SPRING 2005

Canine comfortPage 6

What is a good death?Page 4

B A P T I S T H E A L T H S O U T H F L O R I D A

A new option for painful knees Page 8

Heart valves fixed with less pain Page 12

Until a few years ago, treating uter-ine fibroids meant one thing: sur-gery. Whether a woman chose to

have a hysterectomy (surgical removalof the uterus) or myomectomy (surgicalremoval of the fibroids, leaving theuterus in place), there was no real alter-native to these invasive procedures.

But another treatment option thateliminates the need for surgery — uter-ine fibroid embolization (UFE) — got alot of news media attention last fall whenCondoleezza Rice, now secretary ofstate, had the procedure. Like mostwomen who have UFE, Ms. Rice wasback to work in a few days.

“A fibroid is a benign [noncancerous]growth in the muscular wall of theuterus,” said James F. Benenati, M.D.,interventional radiologist at Baptist Car-diac & Vascular Institute. He’s beendoing fibroid embolizations since 1999and has treated several hundred women.

Embolization is used to treat fibroidsin premenopausal women. After meno-

pause, fibroids tend to shrink on theirown. Women who have fibroids oftenexperience heavy, lengthy menstrualbleeding, abdominal pain and bloating.There may be a feeling of pressure in thebowel or a constant need to urinate.

Using X-ray images, the doctorthreads a catheter through blood vesselsleading to the fibroid to place particles ofplastic or gelatin the size of a grain ofsand.

“These particles cut the blood sup-ply to the fibroids, causing them toshrink,” Dr. Benenati explained.

The procedure, which is done byinterventional radiologists, takes about45 minutes. Instead of general anesthe-sia required in some surgery, UFE useslocal anesthesia, and patients only stay inthe hospital overnight. Most women canresume their normal activities in about aweek, and symptoms are reduced signif-icantly within three months.

“About 70 percent of women withfibroid problems are candidates for UFE.Of those, the procedure is 90 percenteffective in alleviating symptoms,” saidJulio Baquero, M.D., medical director ofinterventional radiology at South MiamiHospital.

Josie de Varona-Kuntz had UFE at

On the cover: Alec Morera, 4, is greeted by Cassie, a Yorkshire terrier, at Baptist Children’s Hospital. See story on page 6.

Baptist Health South Florida Chairman of the Board, George Cadman III; President, Brian Keeley. Trustees:Calvin Babcock, Wendell Beard, H. Robert Berry Sr., James Carr, the Rev. William Chambers III, the Rev. DavidCleeland, George Corrigan, William Dickinson, Judge Robert Dubé, Herbert Greene, M.D., George Harth, JayHershoff, Charles Hood III, Norman Kenyon, M.D., the Rev. Richard Ledgister, the Rev. Wilner Maxy, Paul May,Arva Parks McCabe, the Rev. Dr. Marcos Ramos, Robert Singleton, Roberta Stokes, W. Peter Temling, the Rev.Tom Thompson, Scott Weston, the Rev. Dr. William White.

Baptist Hospital of Miami Chairman of the Board, Calvin Babcock; President, Baptist Hospital Medical Staff,Sergio González-Arias, M.D.; Chief Executive Officer, Lee Huntley.

South Miami Hospital Chairman of the Board, Judge Robert Dubé; President, South Miami Hospital MedicalStaff, George Tershakovec, M.D.; Chief Executive Officer, D. Wayne Brackin.

Homestead Hospital Chairman of the Board, the Rev. William Chambers III; Chief of Staff, J. Rudolph GossmanJr., DMD; Chief Executive Officer, Bo Boulenger.

Mariners Hospital Chairman of the Board, Jay Hershoff; Chief of Staff, Sanford Yankow, M.D.; Chief ExecutiveOfficer, Robert Luse.

Baptist HealthSouth Florida

6855 Red Road, Suite 600Coral Gables, FL 33143-3632

Doctors Hospital Chairman of the Board, Norman Kenyon, M.D.; President, Doctors Hospital Medical Staff, JohnZvijac, M.D.; Chief Executive Officer, Lincoln Mendez.

Baptist Health South Florida Foundation Chairman of the Board, James Carr; Chief Executive Officer, Robert Baal.

Baptist Outpatient Services Chairman of the Board, George Cadman III; Chief Executive Officer, Patricia Rosello.

Directors of Affiliated Boards Richard Alger, Cira Almeida, Tony Alonso, Dick Anderson, George Aronoff, OrlandoBajos, Oscar Barbara, James Barker, Yerby Barker, Rodney Barreto, Jill Beach, James Boilini, O.D., James Bokor,Joseph Bolton, James Boruszak, Robert Breier, Oscar Bustillo Jr., Barbara Calev, A. Ruben Caride, M.D., ThomasCarlos, Willie Carpenter, Gerald Case, John Cassel, M.D., Mauricio Cayon, Carol Cianciolo, Richard Dailey, Xavierde Amezola, Denise Ehrich, Allan Feingold, M.D., Susan Gallagher, Mehdi Ghomeshi, Robert Gintel, Paul Gluck,M.D., K. Lawrence Gragg, Michael Graham, M.D., Curtis Gray, David Hallstrand, M.D., Barry Halpern, M.D., KentHamill, Barbara Hanck, Dan Hanrahan, Carl Hanson, James Harris, Steven Hayworth, Sara Herald, ElizabethHernandez, Agustin Herran, Gerald Hirsch, Nathan Hirsch, M.D., Jacque Huttoe, David Johnson, S. Lawrence KahnIII, George Knox, Rudy Kranys, Manuel Lasaga, Cynthia Leesfield, Orlando Leon, M.D., James Loewenherz, M.D.,Miriam Lopez, Bruce MacArthur, Luis Machado, Michael Marcus, Stanley Margulies, M.D., Charlie Martinez, HansMueller, Thomas Murphy Jr., Louise Orzel, Ramon Oyarzun, Omar Pasalodos, M.D., Gordon Present, AlfredoQuintero, Ramón Rasco, Charlen Regan, Ian Reiss, M.D., Mindy Rich, Ron Robison, Domingo Rodriguez, RuthRosenberg, Audrey Ross, Jeff Rubin, James Russell, Steven Sapp, I.E. Schilling, Emery Sheer, Ronald Shuffield,Paul Soulé, Karl Smiley, M.D., Henry Tie Shue, Bill Tillett, Barbara Towner, Joseph Traina, M.D., Wanda Trouba,Frederick Vihlen, M.D., Morton Weiner, Stuart Weiss, Lisa White, Philip Wolman, Leonard Zwerling, M.D

