healthworks
Emerson Hospital
| Autumn 2016
Back to
playing again
AFTER AN
APPENDECTOMY
AT EMERSON
Cancer center
expansion is well
underway
A hip replacement,
followed by a season
of tennis
Pepperell resident is
grateful for successful
rehab
After a stroke,
comprehensive care
makes the difference
A Letter from
Christine Schuster
Dear Friends:
In this issue of HealthWorks, you will read
about the two-part expansion and upgrade
underway at our Mass General Cancer Center
at Emerson Hospital-Bethke. This summer,
patients began coming for appointments at the
new clinical oncology unit. By year’s end, the
new Naka Infusion Center, located next door,
will be completed.
Climbing the
mountain
For Pepperell woman, a year of
rehab leads to triumph
We understand that the setting for cancer care
is important, so we are creating a more comfortable environment to better deliver the personalized care for which our center is known.
We continue to provide a range of important
clinical services. You will read about pediatric
surgery—the surgical expertise, as well as the
outstanding inpatient care we provide to pediatric patients. There are articles about hip
replacement surgery and rehabilitation after a
stroke thanks to the comprehensive approach
provided by our talented professionals at the
Center for Rehabilitative and Sports Therapies.
Finally, our Emergency Department staff is at
the forefront of addressing the opioid crisis in
our community. Gert Walter, MD, one of our
emergency physicians, is featured here.
Here’s to a happy, healthy fall season!
Christine C. Schuster, RN, MBA
President and CEO
Carol Rizzitano worked hard, achieved a series of milestones and was able to hike with her family
in July.
Emerson Hospital is an acute care medical center
located in Concord with health centers in Groton,
Sudbury and Westford. It is well known for its medical and surgical specialists, outstanding nursing care
and patient-centered services, including the Clough
Birthing Center, the Mass General Cancer Center at
Emerson Hospital-Bethke, the Polo Emergency Center
and the Clough Surgical Center.
www.emersonhospital.org
2
When Carol Rizzitano arrived at the Center for Rehabilitative and
Sports Therapies in Westford in June 2015, she was in a wheelchair.
The Pepperell resident and her husband had requested a tour.
“I remember Carol saying ‘I’m not sure there is anything you can
do for me,’” says Rachel Kim, PT. Ms. Rizzitano soon learned that,
thanks to the expertise of Emerson rehab staff in Westford and
Concord, as well as her own hard work, she would make stunning
progress.
year of rehabilitation at Emerson took Carol
A
Rizzitano from a wheelchair to the top of Black Cap
Mountain in North Conway, New Hampshire.
Still, her case was exceedingly complex.
Two months earlier, Ms. Rizzitano was hiking when a tree branch fell on her, causing
her to fall awkwardly, dislocating her right
knee and severing a major artery and other
blood vessels in her leg. Her husband
quickly applied a tourniquet, but her leg
suffered nerve damage due to blood loss.
After having surgery to repair her blood
vessels, Ms. Rizzitano was cleared to begin
rehab. But her right leg was weak, and
she had no feeling below her ankle.
“I knew I couldn’t go on vacation,” says
Ms. Rizzitano, in reference to the hiking trip
she and her family take each summer.
“When I arrived at Emerson, I tried to imagine going from a wheelchair to a walker
to two crutches to one crutch. I had to take
it one day at a time.”
Ms. Kim’s initial objective was to increase
the range of motion in Ms. Rizzitano’s knee,
which was too weak to bear weight. “We
started with small, short-term goals, which
became increasingly bigger,” she says. “The
real goal was for Carol to walk again. She
was amazing; Carol worked hard and surpassed every goal.”
Ms. Rizzitano started by using the LiteGait
machine, a harness that supports an individual’s weight while they begin moving safely
on a treadmill. “This allowed Carol to get
back to the mechanics of walking,” Ms. Kim
explains.
As her nerves slowly regenerated, the numbness in her foot was replaced by pins and
needles—not pleasant, but a sign that
sensation was returning. “We did every-
thing possible, including massage, to get
Carol’s foot moving again,” Ms. Kim notes.
After eight months of challenging physical
therapy, Ms. Rizzitano reached an important
milestone: she walked on her own on a
treadmill.
Aquatic therapy followed by a triumphant
hiking trip
There was much more progress to make.
In March 2016, Ms. Rizzitano, a manufacturing engineer with three children, began
aquatic therapy at Emerson’s other rehab
center in Concord, which was overseen
by Lisa Coppola, PT, DPT. “I continued to
focus on Carol’s knee,” says Ms. Coppola.
“The water provides buoyancy, which
unloads body weight, so she could move
more comfortably.”
“The aquatic therapy relieved the stiffness,”
says Ms. Rizzitano. “I walked on the underwater treadmill and was able to do lunges.”
In 92-degree water, she could move her toes.
The warm water made her pins and needles
subside, which allowed her to push herself
during physical therapy.
Her nerves were regenerating, Ms. Coppola
explains. “We did a lot of work on Carol’s
big toe, which is important for balance and
pushing off when walking, as well as her
proprioception—her sense of where she is
in space.” Ms. Coppola also used tools to
assist in soft tissue mobilization, aimed at
relieving the tightness around her scar.
“We knew that the combination of therapy,
in the pool and on land, would bring sensation back to her foot and mobility back to
her ankle.”
Along the way, they developed a lasting
admiration for their patient, who never gave
up. “Carol was a complex patient who suffered a traumatic injury,” says Ms. Coppola.
“We challenged her, and we built a rapport
with her.”
“We were both surprised at how well Carol
did,” Ms. Kim adds.
She had plenty of motivation: a family
vacation was scheduled for July, when she
would attempt to climb Black Cap Mountain
in North Conway, New Hampshire. “We
knew it was within Carol’s reach,” says
Ms. Kim.
Using ski poles to keep steady, wearing good
hiking shoes and with her husband hiking
beside her, Ms. Rizzitano made a successful,
four-story climb. “It was wonderful being
able to get to the top,” she says. “I walk a lot
anyway, but hiking keeps me happy.”
Looking back at the year of rehabilitation
at Emerson that took her from a wheelchair
to the top of Black Cap Mountain, Ms.
