Health and Lifestyle

Take Care This Winter: Protect Your Family During Cold and Flu Season

Thu, 03 Nov 2011 20:01:00 GMT

Flu season is just beginning, and it will be in full force in just a few weeks. Other typical winter viruses, like colds and RSV, are commonplace as well during the winter months. But don't panic – all of these illnesses are treatable, perhaps even preventable. Besides a few days of feeling crummy, your family can escape flu season mostly unscathed. Fluids, medicine and TLC go a long way!

Seasonal flu, colds and RSV share many of the same symptoms, but each has slight variations (see table below). Cold symptoms tend to be less severe than flu symptoms, and RSV symptoms are more severe and serious than all other winter illnesses, particularly for infants and children.

What can I do to prevent my family from getting a winter illness?
There are measures you can take to help you and your family stay as healthy as possible. Talk to your children about things they can do to help them from getting sick.

Cover your nose and mouth with a tissue when you cough or sneeze.
If you don't have a tissue, cough or sneeze into your upper sleeve not your hands.
Put used tissues in the trash immediately.
Wash your hands frequently. Use soap and warm water if possible, and alcohol-based hand sanitizer if not.
Avoid touching your eyes, nose and mouth.
Keep your immune system strong by eating a healthy diet, exercising often and getting a full night's sleep.

If you or your child get sick, limit your contact with others. Stay home until at least 24 hours after fever and symptoms subside without the use of fever-reducing medications.

What do I do if my child gets sick?
If the illness is relatively mild and your child doesn't have a chronic medical condition, you can treat the illness at home with rest, fluids and fever-reducing medications (Tylenol or Motrin).

If you feel that the symptoms are severe or worsening, or if your child has a chronic medical condition, visit your primary care physician or an urgent care center for evaluation. They can assess the situation, provide guidance on how to care for your child and evaluate if a prescription medication would be beneficial.

There are certain warning signs that need urgent medical attention. If your child experiences one of these symptoms, visit a doctor immediately.

Flu symptoms that improve but then return in a more severe state
Severe irritability (so much that the child doesn't want to be held or touched)
Not waking up or not interacting
Fast breathing or trouble breathing
Bluish or gray skin color
Refusal to drink fluids
Severe or persistent vomiting

If my child's doctor isn't available, where should I go?
As always, your child's regular doctor is his or her best line of defense. The doctor knows your child and his or her medical history, and that can be helpful when diagnosing and treating illness. However, emergency departments and urgent care centers are great alternatives, especially after hours or on the weekend.

In most instances, your child will be able to get the care he or she needs at an urgent care center. Urgent care centers are staffed with physicians and nurses who can care for most non-life-threatening illnesses and injuries. They are especially prepared during the winter months to treat flu-like symptoms. Urgent care centers offer night and weekend hours, and no appointments are necessary.

For serious or life-threatening illnesses, visit an emergency department. Open 24 hours a day, 365 days a year, emergency departments are equipped to handle traumatic illnesses and injuries. Presbyterian Children’s Emergency Department recently tripled in size, added new beds and redesigned the space to make it even more child friendly. Specially trained pediatric emergency medicine physicians, nurses and child life specialists put kids and their parents at ease. (And the bright murals, virtual aquarium and child-friendly décor don’t hurt, either!)

For a complete list of emergency departments and urgent care centers, visit www.presbyterian.org/carenow.

What’s new, improved and even more child-friendly at Presbyterian Children’s Emergency Department?

Mon, 31 Oct 2011 14:07:00 GMT

What’s new, improved and even more child-friendly at Presbyterian Children’s Emergency Department?

Back in 2003, Presbyterian opened the first children’s emergency department in the Charlotte area. Dedicated solely to children and their immediate health needs, Presbyterian Children’s Emergency Department recognized that children have different needs than adults and sought to provide care for them in a more child-friendly, comfortable environment.

Flash forward to 2011: Presbyterian Children’s Emergency Department recently grew to better serve the needs of children in the community. Tripling in size, the expanded facility added new beds and redesigned the space to make it even more child friendly.

