogynecologic care, including
conditions such as bowel and urinary
incontinence, uterine fibroids, urogenital
fistulas, and pelvic organ prolapse,” says
Briana Walton, MD, director of female
pelvic medicine and
reconstructive
surgery. “We pride
ourselves on taking
the necessary time
for new patient
consults, listening
carefully because we
need to understand
Briana Walton, MD
the impact on the
woman’s quality of life, not just what we
see during an exam.”
Urogynecology only recently became
a board-certified subspecialty, requiring
fellowship training in female pelvic
medicine and reconstructive surgery,
clinical practice experience, case collection
and a rigorous exam. Kay Hoskey, MD,
urogynecologist, adds, “Collaboration
is critical. We work as a team, holding
weekly pre-operative
conferences.
Our nurse
practitioners
co-manage patients
and we meet
quarterly with
pelvic floor physical
still experiencing issues. We determine
therapists to
Kay Hoskey, MD
their goals, whether it’s comfort, less pain
coordinate care.”
or a better sex life. We then offer the
most
appropriate non-surgical or surgical
Minimally Invasive Pelvic
options
to meet those goals.”
Prolapse Surgery
Dr.
Walton
explains, “Some 75 percent
Today, patients who fail conservative
of patients are appropriate for a vaginal
measures to manage pelvic prolapse can
minimally invasive surgery approach,
take advantage of
and
the remainder receive laparoscopic
far less invasive
or
robotic
sacrocolpopexy. e best
surgical options.
approach depends on the patient’s lifestyle
Yong Zheng, MD,
and
activity level. We’ve used the robot
urogynecologist,
since
2006 and our complication rates are
notes, “We oen see
extremely
low.”
patients who have
Yong Zheng, MD
had some type of
treatment or
procedure but are
For more information, visit
askAAMC.org/pelvichealth or call
443-481-1199.
Newer Treatments for Overactive Bladder
“Overactive bladder (OAB) treatments have changed significantly,” says urologist Mara Holton, MD, of
Anne Arundel Urology. “I tailor treatment to the patient’s lifestyle and preference, often combining allopathic
and holistic approaches such as acupuncture. This is especially important because long-term medication
compliance rates are often less than 25 percent in a patient population where polypharmacy is already an
issue.” While pelvic floor physical therapy, behavioral modifications and medications provide good outcomes
for 70 to 80 percent of patients, those who fail conservative methods can benefit from percutaneous tibial
nerve stimulation (PTNS) or BOTOX injections into the bladder.
Mara Holton, MD
For more information, call 410-266-8049.
4 A A MC I N PRACT ICE | AP R I L 20 14
Women’s Rehabilitation
Services
We offer physical and occupational
therapy to treat a wide variety of
women’s medical issues. Specialized
services include rehab for women
recovering from surgery and those
with pelvic health issues.
In 2014, Anne Arundel Medical
Center’s comprehensive cancer
rehabilitation program became
STAR-certified (Survivorship Training
and Rehab Program), a designation
given to programs that emphasize
evidence-based best practices.
For more information, visit
askAAMC.org/CancerRehab.
Lymphedema Center
Women who have had lymph nodes
surgically removed are at risk for
lymphedema. Early treatment can
address this problem before it
becomes disabling. Physical therapists
and lymphedema specialists provide
patient education and a series of
exercises to strengthen the muscles,
regain range of motion and provide
a gentle skin stretch. Additional
therapeutic approaches may include
aerobic activity to increase tolerance,
multi-layered bandaging that includes
fitting for compression garments,
manual lymphatic drainage and
intermittent compression pumps.
To refer a patient, call 443-481-3805.
Rehab for Pelvic Conditions
Specialized physical therapy can help
address multiple pelvic problems,
including urge and stress urinary
incontinence and fecal incontinence,
pelvic pain, constipation, interstitial
cystitis, osteoporosis, and pre- and
postpartum pain. Customized
programs may include education, pelvic
floor biofeedback, manual techniques,
electrical stimulation, targeted pelvic
exercises, and behavior modification.
Patients receive individualized
treatment in private rooms.
Call 443-481-1140 for more information.
5 A A MC I N PRACT ICE | AP R I L 20 14
How to Manage Patients with
Breast Nodularity, Breast Density on
Mammography and Other Issues
Knowing when to refer a patient for further
evaluation can be challenging, especially
when the physician has received a report
noting dense breasts or a high level of
breast nodularity. Lorraine Tafra, MD,
medical director of the Anne Arundel
Medical Center Breast Center, offers
some advice.
“Every patient is different and has
a different level of breast nodularity,” she
says. “As many as 10 percent of women
will present with severe nodularity, which
makes it difficult to have a high degree
of confidence in your exam.”