Rizzitano reflects on the staff at the Center
for Rehabilitative and Sports Therapies.
“At every physical therapy appointment,
I received positive feedback and direction
on where my rehab was headed,” she says,
“and I had faith they were never going to
hurt me.”
She knows she would not be where she is
today without the expertise and encouragement of Ms. Coppola and Ms. Kim. “Rachel
and Lisa have been wonderful,” she says.
Ms. Rizzitano’s rehab proceeded in two
locations with the two physical therapists.
“Rachel and I stayed in regular contact to
discuss Carol’s progress,” says Ms. Coppola.
3
Back on the tennis court
Hip replacement returns Boxborough resident to active life
Roger Meyer is used to moving fast. That is what he did when he ran track
in college and later when he played softball, and it was always true when he
played tennis. But he steadily lost speed on the tennis court, which brought
him to the office of John McInnis, MD, an orthopedic surgeon at Emerson.
A few months after having hip replacement surgery, the Boxborough resident, who is 74, got back on the court.
It took a while for Mr. Meyer to realize the
source of his problem. For a few years, the
pain he felt was in his back. “In general, I
was stiffening up,” he recalls. “I started
working out to strengthen my core and regain flexibility. But I was losing my mobility on the tennis court. I felt like a car that
was beginning to break down. It was
frustrating.”
Barbara Peters, MD, his primary care physician, suggested he have an x-ray taken of
his hip, which led to an appointment with
Dr. McInnis. Mr. Meyer will never forget
what happened that day. “Dr. McInnis put
the x-ray on the board and said, ‘you have
no cartilage; the ball of your hip is right up
in the socket,’” says Mr. Meyer. “I wondered how that was possible, because I was
still running on the tennis court and riding a
stationary bike. I wasn’t even limping.”
Dr. McInnis explained that osteoarthritis of
the hip doesn’t behave in a predictable way.
“Unlike knees, hips don’t always correlate to
what we see on the patient’s x-ray,” he says.
“A hip joint can look very bad on an x-ray,
but the patient won’t necessarily be in pain.
Or they might instead feel the pain in their
back or their side, or notice their leg has
become weak.”
Even then, Mr. Meyer, a real estate broker
until his retirement a few years ago, assumed that hip replacement surgery was
well down the road. “I was thinking the
timeframe was three or four years,” he says.
But Dr. McInnis surprised him when he said
that, based on his x-ray and symptoms, he
would likely need to have surgery within
a year or so.
“He even drew me a picture of what I could
expect,” says Mr. Meyer. “It was a line
heading slowly downhill. After all, I didn’t
have any cartilage in that hip.” It was June
2015, and Mr. Meyer’s tennis season, which
included playing on an indoor court, would
begin in October.
Surgery, minimal pain and great results
As it turned out, Dr. McInnis’s drawing
was prophetic. “Once I began playing tennis
last fall, I just wasn’t moving well,” Mr.
Meyer says. “Off the court, I started limping
a bit on the stairs.” He returned to see
Dr. McInnis, and his surgery was scheduled
for March.
“I always prefer for the patient to tell me
that they’re ready for surgery,” says Dr.
McInnis, who specializes in joint replacement surgery. “If they’re unsure, I ask what
activities they’ve given up because of pain.
Once someone says they can’t sleep at night,
it usually means they’re ready for surgery.
4
“It couldn’t have gone better,” says Roger Meyer of
the hip replacement surgery that John McInnis, MD,
performed earlier this year.
“With younger patients, we try to help
them hold off, if possible, so that they won’t
require a revision—having another joint
New approaches
to pain control have
transformed joint
replacements
sis—blood clots, a potential complication—
and it gets physical therapy started. Many
patients go home two days after having a
joint replacement.”
Mr. Meyer is one of the lucky people who
continued to experience almost no post-surgical pain. “The nurses kept asking how my
pain was, on a scale of 1-10,” he recalls. “I
kept saying I had none. They wanted me to
stay ahead of the pain, because it would be
easier to treat.
This x-ray shows Roger Meyer’s hip after surgery:
pain-free and, before long, ready for tennis.
replacement later. The design of today’s
hip implants has improved to where most
patients can expect to get 30 years from a
new hip.”
Dr. McInnis encourages his patients to
attend Emerson’s two-hour class, Preparing
for a Joint Replacement. “I thought it was
great,” says Mr. Meyer, who attended the
class and continued his regular workout in
advance of his surgery. “My wife and I were
in Florida for six weeks, and I decided to
join a gym so I could stay in shape.”
When the day of his surgery arrived, Mr.
Meyer says he was a bit apprehensive, but he
was ready. “It couldn’t have gone better,” he
says. “After surgery, I felt no pain or discomfort in my hip. They got me up and, six
hours after hip replacement surgery, I used
the walker to head down the hall.”
Thanks to minimally invasive surgical techniques and better pain control, that is now
standard procedure. Still, Dr. McInnis says
patients often are surprised to be walking on
a new hip or knee the same day as their surgery. “It accomplishes a few things at once,”
Dr. McInnis notes. “It builds the patient’s
confidence, it prevents deep-vein thrombo-
“Even Dr. McInnis stopped in to say that no
one gets through a hip replacement by taking
just Tylenol, especially when they have
physical therapy to do. I did take a pain pill,
and it was easier for me to get out of bed and
walk even further. Pretty soon, they had me
going up and down the stairs.”
Once at home, Mr. Meyer had regular visits
from Emerson Home Care staff, including a
nurse and a physical therapist. “They were
great,” he says. From there, he moved to an
exercise program approved by Dr. McInnis.
“I wanted to do more than 50 minutes of
exercise a day, but I knew I had to follow
the protocol.”
“Some patients feel so good and have so
little pain that we have to hold them back
a bit,” says Dr. McInnis. “I tell them:
remember that you have to let the bone
grow around the implant to complete the
healing process.”
Mr. Meyer started early—in June—and
slowly, to move around on the tennis court
and steadily increased his activity level
over the summer. “When I realized I needed
a hip replacement, a few people suggested
I go to a different hospital,” he says. “But I
know Emerson, and I know it’s a first-rate
hospital.”
“Some patients feel so good and have so little pain that
we have to hold them back a bit.”