Highlights of Presbyterian Children’s Emergency Department include:

- 14 private rooms, including two triage rooms and two critical care rooms

- Specially trained pediatric emergency medicine doctors and nurses

- Child-friendly décor, including brightly colored murals in every patient room, a virtual aquarium and under-the-sea theme

- Child life specialists dedicated to helping children cope with an emergency and minimizing psychological and emotional trauma

- Separate entrance and waiting room especially for children (and their parents)

- Direct access to Presbyterian Hemby Children’s Hospital (located one floor above) if needed

- Can treat children from birth to 17 with any illness or injury

- Open 24/7

For more information on Presbyterian Children’s Emergency Department, watch our video, call 704-316-KIDS (5437) or visit www.presbyterian.org/KidsEmergency.

Empowering Breast Cancer Patients & Survivors (PDF)

Mon, 10 Oct 2011 14:36:00 GMT

Click to download the PDF which includes:

- A Reminder about Screening

- Breast Cancer Clinical Trials

- Support for those with Metastatic Breast Cancer

- Partial Breast Irradiation: Another Treatment option for Breast Cancer

- Buddy Kemp Cancer Support Center

- Calendar of Upcoming Events...

Cancer navigators coach patients from diagnosis thru treatment

Mon, 10 Oct 2011 14:30:00 GMT

Nurse Mary Keefe has observed nearly every reaction to a cancer diagnosis; some patients break down in uncontrollable tears, others glaze over stoically and many experience a surreal shock. No matter the response, when the radiologist leaves the room after presenting the results, Keefe remains with the patient and their new diagnosis. She educates and answers questions for as long as the patient needs – usually between one and two hours during the initial visit – and then stays attentive and accessible throughout further tests, surgery, treatments and beyond.

Keefe has served as one of six cancer navigators at Charlotte’s Presbyterian Cancer Center since the program’s infancy more than five years ago. Cancer navigators act as patients’ anchors through the sometimes stormy cancer journey by serving as advocates, coordinators, supporters and experienced guides.

Within the next three months, Presbyterian Hospital Matthews and Presbyterian Hospital Huntersville will also offer on-site, personal cancer navigators.

“Our navigators at Matthews and Huntersville will be well-rounded medical experts who have a lot of experience with all types of cancer and cancer sites,” Keefe, a Matthews resident, said. “It’s nice for patients to have someone with medical knowledge that’s accessible, responsive and trying to make this difficult thing as easy as possible.”

In addition to thoroughly explaining the diagnosis and all possible treatment options, navigators can link patients to beneficial community resources, financial assistance and psychosocial support; they also expedite care, and offer patients a personal medical expert.

“Instead of getting a phone call to hear they have breast cancer and that they need to see a surgeon at an appointment in two weeks, we can explain it in person, answer questions, have an appointment with a surgeon pre-scheduled for within 48 hours, and give them a comprehensive book with specific selections to read in preparation for their appointments,” Keefe said. “We give very good information right at the time of diagnosis; it’s much better than looking for answers on the Internet.”

Once the diagnosis settles in, navigators cheer patients on with their understanding, familiar presence and constant support.

“We’re their coach. We’re preparing patients for each step; telling them what to expect, and encouraging them as they go,” Keefe said. “We’re there before and after surgery, we stop by if they’re having tests in the hospital, and we hear how appointments went. We’re there from the initial appointment and throughout treatment, and we remain in contact months after.” Call a cancer patient navigator: 704-384-5373. For more information on cancer services available at Presbyterian, visit www.presbyterian.org/cancer.

Ernestine Kuhr’s Story

Mon, 10 Oct 2011 14:29:00 GMT

Of the many positive traits Ernestine Kuhr’s family passed down to her, her genes were not one of them. This working mother of two boys, ages 18 and 21, knows all too well that sometimes what you don’t see is what you get. In high school her father had his first of three bypass surgeries. By the time Kuhr reached college, her mom was facing a breast cancer diagnosis. Add to the mix three grandparents who died of heart disease and one who died of cancer, and all of a sudden Kuhr had a very full medical history without ever really being sick herself.