Women&Health

Silent killer no longer so silent

Treatment shrinks uterine fibroids without

What used to be called a silent killer — ovarian can-cer — now has three warning signals that, ifheeded early enough, could save lives.

The signs are a swollen abdomen, a bloated feeling andurgent urination. If these symptoms are persistent and severeand they began recently, they could be signaling ovarian can-cer, according to a study in the Journal of the American MedicalAssociation.

“We’ve always thought that ovarian cancer is such a killerbecause symptoms didn’t appear until the disease was

advanced and the chance of a cure was poor,” said ManuelPenalver, M.D., a gynecological oncologist at Doctors Hospital.“These three symptoms may help women get treatment earlier,when we have a better chance of saving their lives.”

About 26,000 women will be diagnosed with ovarian cancerthis year, according to the American Cancer Society. If thecancer is caught at an early stage, the five-year survival rate is70-90 percent, compared to 20-30 percent for advanced stagedisease.

— Anne Streeter

Josie de Varona-Kuntz said, “Within aweek, I was fine.”

The good news is that about half of the 50,000 women diagnosed every yearwith a certain type of breast cancer may not need to have chemotherapy. Anew genetic test predicts who is at high, medium or low risk of having their

breast cancer return. Those who have a higher risk for a recurrence benefit the mostfrom chemotherapy, a recent research study found. Those with a low risk benefit the least.

“When the risk of a relapse is low, it has been harder to choose which patientswill not get chemotherapy,” said Grace Wang, M.D., cancer specialist at Baptist-SouthMiami Regional Cancer Program. “Chemotherapy has side effects and risks, andthough those risks are more manageable today with new medicines, there is still arisk. We are using this test to help make those difficult decisions about who doesn’tneed chemotherapy.”

The results of the new research are based on women diagnosed with the kind ofearly-stage breast cancer that is stimulated by estrogen, and who have no signs of thedisease spreading to the lymph nodes. The women in the study were taking the can-cer drug tamoxifen, which blocks the effects of estrogen on breast cancer cells.About half of all women diagnosed in the United States have this type of cancer;chemotherapy is now recommended for most of them.

Researchers first developed a recurrence score based on the test that looks atthe presence of 21 cancer-related genes in breast cancer tissue samples. Low-riskgroups have a score of 18 or lower; medium-risk patients have a score of 19-30; andthose with a score of 31 or higher are at high risk for a recurrence of their cancer.

Researchers then looked at 668 women to see if the test’s ability to predict recur-rence of the cancer could also help predict which women would benefit fromchemotherapy. The latest study showed that chemotherapy helped high-risk women,with women at low risk less likely to benefit from chemotherapy.

The test, performed only by one company, costs $3,460, and insurance may not pay for it. For more information, call the Cancer Resource Service at 786-596-2340.

— Anne Streeter

R E S O U R C E 3

Treat yourself (or someone you love) to a massage at South Miami Hospital.Licensed massage therapists from the Behavioral and Collaborative MedicineProgram are available by appointment for full-body Swedish massage orspecialty massage, including craniosacral, neuromuscular, reflexology andpregnancy massage. The cost is $70 for an hour; $40 for 30 minutes. Call 786-662-8106.

Women&HealthTest tells who needschemotherapy

surgeryage 40. “I had been having terrible prob-lems with uterine fibroids. My gynecol-ogist told me that my only solution washysterectomy. I wasn’t comfortable withthat, so I did some research and con-tacted Dr. Benenati. I didn’t want drasticsurgery. I’d had a cesarean section yearsbefore, and I knew how painful anddebilitating abdominal surgery was.

“The embolization alleviated the painI’d been experiencing. The recoverywasn’t bad at all,” she said. “Within aweek I was fine.”

The risk of complications associ-ated with UFE is very low. Fewerthan 2 percent of women who

have the procedure experience earlymenopause as a result. There also is aminimal risk of infection. Though it maybe possible for a woman who has hadUFE to get pregnant, UFE is not recom-mended for those who want to conceive.

“Women should first see a gynecol-ogist before considering having the pro-cedure,” Dr. Baquero said. “If the gyne-cologist does not suggest talking to aninterventional radiologist about UFE asan option, ask about it.” UFE is generallycovered by insurance.

— Tom Neile(For referral to a physician who does

uterine fibroid embolization, call BaptistHealth’s Physician Referral Service at 786-596-6557, toll-free at 800-228-6557.)

Find out moreLearn more about uterine

fibroid embolization at either ofthese free programs:

(In Spanish) – Julio Baquero,M.D., Wednesday, April 20, 7-8p.m., South Miami HospitalAuditorium, U.S. 1 and SW 62Ave. Call 786-596-3814.