– John McInnis, MD, orthopedic surgeon
There’s a reason Mr. Meyer experienced
so little pain after his hip replacement:
multi-modal pain management has transformed joint replacement surgery. He
benefited from a carefully designed approach to pain that kept him comfortable—as well as ready to begin his rehab
just a few hours after arriving in his room.
“Two things occurred in the operating
room,” explains Dr. McInnis. “I placed
long-acting Novocain into Mr. Meyer’s incision, and we started him on Toradol, a
non-steroidal anti-inflammatory medication, through an IV.” As a result, Mr.
Meyer woke up in the recovery room with
no pain. After that, he received a combination of Tylenol and Toradol and a narcotic painkiller—but cautiously and only
as needed for breakthrough pain or in advance of a physical therapy session to prevent pain from developing.
Regional anesthesia plays a substantial
role in the new world of pain control.
“Most of our knee replacement patients
and some of our hip replacement patients
receive regional anesthesia prior to their
surgery,” says Dr. McInnis. “They’re
numbed from the waist down and, by
avoiding general anesthesia, experience
less post-surgical confusion. Regional anesthesia is associated with less pain, less
blood loss and less chance of blood clots.”
The knee is more exposed than the hip
and has less tissue to protect it. As a result, knee replacement surgery is associated with a greater degree of post-surgical
pain. “The use of nerve blocks has revolutionized knee replacement surgery,” says
Dr. McInnis. “All credit goes to our anesthesia department colleagues, who manage our patients’ pain control problems.
They now provide nerve blocks that address the patient’s pain without affecting
the quadriceps muscle.
“As a result, they can move with confidence and begin their rehab right away.
Our patients are very pleased.”
5
Pediatric surgery
Bedford boy with
appendicitis received
all the care he needed
in the right place,
at the right time
Theo Kollias remembers the bellyache that
kept him on the sofa for two days. “It was a
big one,” says the Bedford boy, who was six
at the time. A stomach bug was going
around, so his mother, Emilie Kollias, kept
an eye on him and didn’t worry too much—
until he began vomiting and complaining.
Happy again: (left to right) Theo Kollias with his
mother, Emilie, brother, Alexander, and Monk the
cat. The two boys have been to the Emerson
Emergency Department on a few occasions.
“I asked Theo to stand up and jump,” Ms.
Kollias recalls, noting that, if he felt sharp
pain, it could indicate appendicitis. “He
wouldn’t do it; he said it hurt too much. I
called his pediatrician, and we drove to the
Emerson Emergency Department.”
Theo was quickly examined by Bradley
Judson, MD, an emergency medicine physician, who administered pain medication.
Mallory Harrison, a member of the Pediatric
Intervention Team (PIT), soon appeared
with a coping kit, a bag of therapeutic toys
that helps children cope with the hospital
experience. Theo needed the distraction
of bubbles, a Beanie Baby and Hot Wheel
truck; his pain was worse, and it took a
while for the medication to help.
It was not clear that the boy was suffering
from appendicitis, notes Atif Khan, MD,
general surgeon. “I was concerned about
Theo, because he was getting sicker,” says
Dr. Khan, who felt there was a chance his
problem was a bowel rupture. “He had
shaking chills. Kids can quickly deteriorate;
we needed to make a decision.”
Having a CT scan would lead to a diagnosis,
but when a child is involved, this merits
careful discussion. “I decided I’d rather
have Theo exposed to radiation than have
him go through unnecessary surgery,” says
Ms. Kollias. Emerson radiologists follow
Image Gently protocols, which use less radiation when children receive imaging tests.
6
The test results showed that his appendix
appeared to be quite inflamed, and possibly
perforated—a process that potentially
spreads infection throughout the abdomen.
With his parents looking on, Theo headed
into the operating room for an appendectomy. “It was traumatic for me,” recalls
Ms. Kollias.
Dr. Khan understood completely. “I have
a six-year-old daughter,” he says. “It definitely touched me, because I thought of her
going through the same thing and needing
surgery.” When the 30-minute procedure
was complete, Dr. Khan informed Theo’s
parents that his appendix had perforated.
After removing Theo’s appendix—a small
pouch that protrudes from the large intestine—Dr. Khan washed out the area and
used sutures to close the incision.
Before long, climbing trees again
Theo remembers waking up after surgery.
“Straight away, I looked at the scar,” he says.
“They drew on my belly with a marker. The
real problem was sitting up. It hurt.” He
didn’t eat for the first day or so and was
given antibiotics and pain medication.
Between 7 and 10 percent of the population
develops appendicitis—an infected appendix—at some point in their lives. Regardless
of one’s age, there is a risk for complications
after surgery, especially if the appendix perforated. “We watch for infection, abscess or
ileus—where the gastrointestinal tract temporarily shuts down,” says Dr. Khan. “We
like patients to stay on a liquid diet until
we’re sure they have not developed ileus.”
Emerson has a 24/7 pediatric hospitalist service that is available to see surgical patients
for anything related to their medical care.
“We can help manage the child’s pain and
give advice regarding the appropriate dose of
intravenous fluids and medications,” says
Inger-Marie Pu, MD, who directs the pediatric hospitalist service. “Sometimes a child
has an underlying medical condition that is
best cared for by a pediatrician. We help
with the medical issues while the surgeon
takes care of the acute surgical issue.”
Inger-Marie Pu, MD, director of the pediatric
hospitalist service, checks on a sick patient.
The pediatric hospitalists provide another
service that parents appreciate. “We communicate with the child’s pediatrician in the
community,” she notes. “We consider our-
selves to be an extension of the child’s pediatrician while they are at Emerson.”
Theo was happy to see Ms. Harrison the
morning after his surgery. “She brought me
a PlayStation and a DVD player,” he says.
“We often debrief with children who have
surgery by asking them about their experience,” says Ms. Harrison, noting that the
PIT’s focus is the emotional care of children,
as well as their families. “We might ask
‘What was the hardest part? Were there any
surprises? Was there a good part, too?’”
Once at home again, Theo stayed out of
school another week while his incision
healed and he regained his energy. He discovered that having surgery wasn’t so bad.
“I got two Lego sets, and my whole class sent
me get well cards,” he says.
Pretty soon, he was climbing trees again.