It wasn’t until her own breast cancer diagnosis in 2000 that Kuhr took action on a suspicion that had been haunting her all along: was there a genetic link that put her at increased risk to develop cancer? She already knew that her Ashkenazi Jewish ancestry made the chance of hereditary cancer more likely, so she scheduled an appointment with a genetic counselor and proceeded with genetic testing.

Much to her dismay, the tests came back positive for not one but two gene mutations! BRCA1 and BRCA2 mutations can be found in women or men, and their presence puts carriers at significantly higher risk to develop breast, gynecologic or other cancers. With only 10 percent of cancers being hereditary, the fact that Kuhr possessed both high-risk mutations was an anomaly and a double whammy.

With her new knowledge in hand, Kuhr bravely faced her cancer treatment and took action to protect herself and her family from further ramifications of the disease. “I decided to get a hysterectomy to reduce my risk of getting ovarian cancer, and then I convinced my family to get tested as well,” she said. “Fortunately, my siblings’ tests came back negative.”

Five years later, Kuhr found herself in a familiar situation: facing a second breast cancer diagnosis, this time in the other breast. Once again, steadfast in her resolve to beat the disease, she elected to have a mastectomy, followed by chemo. This time she also enrolled in Presbyterian Cancer Rehabilitation & Wellness’ Strides to Strength, an individualized exercise class designed to combat treatment side effects and manage weight to improve recovery.

Kuhr thought she had released herself from cancer’s grip until she read an article in Presbyterian Cancer Center’s newsletter. There she learned about a new area of focus: cardio oncology. Recent studies had shown that survivors with certain types of cancer who either had chemo or radiation could be at increased risk to develop heart disease. It took no time for the light bulb to go off in Kuhr’s head; this two-time breast cancer survivor and daughter and granddaughter of heart disease patients knew she needed to get checked.

So Kuhr scheduled an appointment with Dr. William Ntim, a cardiologist with Mid-Carolina Cardiology and the lead physician with Presbyterian’s cardio-oncology program. Tests showed that her heart function was decent, but her calcium score came back less promising. “Dr. Ntim said there was no mistaking that I was my father’s daughter, and now I’m on medication to get my (cholesterol and blood pressure) numbers back down to healthy levels,” Kuhr said.

While an outsider may look at carrying the weight of two serious family health histories to be tiring, Kuhr sees things in a different light. “I truly believe that knowledge is power,” she remarked. “I’m content in knowing that I’ve done everything I can to protect myself from my own family history.”

To learn more about learn more about the genetics, rehab and cardio-oncology programs Kuhr used in her recovery, visit www.presbyterian.org/cancer.

Cancer Support Times Two

Wed, 07 Sep 2011 02:47:00 GMT

A diagnosis of prostate cancer can be a shock to the man who is receiving the diagnosis. In many cases, there is a wife who is also experiencing the same shock and disbelief. As one begins the journey through diagnosis and treatment,

where do you and your spouse go to find support?

I spoke with Mati, whose husband was diagnosed and treated for prostate cancer in 2007 at Presbyterian Hospital. Mati said she was in disbelief when she heard the news from her husband. She mentioned that she and her husband had attended different support groups in the past, and therefore knew this was what they would need for this hurdle in their lives.

They soon found what they were looking for at Buddy Kemp Cancer Support Center – a prostate cancer support group. The Us TOO website, www.ustoo.com, which is dedicated to providing information and support to prostate cancer survivors and their families, proved to be a great resource for leading them to Buddy Kemp.

When asked about how the support group has benefited her, Mati mentioned how helpful it is to know there are other people in the same situation. She also enjoys the opportunities the group has to learn about prostate cancer thanks to the many special expert speakers that attend.

With a prostate or any cancer diagnosis, it is important for caregivers to recognize their need for support, too. If you are watching a loved one experience cancer, know there are resources available for you. Sometimes attending a support group with your loved one is helpful; other times individual counseling may bring you the most comfort. Whatever

your needs, the experts at Buddy Kemp Cancer Support Center can help you navigate a cancer diagnosis for you or your loved one.

The prostate cancer support group meets at Buddy Kemp Cancer Support Center on the second Monday of each month at 7 p.m.

