“Caring for the sick, elderly and dying in their homes truly is a privilege for us,” said Lora Clark, executive director of Floyd Memorial Home Health. “Home care services make it possible for people to stay in their homes, regardless of their condition.”

Through technological advances, home-delivered healthcare has grown far beyond basic professional nursing and homecare aide services. Floyd Memorial Home Health offers nursing, physical, occupational and speech therapy, and medical social services as well as home medical supply education and personal care. The staff is highly-trained in cardiac, diabetes, wound and post-operative care.

Floyd Memorial Home Health is accredited by the Accreditation Commission for Health Care, Inc. (ACHC). For more information, call 812-948-7447.

We are so fortunate to have the expertise of the Harvard-affiliated Joslin Diabetes Center Affiliate located on our campus. Offering board-certified endocrinologists and a team of specially-trained certified diabetes educators and nurses, the program embodies the concept of combining medical treatment, patient education and clinical research for optimal patient success.

This year also marked the 21st annual Prostate Cancer Screening sponsored by the Floyd Memorial Foundation. Our team of volunteer physicians and staff screened over 859 men in two hours on Sunday, September 27. The previous year, we screened over 820 men and detected prostate cancer in 17. For those men, a 15-minute screening became a lifesaving experience.

Finally, I want to end my column for the year on an extremely high note. Floyd Memorial has once again been recognized for its clinical achievements by HealthGrades, the nation’s largest independent healthcare ratings organization.

Here are just a few of the distinctions from the 12th Annual 2010 HealthGrades Quality in America Study:

CARDIAC

• Best Rated in Louisville/Southern Indiana* for Overall Cardiovascular Services and Surgery
• Recipient of the HealthGrades Cardiac Surgery and Cardiac Care Excellence Awards
• Ranked in the Top 3 in Indiana for Cardiac Surgery and Overall Cardiac Services
• Five-Star Rated for Coronary Bypass Surgery – Two Years in a Row
• Five-Star Rated for Treatment of Heart Attack and Heart Failure

PULMONARY

• Best Rated in Louisville/Southern Indiana* for Overall Pulmonary Care
• Recipient of the HealthGrades Pulmonary Care Excellence Award – Two Years in a Row

GASTROINTESTINAL

• Best Rated in Louisville/Southern Indiana* for GI Services, Procedures and Care
• Ranked #1 in Indiana for Gastrointestinal (GI) Surgery

ORTHOPEDIC

• Five-Star Rated for Hip Fracture Repair – Five Years in a Row

CRITICAL CARE

• Ranked in the Top 10 in Indiana for Overall Critical Care

PATIENT SATISFACTION

• 2009 Highest Recommended Hospital in the Region by Hospital Compare**

Our Mission

Floyd Memorial Hospital and Health Services delivers comprehensive healthcare to our local and extended communities with compassion, quality and excellence.

Check out our quality ratings for yourself at: www.floydmemorial.com/quality

Anticoagulation is a drug therapy that slows blood clotting to prevent the development of harmful clots. Sometimes the medications are referred to as “blood thinners.” Because the use of anticoagulation drugs, including Lovenox and Coumadin (Warfarin), require close monitoring, Floyd Memorial has started an Anticoagulation Management Services Outpatient Clinic. The goal of the Clinic is to monitor adult patients receiving anticoagulation therapy in partnership with the patient’s physician, providing a resource for physicians to improve the overall quality and continuity of care for their patients on anticoagulation therapy.

The Clinic is supervised by a physician medical director and staffed by clinical pharmacists who are highly-trained in anticoagulation management. The clinical pharmacists closely monitor patients, assess adverse reactions and counsel on regimen adherence. Patient education plays a key role as well as close interaction and follow-up with the patient’s physician. National research shows that receiving coordinated care for anticoagulation therapy can decrease the risk of negative side effects and improve patient results.

Patients interested in enrolling in the clinic should talk to the physician managing their anticoagulation therapy. For a free brochure, call 812-948-7674.

