Task Force Unites Community to Break Down Barriers

MedStar Harbor Hospital is fully committed to meeting the healthcare needs of its community. But knowing exactly what those needs are, and putting the right programs and services in place to meet them, can require a bit of research.

That’s the focus of the MedStar Harbor Hospital Community Health Needs Assessment Task Force, which brings hospital leaders and physicians together with representatives from the Baltimore City Health Department, Baltimore City government, and other local non-profits, for open discussion and dialogue about healthcare resources that exist, or don’t but need to, in our community. Along with these discussions, the task force collects insight from the public through surveys and community input sessions.

“MedStar Harbor is one of the anchor institutions in the city for healthcare services,” says Ryan Moran, who serves as the hospital’s director of Community Health. “It’s important that we assess what people are experiencing in a way that directly involves them and then respond to fill those gaps.”

Most recently, the task force identified an increasing need for behavioral health and chronic disease management services in the communities that surround MedStar Harbor. Moran says that the hospital is putting new programs and resources in place in response to this. One of the most significant investments has been the development and launch of a Peer Recovery Coach Program. This program is designed to provide support, guidance, and a path to recovery for individuals with substance abuse or addiction issues.

Jerry Gross is one of three peer recovery coaches the hospital now employs through grant funding from the Baltimore Population Health Workforce Collaborative. If and when a patient screens positive for substance use in the Emergency department, Gross’ job is to engage that person in a supportive, no-judgement conversation. He attempts to first gain their trust by explaining that earlier in his life, he was in their shoes.

“Fifteen years ago, I was addicted to drugs and alcohol, and I lost everything because of it,” Gross explains. “I got help and turned my life around. And now I am so fortunate that I get to help others. Being able to make that first connection with someone is so important. That’s what I needed a long time ago. And that’s what I am giving now.”

Moran says that MedStar Harbor offers a number of health education programs and classes to give people additional resources to help them prevent and manage chronic diseases and pursue healthier lifestyles.

“By creating better access to care, we can play a significant role in helping people get well and stay well,” said Moran. “That is what the Community Health Needs Assessment Task Force is really setting out to accomplish.”

In addition to the Emergency department, peer recovery coaches provide services in the inpatient behavioral health and mother and infant services units.

Dedicated Nurse Leader Retires After 45 Years

It was more than 45 years ago when Lenora Addison, RN, BSN, MA, first stepped foot into South Baltimore General Hospital— now MedStar Harbor Hospital—to begin learning how to take care of patients. She was a student at Mergenthaler Vocational-Technical High School aspiring to become a nurse. By the time Addison earned her high school diploma, she had satisfied the requirements to become a licensed practical nurse (LPN) and knew she’d found her true calling.

“I had fallen in love with taking care of people who are sick,” says Addison. “I was born to be a caregiver.”

For her first eight years as a licensed nurse, Addison worked on the hospital’s oncology unit. Eager to advance in her career, she took advantage of the tuition reimbursement program to continue her nursing education. She also pursued any opportunity to further develop both practical and leadership skills. Over time, she worked in every division of nursing and was appointed to an interim vice president role, which eventually led to her being named Vice president of Patient Care Services and chief nursing officer.

“Without a doubt, my journey taught me the importance of embracing change,” Addison says. “But regardless of where I was working or the title I held, it’s always been about taking care of people. No matter where I was standing or what I was wearing, I always have been and always will be a nurse first.”

Addison’s longevity at MedStar Harbor, combined with her commitment to excellent patient care, safety, and outcomes, earned her a reputation as one of the organization’s most valuable leaders. Stuart Levine, MD, who took over the role of president and chief medical officer in 2017, says that Addison played a significant role in shaping the hospital into what it is today.

“The members of our team who work directly with our patients all answered to Lenora for many, many years. She was the leader responsible for patient care and experience and she dictated the ‘tone’ of our hospital,” he notes. “She’s been a positive role model for so many people because she is a strong strategic thinker who is also a fierce advocate for nursing teamwork and safety. And she is well-liked, and that means a lot. When she speaks, people listen. She earned that respect.”