(In English) – Alex Powell,M.D., Tuesday, May 3, 7-8 p.m.,Women’s Health Resource Cen-ter at Baptist Medical Arts Build-ing, 8950 North Kendall Drive.Call 786-596-3812.

Stressed? Enjoy Some Pressure.

4 R E S O U R C E

Traditionally, Western med-icine has focused on get-ting people well. Once-common diseases havebeen eradicated, chronicdiseases are controlled

and life expectancies have never beenhigher. But we all still will die. And thatinevitability is more often denied thanembraced.

As a result, healthcare promoters areacknowledging the need to improve careat the end of life, and help patients “diewell.”

“We have a commitment at the top ofthe Baptist Health organization toadvance the care of people at end of life,”said Pat Collins, R.N., a South MiamiHospital nurse specializing in pain man-agement and cancer care.

Freddie Williams knows how impor-tant such care can be. Her sister, Cather-ine Johnson, was just 53 when she diedof cancer in 2003. Ms. Williams’ eyesbrim with tears at the memory, but ithelps to know she was able to get hersister home, where she longed to be,before she died. Ms. Johnson had beenin a nursing home, where her pain wasnot controlled as well as it was when shewent home with special end-of-life carecalled hospice.

“She kept saying, ‘I want to go home.’And at home, she started sleeping betterand resting more,” Ms. Williamsrecalled. “In a few days, she just slippedaway, pain free. That’s what she was wait-ing for, to get home.”

Surveys show that 90 percent ofAmericans would prefer to die at home.While Ms. Johnson’s desire was notunusual, the fact that it was carried outwas. In reality, only 20 percent of termi-nally ill patients die at home, accordingto a recent medical school study. Themajority, 60 percent, die in the hospital.

T o raise awareness about end-of-life issues, the Baptist HealthBioethics Committee has spon-

sored a course, “What Is a GoodDeath?,” for doctors, nurses, chaplains,social workers and others.

To enable “a good death,” patients,families and caregivers must overcomecultural taboos that inhibit candid dis-cussions about death, said Raul deVelasco, M.D., chair of Baptist Health’sBioethics Committee.

“Not only physicians but society ingeneral sees death as failure,” Dr. deVelasco said. “We are taught as physi-cians to do what we can to keep peoplealive. But sometimes continuing treat-ment is not the best option for thepatient.”

In the good death course, caregiverslearn about the range of needs thatdying patients have — from pain controlto spiritual concerns, from place of deathto type of treatment.

“It’s our responsibility to let othersknow how we want to die,” said KennethGoodman, a University of Miami med-ical ethicist.

Baptist Health hospitals accommo-date hospice care, a choice forpatients expected to live less than

six months. Hospice focuses on creatingthe highest quality of life. Treatment isaimed at relieving symptoms, not pro-longing life.

“Patients can die almost whereverthey choose — in their own bed or in aninstitution,” said Barry Kinzbrunner,M.D., medical director of VITAS hos-pice. “Most pain can be controlled withmedicine. But total pain is not only phys-ical. Fear of dying, psychosocial and spir-itual things — they all contribute to thepatient’s perception of pain.”

What is a good death?

“In a few days, she just slippedaway, pain free.That’s what she was waiting for,

to get home.”

Freddie Williams holds a photo of hersister, Catherine Johnson, who died in2003.

When possible, keeping the patientalert enough to communicate is crucial.Some patients long to give or requestforgiveness, or express love. Many wantto remain useful. Others may have sim-ple but meaningful requests.

Hospitals try to make specialarrangements for patients in theirfinal days. “Sometimes, patients

want to see their pet,” said Cindy Bowl-ing, R.N., nurse manager for Baptist Hos-pital’s cancer unit.

Last year, a dying patient received hiscollege degree in a one-man graduationceremony at Baptist Hospital.

Baptist Hospital Chaplain RenatoSantos said there’s a natural inclinationto seek spirituality at the end of life.Often it’s a messy process emotionally,with stages of anger, sadness and confu-sion. Sometimes that leads to peaceful acceptance.

“There is such a thing as a gooddeath,” Chaplain Santos said. “It’s atremendous time for reconciliation. People bridge gaps and grow and it’s a beautiful thing to see. It’s a sacred experience.”

Baptist Health’s pastoral care pro-gram offers counseling to any patientand family of any faith — or no faith at all. “We don’t push religion,” ChaplainSantos said. “We’re a companion along the journey, a sort of spiritual midwife.”

Jane McMillen is all too familiar withdeath. Her first husband, RaySoutherland, and their three sons

all died of cancer. Ms. McMillen saidasking doctors direct questions and get-ting direct answers helped her familytake advantage of the time that was left.

“I told Ray, ‘I am so sorry for any-thing I said or did that hurt you, and Ilove you very much.’ He said to me,‘You’re the best wife a man could everask for.’ It was a tremendous help tohave had those conversations.”

— Patty Shillington

R E S O U R C E 5

Jane McMillen recommends asking directquestions.

Maybe you’d like to die in yoursleep, utterly unaware. Or dropon the golf course, still doing

what you love at a ripe old age. Maybeyou’d prefer a little notice to tie up looseends.

In reality, millions of Americans willdie from chronic disease.

Here are some ways to improve yourchances of having the care you want atthe end of your life:

� Fill out an advance directive, alegal plan that sets forth your wish-es if you become too sick to speakfor yourself. Signing a living will andchoosing a health surrogate tocarry out your wishes are two waysto express desires about end-of-lifecare — whether you would want tobe put on a breathing machine, forexample. Yet only 19 percent ofAmericans have living wills, accord-ing to a University of Michiganreport. People without such a plansometimes receive care they don’t

want, care that can induce and pro-long suffering. Hospitals arerequired to ask patients if they wantto complete an advance directive.Baptist Health has created an edu-cational brochure on the topic thatincludes an advance directive form.(Check the box on the reader sur-vey card to receive the form inEnglish or Spanish, or go towww.baptisthealth.net and click onthis article.)