Now Floyd Memorial patients who have undergone breast MR and have detected growths have a less invasive option available. MR-guided biopsy is a new procedure that allows a radiologist to perform a tumor biopsy in the Radiology Department under local anesthetic, forgoing the need for surgical biopsy and general anesthesia (being “put to sleep”). Using MR-guidance to calculate the exact position of the abnormal tissue and verify the correct placement of the needle, the radiologist numbs the immediate area around the breast with local anesthetic, inserts a biopsy needle through the skin, advances it to the lesion and removes tissue samples for further examination under a microscope.

They are also able to leave behind a tiny “marker” that the general surgeon may use to more accurately locate the tumor in later surgeries should cancer be detected.

Benefits of MR-guided breast biopsy include:
• Little or no scarring
• Shorter procedure time
• Quicker recovery time
• Less risk after local vs. general anesthetic

Floyd Memorial’s Radiology Services includes the Women’s Imaging Center which offers the latest in digital mammography and the added comfort of Mammopads for all patients. The Center also offers a private waiting area and point-of-service registration. One of only 30 in Indiana, Floyd Memorial’s Cardiac Rehab Department received re-certification by the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR). The commendation was granted for clinical excellence in program management, personnel, documentation and patient care.

The Cardiac Rehab Department provides a medically supervised rehab program for patients who have suffered a cardiac event such as a heart attack or open-heart surgery. The program also offers a maintenance program that is offered to
the public at an out-of-pocket rate.

For more information or a free Women’s Services pamphlet, call 1-800-4-SOURCE (1-800-476-8723).

For a free Cardiac Rehabilitation brochure, call 1-800-4-SOURCE (1-800-476-8723) or visit us online at www.floydmemorial.com and request the brochure by clicking on “Contact Us.”

Deepak Azad, MD, MPH, an internal medicine physician in Scottsburg, was recently re-elected to serve as Treasurer of
the Indiana State Medical Association (ISMA), a statewide physician organization with approximately 8,400 members.
This is Dr. Azad’s third one-year term as treasurer. Previously, he served two one-year terms as assistant treasurer.

He was appointed to the Commission on Health Care Interpreter and Translators by late Gov. Frank O’Bannon. Dr. Azad
is also a member of the ISMA Physician Medicaid Task Force and has served on the organization’s Commission on Legislation.

Local Pediatrician Rides to Conquer Cancer

Stuart Eldridge, MD, a pediatrician with Physician Associates of Floyds Knobs and member of the Floyd Memorial Hospital Board of Trustees, participated in the Ride to Conquer Cancer on September 26 and 27. The ride, a two-day, 150-mile journey from Louisville to Lexington, and back, raised funds to support cancer awareness and research. As Dr. Eldridge expressed, “Great accomplishments come only through hard work, dedication and the support of family and friends. I was truly blessed to be able to participate in this event and raise over $4,200 for such a noble cause.”

“Diabetes is chronic. It’s going to be there. The education classes we offer give individuals the tools and knowledge to handle the disease. They get you recharged about taking care of yourself.”

Vasti Broadstone, MD
Board Certified Endocrinologist
Floyd Memorial Joslin Diabetes Center Affiliate

The Center opened in 1997 as Kentuckiana’s only diabetes program affiliated with the world-renowned Joslin Diabetes Center at Harvard Medical School in Boston. Joslin, a global leader in diabetes research, care and education, has been dedicated to conquering the disease for over a century.

“This is the most comprehensive diabetes program in the area,” said Sri Prakash Mokshagundam, MD, one of the renowned endocrinologists working at the center. “We have a full complement of diabetes education, counseling, weight management and endocrinologists.”

The endocrinologists work closely with the education staff, all of whom are certified diabetes educators by the American Association of Diabetes Educators (AADE), said Vasti Broadstone, MD, a Joslin endocrinologist. “Patient education is so intrinsically tied to what we do, I could hardly function without them.”

Dr. Broadstone explained that while she can tell patients how to control their diabetes, the learning process of how to do it themselves takes much more than a single office visit. “Diabetes requires you to be a pharmacist, nurse, dietitian, doctor and psychologist,” she said. “If you don’t have the right tools, you will be overwhelmed, burn out and give up.”