For more information about other cancer support groups or support services at Presbyterian, call 704-384-5223.

Prostate Cancer Treatment and Your Heart: New Opportunities for Risk Assessment

Wed, 07 Sep 2011 02:46:00 GMT

The thirst for information about heart complications associated with cancer treatment has expanded into many specialties, from the basic scientist to the clinician and social scientist, and even social media. Since my first article on this subject in last year’s newsletter, there has been continued synergy between these disciplines to bridge the laboratory bench and the bedside of the cancer patient.

Presbyterian Cancer Center and Presbyterian Cardiovascular Institute are pleased to have been co-workers on this noble journey, launching the first cardio-oncology program in the Greater Charlotte area in October 2010. Recent milestones include the successful launch of a survivor education series and collaborations with leading cardio-oncology programs across the country. One of several research trials currently under consideration is the use of statins to reduce the risk of cancer treatment associated heart injury

Additionally, I had the opportunity to participate in the first International Conference on Cancer and the Heart by M.D. Anderson in Houston, TX, last fall. Being a part of such a monumental conference reinforced my passion for working with the cancer patient population to reduce their risk of heart disease. Last but not least, our cardio-oncology program was one of the areas highlighted during last fall’s airing of “Think Pink” on the local CBS station.

Despite these noteworthy achievements, there still remain many challenges when it comes to heart risk and cancer treatment. In October 2010 the Food and Drug Administration (FDA) notified manufacturers to add safety information on the “increased risk of diabetes and certain cardiovascular diseases” associated with gonadotropin-releasing (GnRH) agonists, a form of prostate cancer treatment. Several key medical organizations supported this stronger messaging as well.

GnRH agonists, also known as androgen deprivation therapy (ADT), are often an essential part of treatment of metastatic and high risk prostate cancer. Examples of GnRH agonists include leuprolide, goserelin, and triptorelin.

The FDA release has raised some questions. What are the cardiovascular side effects of GnRH? Are there recommendations for screening or cardiovascular risk assessment?

GnRH agonists have been shown in clinical trials to increase body weight, decrease the body’s sensitivity to insulin and cause abnormalities in cholesterol components. These abnormalities usually become evident within three months of treatment. In one particular study, GnRH agonists reduced the body’s insulin sensitivity by 13 percent, which in turn increases the risk of developing diabetes.

Have increased cardiovascular side effects of GnRH agonists translated into major cardiovascular episodes? Some population-based studies have suggested that GnRH agonists may cause up to a 20 percent increased risk of experiencing coronary artery disease, heart attacks and life-threatening heart rhythm abnormalities over five-year follow-up period. It is important to note, however, that other studies have not confirmed this association between cardiovascular episodes and GnRH agonists. Despite these diverging observations, a joint advisory panel still finds there is enough evidence to address the risk.

This panel recommends assessing blood pressure, lipid profile, and glucose level in patients receiving ADT/GnRH agonist for prostate cancer. Physicians should provide a follow-up assessment three to six months after prostate cancer treatment begins. Of course, prostatecancer treatment decisions should appropriately be made by the patient’s physician.

Prostate cancer treatment has propelled into a new era of policy change and potential progress in heart disease risk reduction. The good news is there is increasing knowledge and awareness of what to do to prevent, monitor and treat symptoms. If you’re a prostate cancer patient and you’re concerned about your risk, talk to your physician or call 704-347-2067 to schedule an appointment with a cardiologist.

William O. Ntim, MD, FACC, FACP:

Dr. Ntim is a non-invasive cardiologist with

Mid Carolina Cardiology in Charlotte and is the

lead cardiologist in Presbyterian’s Cardio-oncology

program. He has a personal passion to improve

the lives of cancer survivors through

improved cardiac health.

Prostate Cancer – Many Options for Treatment, Many Experts for Care

Wed, 07 Sep 2011 02:45:00 GMT

Did you know that, next to skin cancer, prostate cancer is the most common cancer in men? And of the more than 200,000 diagnoses each year, approximately 70 percent are found in men over the age of 65.