So, it was with mixed emotions that Dr. Levine and the rest of the team at MedStar Harbor bid farewell to Addison on April 1 as she ventured into the next phase of life: retirement.

“Lenora was a consistent and stabilizing force for our hospital for more than four decades,” says Jill Johnson, vice president of Operations. “Her imprint can be seen in every corner of the organization and will always remind us of her great commitment and leadership. We will certainly miss her.”

Thinking back on her career, Addison is proud of her accomplishments and feels fortunate that she was able to devote her working years to a single organization that truly valued her talents.

“One of the happiest times in my life was when my career was first beginning,” says Addison. “Over the years, I held jobs that I loved. I got to take care of so many people. I got to teach others how to take care of people. And now, I feel an equal level of happiness as I end my career. A door is opening for me to spend more time with my family and relax a bit.”

Addison plans to travel with her husband of 41 years, Leonard, and take time for the simple things in life during her best years to come. She is looking forward to taking part in grandparents’ day at her grandchildren’s school and will be spending a lot more quality time with her two sisters, who are also retired and live nearby.

“You reach a point in your career when you know the time is right to hand it all over,” said Addison. “I will always remember the experiences I have had and the people I’ve worked with, but the time is right. I am ready for this next chapter to begin.”

When EMS arrives on the scene of a medical emergency, the first things they often check are patients’ pulse and blood pressure. But patients with left ventricular assist devices (LVADs) don't have either!

An LVAD is a heart pump that takes over the function of pumping blood to the body for individuals with heart failure. In the mid-1990’s, LVADs were a new treatment for patients with heart failure who were waiting for a transplant. Back then, we had just a few LVAD patients—our surgeons implanted about five to 10 LVADs per year. LVADs were used as a bridge therapy to keep patients with heart failure alive until they got a heart transplant. After 2001, we started to implant LVADs into patients who are not going on to heart transplant as a way to keep heart failure patients alive.

Today, our surgeons implant about 90 LVADs a year, and these patients require special care in the event of medical emergencies. I’ve been a VAD coordinator for more than 20 years, and a large part of my role is to train emergency medical services (EMS), or first responders, in techniques to care for LVAD patients.

Why do LVAD patients need special EMS care?

Today’s LVAD pumps are palm-sized and have a cable that connects to leads outside the body. An impeller within the pump spins thousands of times a minute, resulting in continuous blood flow, which means LVAD patients don’t have a pulse or measurable blood pressure. The external components include a controller—the brains of the system—and batteries, which power the system.

It’s crucial that our EMS providers appropriately assess these patients. For example, if an LVAD patient became unconscious due to low blood sugar, that patient would not have a pulse. Usually an EMS provider would give chest compressions to a patient without a pulse, but an LVAD patient doesn’t need chest compressions. The LVAD is circulating the blood around the body continuously.

How we train EMS providers in LVAD protocol

There are only about 500 VAD coordinators in the world and about 155 hospitals in the United States that implant LVADs, so it is challenging to train community providers. The mission now is to inform EMS providers that a pulseless state is normal for LVAD patients, which is unique from nearly any other condition. This task was easier when we had a small volume of patients. But as our patient volume grew, my original goal to get out to every fire station, on all three shifts, and train EMS providers and paramedics became impossible.

Recognizing this gap in education for EMS, MedStar Heart & Vascular Institute and other heart care centers collaborated to create EMS field guides and quick reference cards for EMS providers to help them respond appropriately when they encounter VAD patients. Some of these LVAD fast facts and materials include:

• The patient won’t have a pulse or blood pressure
• Pictures of the external components and how to interface with them
• Steps to change the battery on five devices

This information is also posted on MyLVAD.com, a website we created for the LVAD community championed by Dr. Steven Boyce, surgical director, Advanced Heart Failure Program at MedStar Heart & Vascular Institute.