In addition to cutting-edge medical care, the right tools at Joslin include educational courses, which feature sessions for people newly diagnosed and those needing a refresher. Also offered are classes that help patients prevent or delay the onset of type-2 diabetes, prenatal programs and free seminars with speakers on relevant topics. Support groups, also led by certified diabetes educators, are open to all patients and their loved ones.

“The certified diabetes educators we utilize are very familiar with the way we treat our patients, and that results in more coordinated care. We view the same problem from two different perspectives.”

Sri Prakash Mokshagundam, MD
Board Certified Endocrinologist
Floyd Memorial Joslin Diabetes Center Affiliate

Pioneering the Best of What’s New

The Joslin doctors also treat other endocrine issues, such as thyroid conditions, polycystic ovary syndrome, adrenal disorders, pituitary disease and hormonal disorders. Just as patients must keep up with their education, Joslin professionals are dedicated to finding new and better ways to help them.

Vasdev Lohano, MD, FACE, an endocrinologist at the Center, is finding much success with a new kind of continuous glucose monitoring system that takes blood sugar levels every five minutes and transmits results to a beeper-size monitor. “If you’re checking only once a day, you don’t really know what’s happening to your sugar level,” he explained. “Continuous monitoring opens your eyes to what happens when you eat certain things.”

Along with using the latest monitoring tools, Joslin’s team is involved in facilitating cutting-edge clinical trials. “The trials help us keep ourselves abreast of the latest developments in our field,” Dr. Mokshagundam explained.

To learn more about clinical trials currently enrolling patients at the Joslin Diabetes Center Affiliate, call 812-981-6684.

“I learned how to properly give myself an insulin injection and when to take medications. I learned the number of grams of sugar I should have and how to spread it out.”

Diana Armstrong-Apple
Diabetes Education Patient

Armstrong-Apple, who was diagnosed with type 2 diabetes 15 years ago, found herself “trudging along” with an A1C level of 9.5 –above the optimum level of less than 7. “I had never had any education classes on diabetes,” she said. “At one time, maybe I got a piece of paper with a diet on it.” All that changed when she signed up for classes with Joslin.

“I learned so much every night,” she said. Best of all, after just three months, her A1C level had dropped to 7.2.
“It was definitely worth it,” she said, noting she is working to reduce her level even more. “They are so helpful and kind. I’d never been to a doctor or group as concerned with my health as they are.”

Education Plays Key Role at Joslin

The five certified diabetes educators at the Floyd Memorial Joslin Diabetes Center Affiliate – including two registered nurses, two registered dietitians and one registered dietitian/clinical exercise specialist–helped more than 1,000 patients last year.

“It’s most important that patients get out in a group environment,” said education program coordinator Beth Ackerman, RD, CDE. “They find out there are a lot of people out there that are just like them and have the same questions.” Joslin educators offer programs such as:

• Balance and Control: a comprehensive diabetes course offered at a variety of timeslots to accommodate nearly
any schedule
• Diabetes Refresher Course
• Classes for women with gestational diabetes
• Support groups
• Exercise programs and special events
• Pre-diabetes education to help those at risk prevent the full onslaught of type 2 diabetes.

Joslin Connects Regionally

Joslin Center Endocrinologist Vasdev Lohano, MD, FACE, knows that 30 miles may be farther than some patients are willing to drive for diabetes care. So he’s bringing diabetes care to them. In August, Dr. Lohano started seeing patients at three satellite locations. “We’re reaching out to people, meeting with local physicians, and bringing the best diabetes care available to previously under-served areas. Everyone is very pleased,” he said.

The new offices are located at:

• New Albany at 2315 Green Valley Road, Suite 100
• Corydon at Northfield Plaza,313 Federal Drive NW, Suite 010
• Charlestown at 9427 Highway 403, Charlestown (in the shopping center next to Jay-C food store)

“A lot of people don’t want to drive a long distance to get the diabetes care they need. Our new centers in outlying areas including Corydon and Charlestown expand the reach of the Joslin Center and bring much-needed care to those communities.”