� Discuss your philosophy of end-of-life care with your doctors andask your family and friends abouttheir preferences.

� If you or someone you love isdiagnosed with a terminal illness,ask direct questions about treat-ments, side effects and otheroptions. If you’re the patient, ask aloved one to talk to the doctors withyou and take notes. Remember thatthe patient is in control.

� Insist on good pain manage-ment — whether for yourself or aloved one. Staying comfortable andhaving the highest quality of lifeare more important than concernsabout drug dependency. If you’retaking a drug that has uncomfort-able side effects and does notimprove the quality of your life, feelfree to drop it. “We tend to throwpills at all problems and we find ifwe throw away half the pills thepatient feels a lot better,” saidBarry Kinzbrunner, M.D., medicaldirector of VITAS hospice.

� Live fully. Those most unable tofind peace when they’re dying oftenhave regrets about the way theylived, psychologists say. Spend amoment pretending you had onlyweeks or months to live. What haveyou not done that you wished youhad? Now would be a good time torearrange your priorities.

Doing It Your Way

With childhood obesity ratesmore than doubling in thelast 15 years, three organiza-

tions — Baptist Health, MemorialHealthcare System in Broward Countyand The Pharmed Group — are joiningforces to help children become fit andhealthy.

The bilingual program will offer edu-cation in nutrition, exerciseand disease prevention bynurses, dietitians and exer-cise experts.

“Childhood obesity is atepidemic levels. Type 2 dia-betes, which used to be strictlyan adult disease, is being diag-nosed in more and more children,”said Adriana Castro, M.D., chief ofpediatrics at Baptist Children’s Hos-pital. “Many children have high cho-lesterol and high blood pressure, which

can lead to heart attack and stroke.”The three organizations spear-

heading the program hopethat other companieswill join the cam-paign. “Childhoodobesity is a commu-nity problem,” saidBrian Keeley, presi-

dent and CEO of Baptist Health. “We’llbe building on what Baptist Children’sHospital already has in place — terrificparenting programs, exercise classesspecifically for overweight kids, evenexercise classes for kids and parentstogether. With the help of other organi-zations, we’ll be able to do even more.”

Carlos and Jorge de Céspedes, broth-ers and founders of The Pharmed

Group, a large distributor of medicalsupplies, recognize that weight prob-

lems are even more preva-lent in Hispanic children.According to the FloridaDepartment of Health, 17

percent of Hispanic chil-dren are overweight.

Alec Morera, 4, (pictured below) plays with Cassie theYorkshire terrier during his monthly appointment withcancer specialist Doured Daghistani, M.D., at Baptist

Children’s Hospital.Aside from his little furry friend, Alec has good reason to

be playful and happy. He’s doing very well two years after abone marrow transplant to treat his immune deficiency dis-ease, called Wiskott-Aldrich Syndrome.

“He is considered cured,” said Dr. Daghistani, affection-ately known as Dr. D.

A rare inherited disorder, the syndrome affects only boys,leaving them prone to deadly infections and lymphoma. “Alecwas always sick, every week in the hospital,” said MildreyMorera, Alec’s mother.

After Alec was diagnosed at age 11⁄2, the Morera family held

blood drives to try to find a bone marrow donor for Alec. “It tookjust six months to find a donor and it usually takes years,” Ms.Morera said. “This 50-year-old woman was a perfect match.”

Alec is slowly being weaned off his post-transplant med-ications and is expected to live a full and normal life. “Alec isdoing awesome,” Ms. Morera said. “And Dr. D is the best. Allthe kids love him.”

And all the kids love Cassie. Once a week, pet therapy vol-unteer Judy Wilson brings her 2 1⁄2-pound Yorkie to cheer upchildren receiving cancer treatments from Dr. Daghistani. Ms.Wilson became interested in volunteering with kids copingwith cancer after she supported her best friend through treat-ment for leukemia.

“I know what these kids are going through,” Ms. Wilsonsaid, “and I wanted to help.”

6 R E S O U R C E

A smooch for a pooch

Anti-obesity campaign aims for hea

Alexandra Uchdorf, 8, works up asweat on the elliptical machineduring a Kid F.I.T. workout.(More information, next page.)

“In honor of Pharmed’s 25th anniver-sary, we wanted to do something thatwould be meaningful and give back tothe South Florida community,” saidJorge de Céspedes, president. “Once westarted talking, childhood obesity stoodout as an issue that needed greater atten-tion and education.”

As the campaign kicks off, BaptistChildren’s Hospital is offering severalclasses and events aimed at overweightkids and their parents, including:

✓Five Steps to Healthy EatingHabits: March 31, 7-9 p.m. $5. (See cal-endar at right for details.)✓Pleasing Picky Eaters: April 12, 7-8 p.m., with dietitian Rosa Alonso Leonat Baptist Medical Plaza at Doral, 9915NW 41 St. Free. Call 786-596-3812.✓Family Fun and Fitness ExerciseClass: Ongoing exercise classes onMondays and Wednesdays from 3:30-4:30 p.m. at Baptist Health ResourceCenter at Informed Families, 2490 Coral Way. For information, call 786-596-5981.✓Young People’s Overeaters Anony-mous Support Group: South MiamiHospital, every Sunday from 7-9 p.m.Free. For information, call 786-596-2930.✓F.I.T. (Fitness Into Tomorrow):Exercise classes that incorporate nutri-tion education at Baptist Health Club.Separate programs for younger childrenand teens. Call 786-596-2424 forinformation and fees.✓Diabetes programs: A variety of sup-port groups and risk reduction programs for kids who already have diabetes or are at risk. Call 786-596-8747.