“After Theo was home from the hospital two
weeks, I could take my mind off him,” says
Ms. Kollias, who is pleased with the care at
Emerson. “We’ve brought Theo and his
brother, Alexander, to the Emergency
Department before—for smashed fingers,
stitches and sprains.”
Looking back, Theo understands what his
“big bellyache” was about. “When you have
appendicitis, you have pain, you can’t walk
very well, and you have a scar afterwards,”
he says. “But I’m not going to have appendicitis again.”
Pediatric specialties are expanding at Emerson
There are many outstanding pediatricians who are affiliated with
Emerson Hospital. During the past few years, they have been joined
by numerous pediatric specialists. These clinical experts have offices
in the community, which makes life easier for patients and families.
John Cahoy, MD, PhD, a pediatric orthopedic surgeon, joined
Emerson this past summer. Dr. Cahoy provides comprehensive orthopedic care of children from birth to young adulthood. His clinical interests include pediatric upper and lower extremity fractures,
treatment of athletic injuries and overuse syndromes and non-surgical management of adolescent scoliosis and spine conditions.
Jennifer Setlur, MD, an otolaryngologist (ear, nose and throat
specialist) with Mass Eye and Ear, Concord, provides the kind of
care that children often need, including inserting ear tubes, removing tonsils and treating airway problems, right in the community.
Four pediatric ophthalmologists, from D’Ambrosio Eye Care and
Lexington Eye Associates, are affiliated with Emerson.
Mass General Hospital for Children has arranged for several pediatric specialists to provide care at Emerson in the following specialties: cardiology, endocrinology, gastroenterology, nephrology and
pulmonology. Ira Skolnik, MD, PhD, a well-known dermatologist
who sees adults and children, is one of only a handful of dermatologists in the U.S. who is triple-board-certified in pediatrics, dermatology and pediatric dermatology.
Children who come for testing, procedures or surgery and stay on
Wheeler 4, the hospital’s pediatric unit, are the focus of the pediatric
hospitalists. These highly regarded physicians are found anywhere
children receive care, including in the Emergency Department. They
attend births when necessary and care for newborns.
Similarly, the Pediatric Intervention Team (PIT) is a staff of three,
including a nurse practitioner who specializes in child and adolescent psychology. They make the hospital experience easier on the
pediatric patient and the family and also bring in a consulting child
psychiatrist when appropriate.
7
Advisor
emerson
Q
your health questions answered by our experts.
My son recently broke his arm. How long before he’ll be back to normal?
Most bone healing occurs in the first three–four weeks;
kids generally are back to unrestricted activity in about
three months. A broken arm is best treated in an
emergency department [ED], not an urgent care center;
an ED has the full range of diagnostic and treatment
options, including access to having a procedure performed under sedation. Whether or not your son had
surgery, he’ll probably be in a cast for three to six weeks.
Q
Few kids with broken bones require formal rehabilitation; stretching exercises at home, performed by
parents, along with normal childhood play, are usually
sufficient. Of course, rehab is essential for some conditions I treat, such as athletic injuries and overuse
syndromes. Treatment of fractures in kids is completely
different from adult fractures. Because kids’ bones are
still growing, even if a fracture isn’t completely straight,
the growth process often will correct much of the
deformity.
Similarly, childhood fractures rarely require any longterm follow-up care beyond three months. However,
when fractures occur in the growth plate—at the end of
a bone, close to a joint—we like to see the patient over
the next few years to make sure normal healing occurs.
john cahoy, md, phd
Pediatric Orthopedic Surgeon – Orthopedic Affiliates
I was just diagnosed with peripheral neuropathy. Is there good treatment for this condition?
Q
Although there are several treatments for peripheral
neuropathy, it is essential that the type and cause of
the neuropathy be first determined. Approximately 20
million Americans suffer from peripheral neuropathy, a
condition that primarily affects the nerves in the hands
and feet. The most common symptoms are numbness,
tingling or weakness. For about 50 percent of patients,
the cause is type 1 or 2 diabetes; the condition is known
as diabetic neuropathy. Controlling one’s blood sugar is
important for those individuals.
Treatment includes oral medication such as gabapentin, pregabalin and antidepressants, as well as topical
creams that provide symptomatic relief.
Other causes include vitamin deficiency, immune system disorders, excess alcohol intake and as a side effect
of chemotherapy. However, in about 30 percent of
cases, the cause is unknown.
anya turetsky, md
Diagnosis of peripheral neuropathy requires a thorough neurological examination and, in certain cases,
a test performed in the office, called a nerve conduction study, may be required. By working together, we
can try to lessen the symptoms and limit the disease’s
progression.
Neurologist – Emerson Neurology Associates
I have a wound that is not healing. What can Emerson offer me?
In our Center for Advanced Wound Care, we offer the
full range of treatments for wounds, from simple to the
most complex. If you come for an appointment, we
will answer two questions: what can we do to help you
today, such as applying the appropriate dressings? And
how will we try to fix the underlying condition causing
your healing problem? We begin with a comprehensive
health assessment, which may include testing to check
your circulation. If you have diabetes, which often leads
to non-healing wounds, we will stay in close touch with
your primary care physician or endocrinologist.
endovascular procedures to repair blood vessels and
state-of-the-art biologic skin grafts. We also have two
hyperbaric oxygen [HBO] chambers; HBO treatment
often takes wounds that are destined to fail and turns
the corner to successful healing.
Our treatments may include compression, use of a
temporary cast that limits use of the foot, surgical or
Vascular surgeon and medical director,
Emerson Center for Advanced Wound Care
I’m a vascular surgeon; our team includes plastic
surgeons, podiatrists, an infectious disease specialist, primary care physician and nurse practitioner. We
approach wound care differently and often collaborate.
stephen hoenig, md
For more information on care at Emerson Hospital, call the toll-free Physician Referral Line: 877-9-EMERSON (877-936-3776) or visit the hospital’s web
site at emersonhospital.org.
8
The doctor is in
Useful information from the Emerson medical staff
Gert Walter, MD, emergency medicine physician,
on caring for individuals who are addicted to opioid
medications
When did you and your colleagues observe an increase in opioidaddicted patients coming to the Emergency Department (ED)?