Vasdev Lohano, MD, FACE
Board Certified Endocrinologist
Floyd Memorial Joslin Diabetes Center Affiliate

To schedule an appointment with Dr. Lohano at one of these locations, please call 812-981-6645.

For more information on Joslin’s diabetes education courses or to receive the quarterly Diabetes Focus newsletter, call 812-949-5700.

“Shawn survived for two reasons-he made it to the ER before his heart muscle suffered irreparable damage, and he was taken to a hospital with 24-hour cardiac cath lab availability. The national standard for door-to-balloon time, or the amount of time that passes from when the patient enters the ER to when they receive an intervention such as angioplasty in the cardiac cath lab, is 90 minutes. We’re proud to say that at Floyd Memorial, our average is 75 minutes. Heart attacks don’t wait for normal business hours, and as the only hospital in Southern Indiana with a 24-hour cardiac cath lab, we’re always ready to save lives.”

Kevin Wurst, MD
Board Certified Emergency Medicine Physician
Floyd Emergency Medical Associates

Shawn’s wife, Melissa, is a nurse studying to be a nurse practitioner. After calling someone to watch their son, she insisted Shawn go to the hospital. “I argued with her every step of the way,” he said. “At my age, there was no way that could happen.” Then, just as they turned onto State Street in New Albany, Shawn went into full cardiac arrest.
Shawn and Melissa were about two miles from Floyd Memorial. She called the ER, which was ready the moment they arrived.

“I’ve been told they immediately gave me CPR and pulled out the paddles,” said Shawn. “According to the doctors and nurses, I was out for at least five minutes. Dr. Steven Filardo was the cardiologist on call that night. He performed an angioplasty and put in stents. My heart was in trauma, so they put me in a medically induced coma to help it heal. They were afraid I might be brain dead.” You can imagine the relief three days later when he spoke his first words.

Michael Bittenbender, MD, is Shawn’s primary care physician. “There were three real heroes in Shawn’s case,” said Dr. Bittenbender. “First, his wife for recognizing the problem and getting him to the ER. Second, Dr. Kevin Wurst, the ER physician. And third, Dr. Filardo, who came in the middle of the night and kept him alive. They’re the reason we have such a dramatic story to tell today.”

“As an interventional cardiologist, I only get the opportunity to do my job if the ER team does theirs first. Dr. Wurst and his team did a phenomenal job of resuscitating and stabilizing Shawn in a very short amount of time. Research shows that the sooner the patient is able to move from the ER to the cath lab for intervention, the better they recover in the long-term. Shawn’s door-to-balloon time was incredibly short-under 60 minutes-which is what ultimately saved his life. I like to use a football analogy to describe it-Dr. Wurst and his excellent team in the ER put the play in motion and executed the most important steps. All I did was catch the ball in the end zone.”

Steven Filardo, FACC, MD, MPH
Board Certified Interventional Cardiologist
Preferred Cardiology of Kentuckiana, LLC

Shawn Still Required Surgery

The heart attack was very difficult for Shawn to accept. “I remember watching my year-and-a-half-old son sleep. I cried, knowing that if I died now, he wouldn’t even remember me.” On March 18, when Shawn’s heart was strong enough, Dr. Sebastian Pagni, a cardiothoracic surgeon, performed a quadruple bypass at the Floyd Memorial Heart and Vascular Center. “The staff was incredible about preparing my wife and I,” said Shawn. “They got me on my feet the very next day. The nursing care was awesome. I was able to go home in just five days. I’m so grateful my wife took me to Floyd Memorial.”

The Next Step was Cardiac Rehab

Six weeks after surgery, Shawn began cardiac rehab. He went at it with the same drive with which he approached his life. “Shawn had a positive attitude and was determined to recover,” said Floyd Memorial Cardiac Rehab Nurse, Carol Griffitt, RN. “He was very strict on himself, almost too strict at times. We treat each patient individually. In his case, we felt that helping him gain a sense of perspective was important. And talking with the other patients really helped him relax. He was a real pleasure to work with. Although I wish he hadn’t had to come in the first place!”