When I train first responders at regional EMS meetings, I always promote the field guides, so EMS leaders can prepare their teams to care for LVAD patients. We run on-site simulations with actual VAD patients and use debriefing to discuss what worked and what didn’t. Our team strives to provide best practices to our EMS partners in the community.

We also train and follow up with our LVAD patients to prepare them to care for themselves when they go home or when they travel. We see patients in clinic routinely and keep their addresses current to communicate to first responders should an emergency arise.

As LVAD patient volumes increase, my VAD coordinator colleagues and I continue to keep a finger on the pulse—or lack thereof!—of LVAD awareness among EMS providers. Together, we’re working to help more patients get appropriate emergency care.

When cancer is a concern, you want the very best care possible. At MedStar Good Samaritan Hospital and MedStar Union Memorial Hospital, we have long been committed to providing the highest quality cancer care. As part of MedStar Health Cancer Network, we are fortunate to have significant resources that we can tap into to effectively meet the unique needs of each patient.

Now, to make access to the region’s top cancer specialists and resources even more convenient, the oncology services at both hospitals have been brought together, with our providers relocating to a newly expanded and renovated 7,800-square-foot cancer center called MedStar Franklin Square Cancer Center at Loch Raven Campus. Located on the grounds of MedStar Good Samaritan, it’s a move that benefits patients and providers alike.

“Integrating our oncology services concentrates our clinical experts in one physical location, enhancing our multidisciplinary care model and further ensuring that patients get the comprehensive and personalized care they need,” says Charles Padgett, MD, chief of Medical Oncology at the new cancer center.

“In addition, the new facility is larger than the spaces previously occupied by our providers, creating a more efficient and effective environment. It’s a much better place for patients to receive care and for us to provide it,” he adds.

Marcia Griffin agrees. The 46-year-old started seeing her oncologist, Medical Director Mahsa Mohebtash, MD, at MedStar Union Memorial late last year after her breast cancer, which had been in remission for seven years, returned when she got pregnant. She was treated there for several months before transitioning to the new cancer center.

“The new center is so much nicer and larger, and the amenities are wonderful. Everyone has their own space…it is very comfortable,” Griffin says. “The best part for me is that I am cared for by the same team that took care of me at MedStar Union Memorial. My nurses in the infusion center are wonderful and I feel like I have a relationship with each and every one of them.”

“Every member of our team understands that quality of life, emotional support, and treatment options are key to successfully treating cancer,” Dr. Mohebtash explains. “Our focus is on the individual needs of each patient and making treatment as comfortable and stress-free as possible. All of our nurses are oncology-certified and play a proactive role in helping cancer patients avoid complications and discomfort from symptoms and the side effects of treatment.”

Also, coming in October of this year to the campus of MedStar Good Samaritan is the new Breast Center, dedicated to providing exceptional breast health services. Led by Maen Farha, MD, medical director, the new state-of-the-art facility will offer customized care from an expert team—all in one convenient location.

“We will provide a positive environment featuring the latest diagnostic technology and clinical services, as well as expedited appointments and results,” Dr. Farha notes.

“Our multidisciplinary approach to care gives patients access to their care team in one session, rather than having to go from one office to another getting confused. This team specializes in developing personalized treatment plans tailored to each patient’s specific situation. Not only do they understand the medical intricacies of effective treatment, they understand the importance of emotional and compassionate support,” he says.

“The most effective diagnosis and treatment plans require state-of-the-art, cancer-fighting resources,” adds Dr. Padgett. “That’s exactly what you’ll find at MedStar Franklin Square Cancer Center at Loch Raven Campus. We have some of the area’s finest minds in medicine, who, armed with state-of-the-art technology and access to the latest research and clinical trials, work together with patients and their families to ensure the best possible outcomes.”

For more information about our cancer services or a physician referral, visit MedStarCancer.org/CancerCenter or call 443-444-2273. Free screenings for breast, cervical, and colorectal cancers are available for eligible individuals. Call 410-350-2001 to see if you qualify.

This article appeared in the summer 2018 issue of Destination: Good Health. Read more articles from this issue.