About five years ago we started seeing more and more people who
got started on pills such as Percocet or Vicodin, either because of a
doctor’s prescription, or because they obtained them from friends or
family. Some people then go on to use heroin because it’s cheaper.
Because we are a psychiatric and detox facility, Emerson has always
seen more patients with substance abuse problems than the average
community hospital. Long before concern grew about an opioid
epidemic, we were already detoxing patients from opioids and
alcohol. Emerson has an exellent reputation, so we treat people
from all over Massachusetts and into New Hampshire.
As an ED physician, you regularly treat patients who are in pain
and have a legitimate need for a prescription painkiller.
Yes. But lately, many parents say “there’s no way I want to give
narcotics to my kid.” We typically give only a small prescription of
narcotics to someone who is clearly in pain or in cases where someone has injured themselves, because we arrange for close follow-up
in the next few days. And we tell patients that, for example, if they
are given a prescription for 30 pills, they can tell the pharmacy they
only want 10.
The fact is, several years ago, physicians and hospitals were informed that they were doing a poor job treating pain; we needed
to be more attentive to our patients’ pain. The pendulum swung
too far the other way and was compounded by the fact that, when
Oxycontin came onto the market, we were told by the pharmaceutical company that it was impossible to become addicted to it. We
found out that wasn’t true.
What efforts are underway to stem the opioid epidemic?
In Massachusetts, the Prescription Monitoring Program, which was
established more than a year ago, has been a big help. It’s a database
that shows how many prescriptions of controlled substances a patient has. It can be eye-opening to see that someone has obtained
prescriptions for opioids from 20 different physicians at 18 different
pharmacies. At the same time, we may see if a patient is truly sick,
because the database will show that they have one physician who is
managing their need for pain and anxiety medications.
When the Prescription Monitoring Program [PMP] first started, 70
percent of the physicians who used it were ED physicians. It’s very
useful to us, because we don’t know the patients we treat. We also
have a program now where, if a patient ranks their pain as more
than 5 out of 10, a member of the staff pulls up their PMP record so
that the physician can see it.
Do you screen patients for signs of substance abuse?
Yes, and we refer appropriate patients to our detox unit at Emerson
if we determine that stopping the opioid pills or alcohol would be
dangerous to their health. Other patients qualify for outpatient
treatment. The hospital’s behavioral health staff make the arrangements. We also send a copy of the patient’s ED record to their primary care physician. Some people don’t wish to be detoxed.
Is Emerson collaborating with the local community?
Yes. I serve as the medical director for the area EMTs [emergency
medicine technicians]. The EMTs who work for the local fire departments have been using Narcan [naloxone], the opioid antidote,
for several years. We now have a Narcan training program for area
police departments. Police usually are the first ones to arrive in response to a 911 call because someone has overdosed. Narcan can
also be purchased at a pharmacy without a prescription for about
$10-20 per dose.
We encourage people to be aware that it is only to be used for narcotic overdoses. It is lifesaving and gives people an opportunity to
get off narcotics, get into a program and get their lives back on track.
9
Jon DuBois, MD, medical director, showed
Gary Doak of Lynnfield the new clinical oncology
unit, which opened in August.
Cancer center upgrade and
expansion is well underway
A more comfortable setting that supports
personalized care
Cancer treatment keeps improving, becoming more specialized and more
successful. Because the setting for care is important, the Mass General
Cancer Center at Emerson Hospital-Bethke is creating a more comfortable
environment to better deliver the personalized care for which it is known.
The cancer center’s upgrade and expansion,
which is well underway, signals a commitment to continue providing the highest quality care close to home. “We know that, in
the future, cancer treatment increasingly
will occur in the community, rather than at
academic medical centers,” says Jon DuBois,
MD, the center’s medical director. “The
Mass General Cancer Network is spearhead10
ing this movement. It is what patients in the
community have waited for.”
With phase one of the project completed this
summer, patients began coming for appointments in the new clinical oncology unit on
the second floor of the John Cuming
Building. By year’s end, the new Naka
Infusion Center, located next door, will be
completed. It will combine the existing
Naka Infusion Center with cancer infusion—
medication administered intravenously,
through an IV—into one integrated space.
“Our current cancer infusion center is a
communal space with 15 chairs,” says
Gerald Browne, RN, nurse manager of the
new Naka Infusion Center. “The new center
will accommodate 18 private and semi-private rooms. We know that some patients
like to visit with each other during treatment; they can do that by opening the curtain that separates them. Those who prefer
privacy and quiet can have it.”
The expanded center will have a lounge area
for use by family and patients who want to
walk over with their IV poles. The larger
space also will have offices available for
dietitians and social services staff.
More than ever, cancer treatment is customized—in many cases, thanks to sophisticated genetic testing of the tumor. As a
result, some patients are able to have targeted therapy, which often is in pill form.
“We’re excited about the oral therapies we
can offer our patients, but we still rely heavily on chemotherapy,” says Dr. DuBois.
The variety of treatments is striking. “Today
we use Velcade, an injectable drug, to treat
multiple myeloma,” says Mr. Browne.
“Those patients are in and out in ten minutes—very different from those with lymphoma, who might be on a five-medication
therapy that takes six to eight hours to administer.” Side effects and complications,
as well as the nature of the disease itself,
Levi+Wong Design Associates
Until now, Naka Infusion Center nursing staff
have mainly cared for individuals who require hydration, antibiotics or treatment for
conditions such as Crohn’s disease or rheumatoid arthritis. The staff all now have advanced, certified skills in caring for cancer
patients. “That means we’ll have a larger
staff of oncology-certified nurses who can follow patients through both the inpatient and
outpatient experience,” notes Dr. DuBois.
The new Naka Infusion Center, scheduled to open later this year, will include cancer infusion and accommodate 18 private and semi-private rooms.
Mass General expert staff located right here
at Emerson. As cancer treatments evolve,
we are pleased these kinds of programs are
becoming possible.”
A unit that supports “the art of nursing”
Patients will benefit from a unit that allows
them to choose between privacy or socializing. The unit’s traffic patterns will change,
notes Amy Carr, RN, an infusion center
nurse. “We’re excited about caring for pa-
“When a patient arrives on that first day, I say ‘Welcome;
I’m going to care for you. Believe it or not, this really
isn’t going to be a bad day.’”