Perhaps one of the least commonly known facts about prostate cancer is that there are so many treatment options that the choices can become overwhelming. At Presbyterian Cancer Center we commit ourselves to providing specialized support and guidance for the prostate cancer patient and their family, beginning at diagnosis and continuing throughout treatment. Such support can be found through nurse navigation, physical therapy, individual and family counseling, nutrition services and second opinion clinics, just to name a few.

In honor of Prostate Cancer Awareness Month, I’d like to share Mr. Pickler’s story to illustrate how the cancer center can meet the comprehensive needs of anyone undergoing treatment for prostate cancer.

Mr. Pickler and I became acquainted in Presbyterian’s outpatient oncology unit one afternoon in November 2010. I introduced myself as the urologic nurse navigator, and we began to discuss his recent and his resulting side effect of urinary incontinence. He explained to me that his surgery was uneventful – he came through things just fine – but the side effects had left him seeking help. After assuring him that urinary incontinence was a very normal side effect of treatment and conferring with Mr. Pickler’s medical team, I offered a solution for symptom management: rehab.

Barbara Green is a physical therapist with Presbyterian Rehabilitation who offers. specialized pelvic floor rehab for those suffering from postoperative incontinence.

Once Mr. Pickler was connected to Barbara his life turned around very quickly. To quote Mr. Pickler, “Barbara is like a terrific coach. She teaches you all the right moves, but it is up to you to show up and do the hard work.”

After undergoing pelvic floor rehab therapy for several weeks, Mr. Pickler started to notice some very powerful results. His incontinence issues started to resolve, and to date he is enjoying life to its fullest!

As you can see, having a team of dedicated cancer professionals at your fingertips can make all the difference in your recovery, whether in the hospital or at home.

The Buddy Kemp Cancer Support Center offers many programs and services for the prostate cancer survivor and his family. We have a monthly support group that meets on the second Monday of the month from 7-8:30 pm.

Gynecologic Surgery: Now With a Quicker Recovery Time

Fri, 01 Jul 2011 14:13:00 GMT

Minimally invasive surgery is a medical term that in simple terms means a surgery with smaller incisions, resulting in a quicker recovery. In the best case scenario, what previously may have required a large abdominal incision and a six-week recovery may now be several very small incisions and recovery time of two to three weeks, with hospital stays of only two to three days. For gynecologic needs, minimally invasive surgery includes vaginal hysterectomy, laparoscopy and da Vinci robotic-assisted procedures.

Once your doctor decides that you need surgery, he or she will draw on experience, knowledge and your unique health situation to determine the best surgical procedure for you. Several factors are considered: your diagnosis, overall health, what the surgery should accomplish and the most practical approach to treatment. If minimally invasive surgery is an appropriate option, your doctor will explain and discuss it with you.

In addition to the quicker recovery time and shorter hospital stays, one of the main advantages of minimally invasive surgery is small incisions that allow the surgeon to bypass the abdominal muscle. Because this muscle is used in so many routine body movements (standing, sitting, walking) the separation or cutting of this muscle is a primary source of pain following abdominal surgery. In addition, the skin incision itself is generally very tender, as your skin is filled with nerve endings. Other benefits to a minimally invasive approach include: minimal blood loss, less scarring and fewer complications, including a reduced risk of infection.

The introduction of laparoscopes, slim tubes with an attached camera that projects the image on a screen, and instruments for cutting, suctioning and suturing expanded the range of those eligible for vaginal hysterectomies and other minimally invasive gynecologic surgeries. This method became the surgery of choice for tubal ligations, endometriosis removal and many gynecologic procedures that had previously been done though a larger incision. When laparoscopic surgery is performed, the surgeon stands at the operating table and maneuvers the instruments through the small incisions. Many procedures can safely and effectively be performed with the laparoscope.

At times, the laparoscope has range-of-motion limitations, making laparoscopic surgery too technically challenging to guarantee success. Recently, the option of minimally invasive surgery using the da Vinci robot has helped overcome this limitation. Using the da Vinci robot, the primary surgeon can sit at a console and use the controls to move the instruments. The instruments can swivel 360º, just like the human wrist. There is another surgeon sitting beside the patient in case an emergency arises. The da Vinci robot expands the range and scope of surgeries appropriate for a minimally invasive approach.