— Adrienne Sylver

R E S O U R C E 7

Join the parenting experts at BaptistChildren’s Hospital for enlighteningconversation and practical advice. Eachprogram is held in the auditorium atBaptist Hospital and costs $5. You mustreserve your space by calling 786-596-3812.

Five Steps to Healthy Eating Habits

Thursday, March 31, 7-9 p.m.Do you think your child’s eating

habits could be better? Most parents do.Whether your child’s over-weight or underweight (orneither, but lives on junkfood), registered dietitianAngie Placeres can help.She’ll talk about how toinvolve children in fooddecisions, the latestfood pyramid recommenda-tions and ways to get your kids to trynew foods. For parents of children ages5 to 12.

What Every Parent Should Know AboutPsychological Testing

Thursday, April 28, 7-9 p.m.James may be gifted, Samantha’s a

behavior problem at school. Psychologi-cal testing is often recommended forchildren to diagnose learning disabili-ties, attention deficit problems, gifted-ness and more. Join psychologist EllenStrot, Ph.D., who will help you navigatethe maze of the many tests that exist,including their purpose and what they’lltell you about your child. For parents ofschool-age children.

Time and StressManagement for BusyParents

Thursday, May 26, 7-9 p.m.No time for yourself? Join the busy

parents club. Juggling kids, a spouse,an outside job and/or volunteer workcan take its toll. Discover how you canfind a few minutes for yourself andexplore new ways to relax and de-stress. Psychologist Roslyn Pass, Ph.D.,will give you a new outlook on manag-ing your life. For all parents.

BAPTIST CHILDREN’S HOSPITAL PRESENTS

8900 North Kendall Drive

Baptist Children’s HospitalBAPTIST

If you have a young child, you may be familiar with the Prevnar vaccine, which most babies receive at 2, 4, 6 and 15months of age. It’s designed to prevent pneumococcus, a bac-

terium that causes pneumonia, blood infections and meningitis.Since the vaccine was approved in 2000, incidences of these healthproblems in the United States have been reduced by 85 to 90 per-cent, according to Emory University researchers.

“We’ve seen a significant reduction in these diseases among chil-dren who are vaccinated,” said pediatrician Norman Goldberg, M.D.“And because there is nothing live in the vaccine, it makes it very safe.It’s well tolerated with minimal side effects and provides strong immunity.”

There’s even some evidence that children with recurrent ear infections benefitfrom Prevnar, although the FDA hasn’t approved the vaccine for this use. While thevaccine is recommended for children under age 2, if you have older children who fall into risk categories for infection, ask your pediatrician about having them vacci-nated, as well.

althy kids

Arthur Work, 9, left, and Andre Paul-Noel III, 8, learn exercise can be fun.

Prevnar vaccine keeps kids healthier

Once sidelined with arthritis in his right knee, SamByron limped around with a cane. “I was a hurtin’puppy,” he recalled. Now, after he proved to be a per-

fect candidate for a new type of minimally invasive knee sur-gery, he’s back to being a man on the go.

“I just came out of the racquetball court right now,” Mr.Byron, 69, said on his cell phone.

Doctors Hospital orthopedic surgeon Richard Levitt, M.D.,who has a keen interest and expertise in knees, did what iscalled a partial knee resurfacing on Mr. Byron’s right knee.Using a small incision, Dr. Levitt bonded stainless steel caps onthe part of the knee joint damaged by arthritis — the way adentist puts a crown on a painful tooth.

This surgery spared Mr. Byron from having a total kneejoint replacement, a bigger operation that he didn’t yet needbut until recently was the only surgical option for someonewith debilitating arthritis in only one area of the knee.

Dr. Levitt, who teaches the resurfacing technique to othersurgeons, was a consultant for the recent development of a bet-ter resurfacing joint implant. Dr. Levitt now does about 200knee resurfacing operations a year — about the same numberas the total knee replacements he does.

Dr. Levitt favors a minimally invasive approach for bothoperations, using an incision of three to four inches,compared with a conventional incision for total joint

replacement of about 12 inches.Several other Baptist Health orthopedic surgeons do mini-

mally invasive total knee replacements. For more than half ofhis knee replacements, Baptist Hospital surgeon FranciscoBorja, M.D., uses a small incision.

“Patients recover quicker, they can straighten their kneeearlier and the rehab is a little easier,” Dr. Borja said.

The knee joint connects the thighbone and the tibia, whichis the larger bone in the lower leg. The joint

has three sections or “compartments” —one in the front on the underside of thekneecap, and the other two on either side.In a total knee replacement, necessary

when arthritis has worn away cartilage inmore than one area, an implant replaces the

entire joint.“There are a lot of people who

just have arthritis on one com-partment and the rest of theknee is OK,” Dr. Levitt said.“In the past, these people

were having total replace-ments. With a resurfacing,patients have a less-inva-

sive procedure, less pain, a much faster recovery and a morenormal knee joint.”

The resurfacing surgery minimizes trauma to the sur-rounding leg bones and ligaments and preserves normal car-tilage in the joint’s healthy areas. If necessary down the road,the resurfacing patient can have a total knee replacement.