– Amy Carr, RN
infusion center nurse
potentially keep patients at the center while
nursing staff manage their symptoms.
“We want the environment to be more conducive to the patient who is here for several
hours,” says Dr. DuBois, “especially those
who are quite sick.”
tients in the new unit. We’ll be going to the
patient more, especially when they are in
the patient lounge. I can accomplish a lot
when I’m sitting between two patients, because I’m able to assess them to see how
they’re tolerating their medication.”
Once the renovation is complete, Dr. DuBois
says he looks forward to the center’s ongoing
evolution. “We plan to further develop our
treatment programs,” he explains. “Our goal
is to provide state-of-the-art multidisciplinary care for each type of cancer, with
This is especially important when someone
begins taking a new drug, she adds. “We
need to know how the patient is tolerating it,
so we watch for potential reactions, such as a
change in their complexion or rapid breathing. This is the art of nursing: seeing things
before the patient does so that you can do
something. When it comes to side effects,
we’d rather observe a spark than a fire.”
The personalized nursing care is seen in
how Ms. Carr introduces herself to patients
who arrive for their first day of chemotherapy. “They think they are going to get sick
and lose their hair, so they feel alone and
scared,” she explains. “They don’t realize
we have tools today to treat those side
effects, and they don’t realize how much
support we’ll give them.
“When a patient arrives on that first day,
I say ‘Welcome; I’m going to care for you.
Believe it or not, this really isn’t going to be
a bad day,’” she says. “I provide education,
make them comfortable and, when they’re
heading home, I ask how it went. They
always tell me it went so much better than
they thought it would. They begin to see
that we don’t provide just the standard care;
we provide individualized care.”
That focus on the individual patient is a
hallmark of the Mass General Cancer Center
at Emerson Hospital-Bethke, says
Dr. DuBois. “We believe the center will
experience future growth, but we’ll never
abandon our roots. We’re not going to lose
the personal touch that our patients
appreciate.”
11
OnCall
Emerson Hospital is pleased to introduce the following new clinicians.
GASTROENTEROLOGY
NEUROLOGY
Lauren Bleich, MD, MPH
Anya Turetsky, MD
Middlesex Gastroenterology Associates
45B Discovery Way
Acton, 978-226-1351
middlesexdigestive.com
3 Accepting new patients
Emerson Neurology Associates
131 Old Road to Nine Acre Corner, Suite 490
Concord, 978-287-8980
emersonhospital.org
3 Accepting new patients
Dr. Bleich earned her medical degree from Tulane
University School of Medicine. She completed her
residency in internal medicine at Lahey Clinic Medical
Center and a fellowship in gastroenterology at Bridgeport Hospital in New Haven, part of Yale-New Haven
Health. Dr. Bleich is board-certified in internal
medicine and gastroenterology.
Clinical interests: Inflammatory bowel disease and
gastroenterology
Dr. Turetsky received her medical degree from St.
George’s University School of Medicine. She completed her residency in neurology at the University of
Massachusetts and a fellowship in neuromuscular
medicine at the University of California Los Angeles.
Dr. Turetsky is board-certified in neurology.
Clinical interests: Neuropathy and muscle diseases,
including myasthenia gravis and ALS
ORTHOPEDICS – ADULT AND PEDIATRICS
INTERNAL MEDICINE
John Cahoy, MD, PhD
Natalie Cohen, MD
Orthopedic Affiliates
54 Baker Avenue Extension, Suite 200
Concord, 978-369-5391
3 Accepting new patients
Acton Medical Associates
321 Main Street
Acton, 978-635-8700
actonmedical.com
3 Accepting new patients
Dr. Cahoy earned his medical degree and doctoral
degree in developmental biology from Stanford University. He completed his residency in orthopedics at
the Harvard Combined Orthopedic Residency Program
and a fellowship in pediatric orthopedics at Children’s
Hospital Los Angeles.
Clinical interests: Pediatric upper and lower extremity
fractures, comprehensive pediatric orthopedic care,
foot and ankle injuries and deformities, treatment of
athletic injuries and non-operative management of
adolescent scoliosis and spine conditions
Dr. Cohen earned her medical degree from the University of Massachusetts Medical School and completed
her residency in internal medicine at the University of
Michigan Hospital System. Dr. Cohen is board-certified
in internal medicine.
Clinical interests: Geriatrics, women’s health, preventive medicine, healthy living and medical education
MATERNAL-FETAL MEDICINE (HIGH-RISK PREGNANCY)
Kathryn Johnson Gray, MD, PhD
Brigham and Women’s Hospital
133 Old Road to Nine Acre Corner
Concord, 978-287-3180
emersonhospital.org
3 Accepting new patients
12
Dr. Gray received her medical and doctoral degrees
from the University of Michigan. She completed a residency in obstetrics and gynecology at Emory University
and a combined fellowship in maternal-fetal medicine
and clinical genetics at Brigham and Women’s
Hospital, Massachusetts General Hospital and Boston
Children’s Hospital. Dr. Gray is board-certified in
obstetrics and gynecology and clinical genetics.
Clinical interests: Prenatal genetics, fetal anomalies,
preeclampsia and postpartum hemorrhage
PEDIATRICS
Megan Church, MD
Pediatrics West
133 Littleton Road, Suite 101
Westford, 978-577-0437
pediatricswest.com
3 Accepting new patients
Dr. Church earned her medical degree from the University of Massachusetts Medical School. She completed
her residency in pediatrics at Mass General Hospital for
Children. Dr. Church is board-certified in pediatrics.
Clinical interests: Newborn care, early childhood
development, preventive medicine, patient education/
counseling, asthma management, urgent care,
allergies and obesity
PEDIATRICS, CONT’D
URGENT CARE
James Daly, MD
Joseph Palomba, MD
Pediatrics West
133 Littleton Road, Suite 101
Westford, 978-577-0437
pediatricswest.com
3 Accepting new patients
Emerson Urgent Care at Hudson
38 Highland Commons East
Hudson, 978-287-8990
emersonhospital.org
Emerson Urgent Care at Hudson is expected to open
this winter.