Dr. Tafra continues, “We recommend
physicians err on the side of caution and
refer patients who have nodular breasts
or a difficult exam. To ease the patient’s
anxiety, they can say ‘Your exam is
challenging and I’d feel better having
a breast expert evaluate your breasts.’ It is
particularly challenging for primary care
physicians faced with a report that now
must state (based on regulations passed
by the State of Maryland) if patients have
dense breasts on mammography. Deciding
the patient needs further imaging with
ultrasound, diagnostic mammography, an
MRI, a high-risk consultation, or nothing is
relatively complex and requires a thorough
review of the actual mammograms,
history, as well as a discussion of the pros
and cons of next steps.”
To meet this need, The Breast Center
plans to develop a high breast density
clinic later this year to make it easier for
patients and physicians to resolve these
issues. “These high density clinic
appointments will be relatively short,
follow a standardized protocol, and will
provide the needed personalized
education patients need to make an
informed decision,” Dr. Tafra notes.
Dense Breast Law Challenges
and Mammography Controversy
The Breast Center staff also can assist
when patients ask questions after being
Breast surgeon Lorraine Tafra, MD, confers with
breast imaging radiologist Daina Pack, MD.
notified that they have dense breasts.
The new Maryland law requires radiologists
to notify patients with dense breasts.
The controversy swirling around
mammograms for women ages 40 to
49 has added to the challenge of
managing breast care in this age group.
Dr. Tafra observes, “While it’s a highly
emotional issue, the data is clear that
screening mammography is supported
in women aged 50 and older. For the
younger age group there are pros and
cons and the discussion needs to be
tailored to the individual patient.”
Managing Nipple Discharge Issues
Dr. Tafra states, “Patients with nipple
discharge can also present a dilemma
for primary care physicians. Non-bloody
discharge that is present only when
squeezing the nipple and discharge from
multiple ducts are not concerning.
Spontaneous or bloody discharge, and
discharge from a single duct (which may
indicate benign intraductal papilloma)
however, require further evaluation and
typically need surgical intervention.
Fortunately, only 10 to 15 percent of these
surgeries will show a malignant lesion.”
To refer a patient to The Breast Center,
call 443-481-5300. For a patient-friendly
brochure on breast density, visit
annearundeldiagnostics.com/BreastDensity.
Nonprofit Org.
U.S. Postage
PAID
Annapolis, MD
Permit No. 179
2001 Medical Parkway, Annapolis, MD 21401
Anne Arundel Medical Center (AAMC), a regional
health system headquartered in Annapolis, MD,
serves an area of more than 1 million people. In
addition to a 57-acre Annapolis campus, AAMC
has outpatient pavilions in Bowie, Kent Island,
Odenton, and Waugh Chapel.
InPractice delivers information designed to
help you manage your medical practice and
enhance patient care. For more information
on AAMC services, visit askAAMC.org.
Gynecologic Oncology
The Gynecologic Oncology Collaborative at Anne
Arundel Medical Center has an experienced gynecologic
oncology surgical team to care for women with
cancerous and pre-cancerous genital tract
malignancies. The program is
led by gynecologic oncology
surgeon Neil Rosenshein, MD,
who was recently joined by
Teresa Diaz-Montes, MD,
ensuring a comprehensive
surgical program.
Dr. Diaz-Montes says, “We
offer robotic and laparoscopic
surgery to women needing
Neil Rosenshein, MD
minimally invasive gynecologic
oncology surgery so they no longer
need to travel from Annapolis to
other centers. We offer robotic
surgery and prophylactic surgery
for appropriate women with
BRCA 1 and 2 gene mutations.”
Other options available to
patients include intraperitoneal
chemotherapy, treatment for pelvic
cancer that has spread into the
Teresa Diaz-Montes, MD
abdomen, and high-dose rate
(HDR) brachytherapy, which delivers highly targeted
radiation to the tumor. In addition, Anne Arundel Medical
Center offers genetic counseling services.
For more information, contact Judeth Davis, RN, nurse
navigator, at 443-510-0324 (mobile), 443-481-3308
(office) or email [email protected].
6 A A MC I N PRACT ICE | APR I L 2 014
Continuing Medical Education
Anne Arundel Medical Center offers physicians and other providers
CME opportunities with in-person and online presentations at
askAAMC.org/CME. To register, email [email protected].
WHAT’S NEW WITH
INFLAMMATORY BOWEL DISEASE?
April 16, 6pm
AAMC Doordan Institute, 7th Floor Belcher Pavilion
Presented by Mark Lazarev, MD,
Assistant Professor of Medicine, Johns Hopkins Hospital, Division of Gastroenterology and Hepatology
1CAT1CME
t
SAVE THE DATE
Contemporary Screening
and Management in
Women’s Cancers
November 1, All-Day Event
AAMC Doordan Institute, 7th Floor
Belcher Pavilion
Featuring Stephen Cattaneo, MD, thoracic surgeon;
Teresa Diaz-Montes, MD, gynecologic oncologist;
Neil Rosenshein, MD, gynecologic oncologist;
and Lorraine Tafra, MD, breast surgeon.