Mr. Byron said he regained 100 percent of the range ofmotion in his knee after the surgery, unlike the typ-ical total knee replacement patient who loses some

flexibility in the joint.Knee resurfacing patients stay in the hospital one night, or

sometimes go home the same day as surgery, Dr. Levitt said. Mr. Byron said he was impressed with Dr. Levitt’s philoso-

phy of listening to the patient’s goals. Mr. Byron wanted toresume sports activities and international travel.

“As a human being, he’s terrific,” Mr. Byron said. “It wasimportant to him that I was able to accomplish what I wanted.Had I not found Dr. Levitt, I wouldn’t be doing the things I’mdoing.”

— Patty Shillington

8 R E S O U R C E

S E N I O RF O C U S

For more informationFor a free referral to an orthopedic surgeon, call the

Baptist Health Physician Referral Service at 786-596-6557.

Orthopedic surgeonRichard Levitt, M.D.,

shows a model of the kneejoint with the implant.

Sam Byron is pain free and playing racquetball again after min-imally invasive knee surgery.

A new option for painful knees

BAPTIST MEDICAL PLAZA AT WESTCHESTER8820 Bird Road, Suite 400, Health Resource Center

Why You Shouldn’t Ignore theSnore. Wednesday, March 23, 7-8 p.m.,Dr. Jeremy Tabak, pulmonologist.Help for Incontinence (in Spanish).Thursday, March 31, 10:30-11:30 a.m.,Dr. George Suarez, urologist. Irritable Bowel Syndrome: The Digestive Distress (in Spanish). Tuesday, April 5, 7-8 p.m.,Dr. Alfredo Rabassa, gastroenterologist.

BAPTIST MEDICAL PLAZA AT WEST KENDALL13001 N. Kendall Drive, Suite 300, Health Resource Center

What to Expect from a Colonoscopy. Wednesday, March 9,1-2 p.m., Dr. Seth Rosen, gastroenterologist. The Do’s and Don’ts of Eating When You Suffer fromGastrointestinal Problems.Wednesday, April 27, 1-2 p.m., LupitaSparkes, registered dietitian.Haven’t Got Time for the Pain (in Spanish). Tuesday, May 10, 7-8p.m., Dr. Moises Lustgarten, anesthesiologist. The Facts About Macular Degeneration. Wednesday, May 11, 1-2 p.m., Dr. Charles Kaiser, ophthalmologist.

WOMEN’S HEALTH RESOURCE CENTER8950 N. Kendall Drive, Suite 105, Health Resource Center

Total Knee and Hip Replacement (in Spanish). Tuesday,March 1, 7-8 p.m., Dr. Francisco Borja, orthopedic surgeon. The Last Word on GERD. Monday, March 7, 7-8 p.m., Dr.James Leavitt, gastroenterologist. Coping with Caregiving. Thursday, April 7, 7-8 p.m., NildaRecabo, medical social worker.Treating Varicose Veins Without Surgery. Tuesday, May 3,7-8 p.m., Dr. Alex Powell, vascular/interventional radiologist. Coping with Caregiving (in Spanish). Wednesday, May 18,7-8 p.m., Ana Padilla, medical social worker.

SOUTH MIAMI HOSPITAL • U.S. 1 and SW 62 Avenue,Victor E. Clarke Education Center

Living with Arthritis. Monday, March 14, 10:30-11:30 a.m.,Dr. Michael Weitz, rheumatologist. Getting Through the Grief Process. Thursday, April 28,10:30-11:30 a.m., Dr. Kaia Calbeck, psychologist.

R E S O U R C E 9

S P R I N G C A L E N D A RIf you’re 55 or older, take advantage of the programs and health screenings offered by Baptist Health. There is a $5 charge formost programs; however, Senior Advantage members attend free unless otherwise noted. To get a Senior Advantage card, call786-596-3895. Registration is required for all programs, including those that are free. Call 786-596-3812. For Spanish programs, call 786-596-3814.

S E N I O RF O C U S

Treating Varicose Veins Without Surgery (in Spanish).Wednesday, May 4, 7-8 p.m., Dr. Abilio Coello, vascular surgeon. Faith and Healing: The Power of Prayer. Thursday, May19, 10:30-11:30 a.m., Rev. James Moon.

BAPTIST MEDICAL PLAZA AT DORAL9915 NW 41 Street, Suite 210, Health Resource Center

Preventing and Treating Osteoporosis (in Spanish).Wednesday, March 2, 7-8 p.m., Dr. Zulma Berrios, obstetri-cian/gynecologist. Free osteoporosis screenings, 6-7 p.m. and8-9 p.m. Appointments are required.

HOMESTEAD SENIOR CENTER • 43 NE 16 Street

2005 Medicare Update. Wednesday, March 2, 10:30-11:30a.m., Kathy Sarmiento, SHINE counselor.

BAPTIST HEALTH RESOURCE CENTER AT INFORMED FAMILIES • 2490 Coral Way

Help for Incontinence. Tuesday, April 26, 7-8 p.m., Dr. JaimeSepulveda-Toro, obstetrician/gynecologist. Chasing the Blues Away (in Spanish). Tuesday, May 17, 7-8 p.m., Dr. Jorge Herrera, neuropsychologist.

MARINERS HOSPITAL • 91500 Overseas Highway, Tavernier

The Facts About Headaches. Tuesday, March 15, 6-7:30 p.m., Dr. Elisa Brown-Soltero, neurologist. Stroke Awareness. Thursday, April 28, 6-7:30 p.m., Dr. Elisa Brown-Soltero, neurologist.