Dr. Daly received his medical degree from Chicago
Medical School. He completed his pediatric residency
at Children’s Hospital of Wisconsin. Dr. Daly is boardcertified in pediatrics.
Clinical interests: Well-child care, childhood obesity
and children with complex medical issues
Dr. Palomba received his medical degree from Georgetown University School of Medicine and completed his
residency at the University of Massachusetts Medical
Center. Dr. Palomba is board-certified in emergency
medicine and family medicine and is medical director
of urgent care at Emerson.
Clinical interest: Urgent care
PSYCHIATRY
Sasikala Manavalan, MD
Monisha Sarin, MD
New England Center for Mental Health
119 Russell Street, Suite #30
Littleton, 978-679-1200
nementalhealth.com
3 Accepting new patients
Emerson Urgent Care at Hudson
38 Highland Commons East
Hudson, 978-287-8990
emersonhospital.org
Emerson Urgent Care at Hudson is expected to open
this winter.
Dr. Manavalan received her medical degree from Sri
Ramachandra Medical College and Research Institute
in India. She completed her residency in psychiatry.
She is board-eligible in psychiatry.
Clinical interest: Women’s health, mood disorders,
schizophrenia, bipolar disorder
Dr. Sarin earned her medical degree from Maulana
Azad Medical College in India. She completed her
residency in family medicine at the University of
Massachusetts Medical Center and a residency in obstetrics and gynecology at Delhi University. Dr. Sarin
is board-certified in family medicine.
Clinical interest: Urgent care
PULMONOLOGY
Rupen P. Amin, MD
Mass Lung and Allergy
131 Old Road to Nine Acre Corner, Suite 410
Concord, 978-341-8660
masslung.com
3 Accepting new patients
Dr. Amin earned his medical degree from Wake Forest
University School of Medicine. He completed his residency in internal medicine and fellowship in pulmonary
and critical care medicine at Indiana University School
of Medicine. Dr. Amin is board-certified in internal
medicine and pulmonology and is board-eligible in
critical care.
Clinical interests: Interstitial lung diseases, sarcoidosis,
pulmonary infections, thoracic oncology, interventional
pulmonology, COPD and asthma
UROLOGY
John Libertino, MD
Emerson Urology Associates
131 Old Road to Nine Acre Corner, Suite 460
Concord, 978-287-8985
3 Accepting new patients
Dr. Libertino earned his medical degree from Georgetown University School of Medicine. He completed
his residency in urology at Yale-New Haven Medical
Center. Dr. Libertino is board-certified in urology.
Clinical interests: Urologic surgery, adrenal cancer,
renal cancer, bladder cancer, continent diversion
surgery, prostate cancer, urethral cancer and testes
cancer
13
News from Emerson
lishing Tony Rinaldo Photography in
1989, he has worked with a long list of
clients in New England and beyond—
universities, corporations and hospitals, including Emerson—while also
taking beautiful artistic photos. The
current exhibition features still life
and landscape photographs. A reception will be held at Emerson Medical
at Sudbury, located at 490 Boston Post
Road (Route 20 in Chiswick Park) on
Thursday, November 10, from 5:007:00 pm.
Cantu Concussion Center receives $1 million-plus grant
The Dr. Robert C. Cantu Concussion Center recently received a grant
for $1,025,000 from the Oak Foundation in Switzerland. The funds
will be distributed over a three-year period to improve patient access
to timely concussion diagnosis and management, advance clinical research on rehabilitation and post-concussion syndrome and support a
wide range of community outreach/education on concussion and
concussion management.
David Green, MD, is honored by the Home Care Alliance
David Green, MD, a pulmonary medicine
physician with Emerson and Harvard
Vanguard Medical Associates, was named
Physician of the Year by the Home Care
Alliance of Massachusetts. Dr. Green created
the Chronic Lung Disease Program at Emerson
Hospital Home Care and continues to meet
with home care staff to discuss how to improve patient care.
Tony Rinaldo’s photography is on view in Sudbury
The work of Concord photographer, Tony Rinaldo, is being exhibited
at Emerson Medical at Sudbury through December 12. Since estab-
Emerson is a “Most Wired Hospital”
The American Hospital Association’s Health Forum named Emerson
a “Most Wired Hospital” for 2016. Only seven Massachusetts hospitals earned the distinction, which is based on how hospitals leverage
information technology to improve performance in the areas of quality and safety, clinical integration, infrastructure and business and
administrative management. Emerson’s technology is at the forefront of most community hospitals in the U.S.
Mary Wheble knows Emerson well and gives generously
Emerson
fills a big
need, says
Mary Wheble
of Bedford.
If it’s Wednesday, Mary Wheble is at the
information desk in Emerson’s front lobby.
“I look forward to Wednesday,” says the
Bedford resident, who has volunteered at
Emerson for 17 years.
Mrs. Wheble enjoys helping people with
anything that comes up, from providing
directions to a doctor’s office to helping with
14
parking details. She has gained a perspective
on how Emerson cares for its patients, such
as when a woman and her young daughter
were leaving after an appointment. “They
stopped at the desk to show me the toys she
received,” says Mrs. Wheble, referring to
the coping kits that Emerson’s Pediatric
Intervention Team gives to pediatric patients.
She has her own reasons to appreciate
Emerson, including the primary care she
receives at Acton Medical Associates and
her hip replacement surgery, which was performed by Donald Driscoll, MD. “My two
grandsons were born at Emerson, and Ray
Tripp is my nephew,” she says of a widely
admired pediatrician who retired in 2011.
She is a long-time donor to Emerson’s
Annual Appeal. “I give regularly to the
Annual Appeal,” she says. Mrs. Wheble
sees the progress at Emerson, including
the growth of programs that the Annual
Appeal supports. “During the years I’ve
known Emerson, it’s grown in size and sophistication. They constructed the wellness
center a couple of years ago; it’s so popular
that it’s outgrown its space.”
She has a track record of generous giving,
including making gifts that named a room in
the hospital’s Cardiac Care Unit for her late
husband, Arthur Wheble, and a room in the
PACU (post-anesthesia care unit). “Before
that, I set up a charitable remainder trust,”
says Mrs. Wheble, referring to a popular
planned giving vehicle.