New techniques and tools will continue to develop, and minimally invasive surgery options will continue to expand. If you think you have a condition that can be treated with a minimally invasive surgical procedure, discuss your options with your physician. If you need an Ob-gyn, Presbyterian has many who are trained in minimally invasive surgery, including the da Vinci robot.

Learn more about minimally invasive gynecologic surgery

Urinary Incontinence: More Common Than You Think

Fri, 01 Jul 2011 14:11:00 GMT

Urinary incontinence is a bladder control condition that results in the involuntary release of urine. While it is quite common, women are embarrassed to talk about it, even though it affects up to 50 percent of women. Because of embarrassment and misunderstanding of the condition, less than 50 percent of those who suffer from incontinence will seek treatment. Many believe incontinence is a normal part of aging, that treatments will not help or that their problem is not severe enough to warrant treatment. That's simply not the case. Of those who seek treatment, 80 to 90 percent experience significant improvement and a better quality of life.

Risk Factors
There are many risk factors and causes for the development of urinary incontinence. While sometimes there may be no identifiable cause for urinary incontinence, many cases can be attributed to one or more of the following:

Pregnancy and vaginal deliveries
Prior pelvic surgery (hysterectomy, for example)
Certain occupations (those involving heavy lifting or exertion)
Chronic constipation, which causes excessive bearing down
Lung disease (asthma, emphysema) where pressure from breathing or coughing cause increased pelvic pressure
Neurological diseases where there is a loss of control of bladder muscles and nerves (Multiple Sclerosis, spinal cord injuries)
Medications (diuretics)
Lifestyle (obesity and exercise)
Diet (caffeine and certain foods)
Bladder disease (stones, cancer and infections)

Types of Incontinence
Bladder control issues range from the intense urge to urinate to the loss of a few drops of urine to the most extreme "flooding" incontinence. Types of urinary incontinence include:

Stress incontinence: This occurs when urine is lost with physical exertion. Most frequently patients lose urine with exercise, coughing, sneezing, laughing or lifting something heavy. Stress incontinence is also the result of physical changes caused by pregnancy, childbirth and menopause. When stress incontinence affects men, it is usually as a result of prostate surgery.
Overactive bladder: Symptoms of overactive bladder include increased urinary frequency, getting up multiple times a night to urinate and the sudden urge to urinate. Some also experience the loss of urine following an urge to urinate. Overactive bladder can be caused by neurological diseases, dietary intake, infections and undetermined causes.
Mixed incontinence: Patients who suffer from stress incontinence and overactive bladder.
Functional incontinence: This often affects people who are physically disabled (they are unable to get to the bathroom in time) or mentally disabled (they do not remember or know to go to the bathroom).

Treatment Options
When choosing a treatment option, all medical conditions affecting the pelvic floor including pelvic prolapse, urinary or fecal incontinence should be addressed. Often these conditions coexist and can be treated simultaneously.

Behavioral therapy: This is the least invasive and most rapidly achievable treatment option. The most basic is the Kegel exercise, which consists of contracting and relaxing the pelvic floor muscles. It can be enhanced with the addition of vaginal weights or a trip to a physical therapist specializing in pelvic floor disorders. For those with an overactive bladder, the addition of dietary restrictions is also recommended (avoiding certain foods and caffeine).
Medications: There are several medications that exist for patients with an overactive bladder. You may have seen advertisements for some of them on television. Two popular ones are Vesicare and Detrol.
Surgery: These minimally invasive surgery options are the mainstay therapy for patients who haven't had complete success with other treatments. A quick office procedure involves tightening the urethral muscle with no recovery time needed. Another simple outpatient surgery is called a tension-free vaginal sling. This procedure has revolutionized incontinence treatment, with success rates higher than 90 percent. There are also other surgery options available, including Botox injections to relieve bladder muscle spasms and InterStim therapy that targets communication problems between the brain and the bladder control nerves.

If you struggle with incontinence, watch our video to learn more about the specialty care offered at Presbyterian Urogynecology.