ONGOING PROGRAMS

Cardiac Screening. Screening and consultation available byappointment. Fee $30. Call 786-573-3755.Osteoporosis Screening. Screening and consultation avail-able by appointment. Fee $15. Call 786-596-3812.Dadeland Walking Club. Mondays, Wednesdays and Fridays, 9-10 a.m. (registration on Mondays only). Free. Call 786-596-7044.SHINE. Get help with Medicare and other insurance con-cerns. Free. Call 305-670-6500, Ext. 270, for an appoint-ment with a bilingual counselor. AARP Driver Safety Program. Fee $10. Call 305-382-5331.

At 17, Rebekah Ray was diagnosed with a rare braintumor called a choroid plexus carcinoma. The averagelife expectancy for someone with this fast-growing

brain cancer is 18 months. Today, at 28, Ms. Ray has not onlyremarkably defied the odds, she’s done it in style, becominghigh school valedictorian, graduating from college and pursu-ing a career as a social worker. She and her doctors credither recovery to a sophisticated procedure performed at Doc-tors Hospital using a Gamma Knife.

“She had a very large tumor that we first removed surgi-cally,” explained neurosurgeon Aizik Wolf, M.D., who along

with Glenn Morrison, M.D., per-formed the procedure at Miami Chil-dren’s Hospital. “But a portion of thetumor could not be removed andwas still attached to the brain stem.”Conventional treatment calls forchemotherapy and radiation, but Dr.Wolf recommended something dif-ferent — the Gamma Knife.

“I didn’t want chemo,” said Ms.Ray, who now lives in North Car-

olina. “I’d seen my mother go throughthat.” When Ms. Ray was 14, her mother died from breastcancer.

So Ms. Ray opted for the Doctors Hospital Gamma Knife,which isn’t actually a knife at all. It’s a machine that preciselyfocuses 201 intersecting, invisible gamma radiation beams atthe target without any incision into the brain. The radiation isso focused that surrounding tissue isn’t harmed. The treat-ment is virtually pain free, with few side effects.

Because a portion of her brain was removed in surgery,

however, Ms. Ray had to relearn how to walk and remainsweak on her right side. “I have a determination and I was notgoing to die,” she said.

Regular MRI checks show that Ms. Ray’s brain is tumorfree 11 years after her Gamma Knife treatment. Although her

story is amazing, she’s not the onlyGamma Knife success. More than 4,500patients have been treated by Dr. Wolf atDoctors Hospital with the Gamma Knife. Itis used to treat a variety of brain cancers(even those that have spread to the brainfrom other sites in the body), brain mal-formations and movement disorders, suchas Parkinson’s disease.

“The number of patients we’ve treatedputs us among the leaders in the world,but even more important is that we’ve hadthe same team together for these 4,500procedures. Like any other field, the moreexperience you have together, the betterthe outcome for patients,” Dr. Wolf said.

— Adrienne Sylver and Patty Shillington

10 R E S O U R C E

HERE&THERE

Rebekah Ray defied the odds.

Keep yourself in circulation:Get informed. Get screened. Get going!

Your blood has places to go and things to do — just like you. But highblood pressure, cholesterol and diabetes can lead to heart attack, strokeand other circulatory problems. Come to a free program featuring a paneldiscussion about cardiovascular disease and diabetes by cardiologistMichael Ozner, M.D., interventional radiologist Barry Katzen, M.D., anddiabetes expert Lois Exelbert, R.N. You can also take advantage of freescreenings for cholesterol, diabetes, peripheral vascular disease, body fatand more. To register for this free program, call 786-596-8877.

Saturday, March 12, 9 a.m. – 1 p.m.

8900 North Kendall Drive

Aizik Wolf, M.D.

Remarkable recovery credited to Gamma Knife ‘surgery’

Fortune shines on Baptist Health

For the fifth time, Fortune magazine has honoredBaptist Health as one of the “100 Best Companiesto Work For.” This year, Baptist Health jumps to

31 in the ranking, up from 51 last year.“This is one of the most prestigious awards any

employer can earn,” said Baptist Health Presidentand CEO Brian E. Keeley. “It recognizes the valuethat Baptist Health puts on its employees. We takegood care of our employees so they can take good care of you.”

The Emergency Centers at SouthMiami and Baptist Hospitals haveopened Heart Attack Units with

the goal of providing heart-sparing treat-ment to patients within 90 minutes ofarriving in the ER. Interventional cardi-ologists at South Miami Heart Centerand Baptist Cardiac & Vascular Instituteare on call 24/7 to provide this new service which, in many cases, willreplace the use of clot-busting drugs torestore blood flow to the heart.

The on-call team swings into action assoon as the Emergency Center is notifiedthat a heart attack patient is on the way. Ifthe patient qualifies, interventional cardi-ologists will perform an emergency angio-plasty. During angioplasty, cardiologistsinsert a catheter into the blocked vesseland open it with a tiny balloon. Studieshave shown that angioplasty is effective inrestoring blood flow to the heart 95 per-cent of the time, compared to about two-thirds of the time with clot-busting drugs.The 90-minute goal to start treatment isbased on guidelines from the AmericanCollege of Cardiologists and the Ameri-can Heart Association.

Immediate angioplasties are done onpatients having the worst type of heartattack, as determined by an EKG.

That’s what happened to Caridad Semino,71, who was one of the first patients to betreated at South Miami Hospital’s HeartAttack Unit.

Ms. Semino was doing laundry oneSunday morning when she experienced

classic signs of a heart attack — chestpain, difficulty breathing and sweating.Paramedics took Ms. Semino to SouthMiami Hospital’s Emergency Center.Within 75 minutes, interventional cardi-ologist Rejesh Dhairyawan, M.D.,inserted a catheter into the blocked ves-

sel and opened it with a tiny balloon torestore blood flow to her heart. Accord-ing to the American Heart Association,1.2 million Americans experience a heartattack each year. Of those, 42 percentwill die before they reach a hospital orreceive treatment.