She is an Emerson corporator and happy to
serve as an ambassador around Bedford. “I
often have an opportunity to talk about
Emerson, and I tell people what’s going on
there. I know that Emerson fills a big need.”
Penelope Maynard
‘‘
Making steady progress
after a stroke
Penelope Maynard was in a familiar place—on the back of a horse—last
November when she suffered a hemorrhagic (bleeding) stroke that left her with
left-side paralysis. After a hospital stay and initial rehabilitation, the Groton resident, who is 74, began receiving therapy from a team at Emerson’s Center for
Rehabilitative and Sports Therapies. Nicole Finch, MS, OTR/L, occupational
therapist, performed Mrs. Maynard’s initial assessment and was soon joined by
Naseem Chatiwala, DPT, NCS, neuro specialist. They later suggested that Joy
Walsh, MS, CCC-SLP, speech therapist, become involved. Thanks to this collaborative approach, Mrs. Maynard understood the stroke’s impact, has been able
to set and reach goals and remains optimistic.
“My health was phenomenally good, so the doctors couldn’t figure out why
I had the stroke. There’s no family history of stroke, and I don’t have high
blood pressure. I’ve always exercised a great deal; I’m outdoors all day.
I grew up in Kenya, where I rode a horse to school, and I worked as a garden
designer for many years.
“It seems I had the stroke while riding through the woods. I fell off the
horse and broke three ribs, but because of the left-side paralysis, I never felt
any pain. I was terribly lucky. And I had no problem with my vision, which
also was fortunate.
“When I got to Emerson for rehab, I met Nicole, who determined what I
needed. Then Naseem began my physical therapy; she said we needed to
build back the muscles in my left arm and left leg. Having a stroke is like
being a child again. I’ve had to teach myself all over again how to walk—
using my brain to get my legs to work.
“I was given a splint for my wrist and began regular electrical stimulation
sessions for my arm and leg. Naseem also watches my balance. She keeps
changing my exercises, adjusting my therapy to what I need and gives me
exercises to do at home. When I met her, I was walking about 500 steps a
day; three months later, I’m up to 3,000.
“At one point, Nicole and Naseem suggested I see Joy for speech therapy.
It was a strain for me to speak, and my voice had no expression; it was
monotone. Joy identified the problem; I needed to relax my neck and torso
muscles so that my voice worked better. We read plays together, which was
a wonderful exercise. I’m much more comfortable now.
“I believe I’ll get back to
where I was, because I’m
getting stronger all the time,”
says Penelope Maynard, who
suffered a stroke that left her
with left-side paralysis.
‘‘
In my
OWN
voice
“There was another problem they identified: left side neglect. Because my
left side wasn’t working, I wasn’t looking in that direction. Nicole and
Naseem continue to work on that problem, because they don’t want me to
trip or fall. That’s one of the phenomenal things about the Emerson rehab
staff: they work together to be sure you receive all the therapy you need. If
you have a stroke, you need to pursue all the treatment that is offered.
“I believe I’ll get back to where I was, because I’m getting stronger all the
time. There are moments when I feel a bit depressed, but I’m incredibly
positive; I’ve always been like that. I’m lucky to have my husband, John,
who is always encouraging me, and the Emerson therapists, who are so upbeat and always smiling.
“One day, I went to my therapy session with Naseem, and she had set up a
bench that I could straddle. Then she said ‘Now I know you’re ready; I want
you to start riding again.’ Because I’ve been riding all my life, Naseem felt it
would be good therapy, as long as someone leads the horse. I was so excited I nearly fell off the chair.
“Soon after the stroke, someone asked me what I wanted to achieve. I said:
I want to stand up at the table and then walk. I can do that, so now I have
other aims—to be able to use my arm to get back to gardening and my
greenhouse.”
15
133 ORNAC, Concord, MA 01742
978-369-1400
emersonhospital.org
HealthWorks, published by Emerson Hospital, is
mailed to residents in the hospital’s service area
and is distributed to the employees and physicians’
offices affiliated with Emerson Hospital.
If you would prefer not to receive such mailings in the
future, please let us know by calling 978-287-3458 or
send an email to [email protected].
Emerson Hospital President and CEO
Christine C. Schuster
HealthWorks Magazine editorial staff
Christine Gallery, Bonnie Goldsmith, Leah Lesser
Writer
Laura Duffy
Photography
Tony Rinaldo
Design and Printing
Fassino/Design and Signature Printing & Consulting
The information included here is intended to educate
readers about health issues, but it is not a substitute for
consultation with a personal physician.
The mission of Emerson Hospital is to deliver
high-quality care to our community that is safe,
compassionate, accessible, appropriate, efficient
and coordinated.
Join our online community at
and emersonhospital.org
More options for weight loss surgery
information sessions
they include new locations and attending online
Upcoming info sessions
October 19
October 26
November 1
November 2
November 5*
November 16
December 7
December 13
Emerson/Concord
Nashua
Leominster
Emerson/Concord
Emerson/Concord
Emerson/Concord
Emerson/Concord
Leominster
Info sessions are held from 6:00-8:00 pm unless
otherwise noted.
* Session will be held at 10:00 am-12 noon.
Locations include:
Emerson Hospital
133 ORNAC, Concord, MA
DoubleTree by Hilton Leominster
99 Erdman Way, Leominster, MA
As those who are familiar with the Emerson
Center for Weight Loss know, step one
is attending a free, two-hour information
session. The sessions are now available
in three locations—at Emerson Hospital
in Concord, in Leominster and in Nashua,
New Hampshire (see addresses at left).
The Concord and Leominster info sessions
also are available online.
Radisson Hotel
11 Tara Blvd., Nashua, NH
During the info session, one of the center’s
bariatric surgeons, either Laura Doyon, MD,
or David Lautz, MD, medical director, provides an overview of the program, describes each type of bariatric surgery, along with their risks
and benefits, and answers questions.
The online info sessions feature live audio and the presenter’s slideshow. After registering for
the online option, a link and password will be mailed out within two days. For more information
or to register, please call 978-287-3532 or visit emersonhospital.org/weightloss.
Front cover: A big bellyache turned out to be appendicitis, for which Theo Kollias of Bedford
received great care at Emerson.