For years, patients with celiac disease or gluten sensitivity have had to limit their diets to eliminate gluten, a protein found in wheat, barley and rye. If they didn’t, they’d run the risk of suffering chronic diarrhea, bloating and other unpleasant symptoms. This limited diet drove people to have to purchase expensive, specialized foods that often are highly processed. To make matters worse, no medications for celiac disease are approved by the Food and Drug Administration as of spring 2018.

However, a promising new drug, Nexvax2^TM, is headed into phase two clinical trial that targets the HLA-DQ2.5 immune recognition gene, which approximately 9 out of 10 celiac patients carry. Not everyone with the gene will develop celiac disease—it’s a complex condition with many unknown factors. And, frankly, it’s a little too early to celebrate the new drug. While it’s exciting progress for the celiac community, many drugs that enter phase two clinical trials don’t make it to market.

As researchers work toward an effective treatment and hopefully a cure, it’s vital for patients with celiac disease to understand that gluten avoidance should still be at the forefront of their minds. This includes eating at home, eating at restaurants and avoiding cross-contamination to prevent symptoms and long-term damage from celiac disease.

LISTEN: Dr. Lee discusses celiac disease in the Medical Intel podcast.

Symptoms of celiac disease

The symptoms of celiac disease easily can be mistaken for symptoms of other conditions. This can be frustrating for patients and doctors alike. Common symptoms include:

• Brain fog or confusion
• Chronic diarrhea
• Headache
• Iron-deficiency anemia
• Joint pain
• Rashes
• Unintended weight loss
• Vitamin deficiency

Further, people with wheat allergies or gluten sensitivity not related to celiac disease also might experience these symptoms. It’s important to see a gastroenterologist to pin down the correct diagnosis and prevent worsening of symptoms or long-term damage. Unfortunately, the best way to determine whether you have celiac disease or another condition is to gauge your body’s reaction to gluten.

Preparing for celiac disease testing

Even if you’ve been avoiding gluten, a gastroenterologist might recommend daily gluten intake for a period of time leading up to your appointment to ensure we make the right diagnosis. Testing for celiac disease might include some of the following techniques, based on your symptoms and health history:

• Blood test
• Genetic test
• Intestinal biopsy
• Skin biopsy
• Physical exam

If you’re diagnosed with celiac disease or another gluten-related disorder, consider working with a dietitian to discuss how to balance a gluten-free diet. Some patients have dealt with vitamin and iron deficiency for so long that they might need special care to heal and prevent future concerns.

Our gastroenterology team has seen many celiac success stories over the years. I vividly remember treating a man who was emaciated—he’d lost substantial weight because, after years of suffering with abdominal distress, he could hardly eat anything without getting sick. When he was referred to our gastroenterology care team, we diagnosed him with celiac disease, and he was relieved to finally have an answer. His doctor and dietitian helped him learn what he could eat, how to check his vitamin levels and how to get appropriate follow-up care. Over time, he returned to a healthy weight and is doing much better today. It was amazing to see him return to his normal life. I only wish he’d come to us sooner!

Hope for people with celiac disease

Though we need more research into celiac disease treatment, there is a light at the end of the tunnel. Today’s consumers can enjoy a wide variety of gluten-free foods and drinks that weren’t available just 10 years ago. Even many restaurants are able to safely offer gluten-free options. While this progress is wonderful for patients and impressive to me as a doctor, we have to remember to always be mindful of gluten exposure.

Healthcare providers know that gluten-related conditions are real and that going gluten-free is not a passing trend or a fad diet. Unfortunately, some people treat it as such, and others don’t take people seriously when they truly have a gluten-related condition. The danger is that patients with an actual condition might be thoughtlessly or accidentally exposed to gluten, which can cause severe, long-lasting symptoms.

If you’ve experienced digestive symptoms and suspect you may have celiac disease or a gluten-related condition, talk to your doctor. We want to help you reduce your symptoms, prevent long-term damage and lead a higher-quality life.