According to Shawn, “The crew in cardiac rehab is awesome. They made me feel comfortable. They helped me with stress management and nutrition. And it was good knowing my heart was being monitored. I felt safe.”

The Road to Recovery

According to Shawn’s Cardiologist, Srini Manchi, MD, he is doing very well. “He is fortunate that he has fully recovered his heart, lung and neurological functions after such a severe cardiac event.”

“In rehab, I learned about a support group called Mended Hearts,” said Shawn. “I am now a Mended Hearts volunteer in
the cardiac unit at Floyd Memorial. I want to give something back. Hopefully I can help raise awareness among younger people.”

“We are seeing more people in their 30s and even their 20s having chest pain that indicates serious heart trouble. I ask my patients to get a baseline lipid panel at 30 years of age to check for high cholesterol. It’s a silent risk factor that can creep along unknown otherwise.”

Michael Bittenbender, MD
Board Certified Family Medicine Physician
Floyd Memorial Medical Group-New Albany

Young People Need to Know Their Risk

“Even when you’re young, you should know your risk factors for heart disease, such as a family history of heart problems, diabetes, high blood pressure and high cholesterol. You should have your cholesterol level checked. If it’s high, get it under control with exercise, a healthy diet and medication if necessary. And never, ever smoke.”

Srini Manchi, MD
Board Certified Interventional Cardiologist
Cardiology Associates of Southern Indiana, PC

“I have a big message for younger people. I know you think you’re invincible. But young people can have heart attacks, too. So know your family history. Know the signs. And most of all, don’t be afraid to go to the hospital. It could save your life.”

Shawn Howe
Heart Attack Survivor

“Diabetes is becoming more prevalent in our society. There is a growing need for new medications. This study will play a key role in making sure a promising new medication does not increase the risk of a serious cardiac event in people who have already had acute coronary syndrome.”

Adriana Spanova, MD, FP
Floyd Memorial Clinical Researcher

According to Adriana Spanova, MD, FP, Floyd Memorial clinical researcher, “The study will evaluate the  cardiovascular safety of this investigational drug in comparison with a placebo in patients being treated for type 2 diabetes. This will be a randomized, international study. Half of the participants will receive the new medication, and half the placebo. We will monitor participants for heart attack, stroke or other major acute cardiac events to determine whether the occurrence is higher among the group taking the new medication.”

The duration of the study will be up to four-and-a-half years, and there will be very strict guidelines. “Participants must have been previously diagnosed with type 2 diabetes, using insulin or other anti-diabetic medication, and have been recently admitted to the hospital with an acute coronary event,” said Dr. Spanova. “If qualified, they will be  randomized 15-60 days after their discharge from the hospital.”

Even Mildly Elevated Blood Sugar Increases Risk for Heart Disease

When Dr. Filardo sees a patient, it is nearly always because the patient has heart disease. But according to him, it is extremely common for his younger heart patients to learn that they also have slightly elevated blood sugar. Dr. Filardo is finding that a mildly elevated blood sugar level often indicates a metabolic abnormality that increases the risk of heart disease – even before the onset or diagnosis of diabetes.

“Even if the patient’s blood sugars are only elevated by a few points, the patient is at risk.” said Dr. Filardo. “I am very aggressive about sending patients to Joslin when they have heart disease and mildly elevated sugars. They need to know that a metabolic disorder is part of their makeup. Elevated blood sugars create the risk for heart disease well before the condition progresses to diabetes. Many times, if they get their weight down and exercise, it can decrease their blood sugars.”

“When a young person has a heart attack, I look at the big picture. If their blood sugars are a little elevated, it makes arteries more prone to blockage. It helps to take a comprehensive approach and get an endocrinologist from the Joslin Center involved to help them deal with the problem. We are very fortunate to have the resources of the Joslin Diabetes Center Affiliate right here on our campus.”

Steven Filardo, FACC, MD, MPH
Board Certified Interventional Cardiologist
Preferred Cardiology of Kentuckiana, LLC