“The sooner we can get the patient tothe Catheterization Lab to open theblockage, the better they do,” said cardi-ologist Armando Garcia, M.D., who wasinstrumental in opening South MiamiHospital’s Heart Attack Unit.

No one knows better than Ms.

Semino’s son-in-law, Eddie Fabregas, a23-year veteran of Miami Fire Rescue.“If someone is having a heart attack, sav-ing time means saving heart muscle,”Mr. Fabregas said. “I was impressedwith how quickly the ER staff assessedher problem and got her to the Cath Labfor the procedure.”

While the start of interventionaltreatment within 90 minutesis not always possible, both

hospitals are taking extra steps to meetthat goal. They are working with Miami-Dade County to ensure that Fire Rescuepromptly notifies the ERs when patientsare en route to the hospitals.

“We’re on top of it before the patientcomes through the door,” said RamonQuesada, M.D., medical director of inter-ventional cardiology at Baptist Cardiac& Vascular Institute.

— Martha Martin-Allen and Anne Smith

R E S O U R C E 11

Heart attack survivor Caridad Seminohas her blood pressure taken by AnnaBeverly, R.N.

Cancer Survivors Day

If you or someone you love hashad to cope with cancer, the Bap-tist-South Miami Regional CancerProgram invites you to join us for

an upbeat andentertaining pro-gram on the healingpower of humor.Comic, championjuggler and cancersurvivor Scott Burton

will give you his very funny take onthe cancer battle and offer a life-affirming message to all cancer sur-vivors and their families. This freeprogram includes a light lunch. Forreservations, call 786-596-2871.

Sunday, May 22, 1-3 p.m.

Victor E. Clarke Education CenterU.S. 1 and SW 62 Avenue

South Miami HospitalBAPTIST

Heart Attack Units open at South Miami, Baptist Hospitals

Anew, minimally invasive surgery is allowing BaptistCardiac & Vascular Institute patients to have life-savingheart valve repair without getting their rib cage

sawed open.“Don’t even think about having valve surgery the old way if

they can do it without opening the chest,” said Joseph Hoak,73, of Saga Bay. “This has been a miracle for me.”

Baptist Cardiac & Vascular Institute surgeon Joseph Lame-las, M.D., repaired the leaky mitral valve on the left side of Mr.Hoak’s heart. The surgeon made a three-inch incision in theright side of Mr. Hoak’s chest. He used long, thin surgicalinstruments mounted with tiny cameras.

“Because of this new, minimally invasive alternative, called‘port access,’ patients don’t have to put off surgery becausethey’re afraid of getting their sternum and rib cage opened,”Dr. Lamelas said.

Mr. Hoak also experienced less pain, less time in inten-sive care, and a shorter recovery after his 31⁄2-hour procedure.

Institute surgeons have been in the forefront using this

minimally invasive technique for nearly a decade. “The surgeryhas evolved over the years with more advanced instrumenta-tion,” said Niberto Moreno, M.D., the Institute’s medical direc-tor of cardiac surgery.

Dr. Lamelas has performed about 180 port access surger-ies over the past two years, more than anyone else in theregion. Along the way, Dr. Lamelas perfected a “single-opera-tor” technique he’ll teach to 70 other surgeons expected totravel to the Institute from around the nation this year.

“Like other types of minimally invasive surgery, port accesscan actually be more technically challenging because the sur-geon has to operate through such a small incision,” Dr. Lame-las explained. “It’s even more difficult to have more than onesurgeon working through that tiny hole. The single-operatorapproach has lower risks for the patient, and that’s why othersurgeons want to learn it.”

Valve surgery patients, in general, suffer twice the mortal-ity rate of bypass surgery patients, which is 3-5 percent. Forthat reason, valve replacement or repair is often postponeduntil a valve malfunction becomes life threatening.

By the time Mr. Hoak underwent port access surgerylast fall, backward flow from his leaky valve was strain-ing his heart, causing it to enlarge and weaken. “I would

get out of breath just walking a few steps from my bedroom tothe bathroom, and it felt like I had a brick tied to each foot,”Mr. Hoak recalled.

He believes his recovery from port access was less painfulthan if his breastbone, or sternum, had been sawed through inthe sternotomy required for traditional valve surgery.

For the first three days after his procedure, Mr. Hoak saidhe got complete relief from pain medication pumped directlyinto his incision.

Being asked to cough to clear the lungs can be excruciat-ing for patients who have had a sternotomy. But Mr. Hoak didnot dread his visits from the respiratory therapists, he said,“because coughing didn’t hurt that much.”

He added, “When I was discharged after five days, theygave me Percocet to take home with me, but I never needed it.I didn’t have any pain.”

According to Dr. Lamelas, the port access procedure isnot for everyone because it cannot be combined with coronaryartery bypass. Still, more than half of all valve surgery patientsmay be candidates.

— Sandy Baksys

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Editor: Jo Baxter. Art Director: Martha Hesse. Associate Editors: Patty Shillington, Anne Streeter, Adrienne Sylver.Writers: Martha Martin-Allen, Sandy Baksys, Tom Neile, Anne Smith.Editorial Assistants: Georgette Koch, Barbara Moore, Dorothy Stein.Photography: Mabel Rodriguez.Production Coordinator: Claudia Rodriguez.Visit us: www.baptisthealth.net Copyright © 2005 Baptist Health South Florida. All rightsreserved. None of the contents of this publication may bereproduced or transmitted without the prior written permissionof the publisher.

Heart valves fixed with less pain

Dr. Lamelas repaired a heart valve through a three-inch incision.