Imagine the triumph of surviving breast cancer. Every test and procedure, every round of therapy was worth it to save your life. But what is a woman to do if the medication that destroyed her cancer cells had caused another serious health condition: a weakened, damaged heart?

This is a situation that women with HER2-positive breast cancer used to face when they were treated with targeted therapies. HER2-positive breast cancer has higher-than-normal levels of a protein called HER2 (human epidermal growth factor receptor). Early forms of targeted medications that hunted and destroyed these proteins also unfortunately caused significant heart problems, including weakening of the heart and heart failure.

While defeating cancer is considered a successful therapy, we never want treatment to endanger our patients’ lives. My cardio-oncology colleagues and I are specialized cardiologists who work closely with cancer doctors and patients with HER2-positive breast cancer to give effective cancer care while protecting their hearts as much as we can. In fact, today’s HER2-targeted therapies are now considered one of the safest cancer treatments for these patients. Less than two to three percent of patients will actually develop any symptoms of heart failure while on HER2-targeted therapy for breast cancer.

How we protect the hearts of HER2-positive breast cancer patients

Before treatment begins, we use echocardiograms to measure how a patient’s heart may be affected by their breast cancer therapy. We’re looking at the heart’s ejection fraction, or how much blood leaves the heart with each heartbeat. About 10 to 15 percent of patients with HER2-positive breast cancer have decreased ejection fraction during targeted therapy. That sounds like a lot, but many of those never show any noticeable symptoms, and the changes are often reversible.

Related research: Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline

During treatment, we continue to monitor heart function with echocardiograms. Close monitoring gives us an early warning if something is wrong, so we can start patients on medications right away. Beta blockers or diuretics can help improve the heart’s blood-pumping ability and keep their symptoms from becoming more serious. Without this specialized cardio-oncology care, heart damage can lead to patients needing a left-ventricular assist device (LVAD) or even a heart transplant.

Current Food and Drug Administration (FDA) guidelines recommend that patients with abnormal heart function at the start of breast cancer treatment don’t receive HER2-targeted medications. At MedStar we designed an investigator-initiated study that investigates the safety of HER2-targeted medications in patients whose heart shows signs of mildly decreased function (the SAFE-HEaRt trial). We hypothesized that treatment may be safely continued with close observation by cardiologists and initiation of cardiac medications. This clinical study was conducted in collaboration of oncologists at MedStar Washington Hospital Center, MedStar Georgetown University Hospital, and Lombardi Comprehensive Cancer Center as well as Memorial Sloan Kettering Cancer Center in New York. The study completed enrollment in December of 2017 and the results will be announced later this year.

Changes in cancer care have led to changes in heart care

We’ve seen massive shifts in the treatment of breast cancer in recent years. People are living longer with breast cancer, even in later stages when the disease has spread. A number of my patients have been on HER2 therapy for 10 to 15 years, and many continue working while they take the medication. In many cases, cancer treatment has become more like treatments for chronic diseases, such as diabetes.

That change in thinking led to cardiologists and cancer doctors partnering to consider the long-term health of the heart for patients with cancer. One such consideration is how much exercise is safe and recommended. When you’re sitting at your desk or watching TV, the heart pumps about three to four liters of blood per minute. But when you’re exercising, it needs to pump six to 10 liters in that same amount of time. If it can’t do that, you may feel short of breath when you exercise. I teach my patients who are on HER2-targeted therapy for their breast cancer to watch for this sign. They know how they should feel when they’re active, so if they notice a sudden shortness of breath during exercise that wasn’t there before, and they can’t explain why, they know it’s time to call me.

Some patients will need to be monitored more closely for their heart function during treatment, and some won’t need as much. I talk daily with my patients’ oncologists and nurse navigators, so we can work together to plan care for each patient’s specific needs.

HER2-targeted therapies are extremely effective in the fight against breast cancer. With what we’ve learned since their introduction, we’ve made sure these medications are safe for patients’ hearts as well. And with good communication among the patient, their oncologist and their cardiologist, we can keep it that way as patients continue their fight against breast cancer for years to come.