GoodHEALTHGood Samaritan Hospital

Caring for the Community

Published Quarterly / Fall 2012

Do You Know:How many yoga-related injuries were reported in 2010?

The answer—as well as ways to prevent yoga injury—is some-where in this issue. Call our Physician Referral Line at 1 (800) GS-CARES with the answer. If you are one of thefirst 50 callers to provide the correct answer, you willreceive a free gift.

Good Samaritan associates and their immediate family members are not eligible to win.

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From Our CEO

Our bodies are complicated systems, whichmeans that treating one problem or conditionmust take into account a host of other issues.This was the case with Dean Crawford, referred to Good Samaritan Hospital for treatment of hissevere foot infection. The article on page 7 describes howtreating Mr. Crawford’s foot required addressing a host of conditions, including anemia, circulatory problems, diabetes, infection and kidney problems.

You will read about other complex cases in this issueof GoodHealth. We’ve included a piece on diabetes, acondition affecting just about every system in the body.Diabetes can take an especially severe toll on the heart,kidneys, nervous system and eyes.

Even positive changes, such as pregnancy, can affectthe body’s balance. We discuss some of the complicationsthat can arise during pregnancy, as well as how to avoidthem. And an article on yoga and stretching cautions that even these seemingly beneficial activities may haveunforeseen consequences on the body.

The body’s complexity is what makes it capable of somany wonderful feats. At the same time, its complexitymust be understood and appreciated in order to provideeffective care. It is our mission at Good Samaritan Hospital to help you keep your wonderfully complex bodies functioning at their best possible level.

Andrew B. LeekaPresident and CEOGood Samaritan Hospital

After undergoing cardiacsurgery, many patients re-quire insertion of a pacingwire, a wire attached to apacemaker to keep theheart beating at a steadybeat. The wire generallystays in for two to three daysand is then removed. How-ever, heart tissue can bedamaged when the wire isremoved, and because itsdesign includes a loop, thewire may catch a graft orother structure.

Cardiac surgeon VaheYacoubian, M.D., has developed a way to avoidthese dangers. His patenteddesign embeds the pacingwire in a chest tube, whichis used to drain blood fol-lowing open-heart surgery.

“Some physicians don’tuse pacing wire because of the risks involved and because the equipment isexpensive. However, with-out a pacing wire, patientsmay suffer brain damage iftheir blood flow is insuffi-

cient due to a heart blockwith precipitous drop inblood pressure,” says Dr. Yacoubian. “This new design allows for the bene-fits of a pacing wire whileeliminating the risks andemergency pacing if theneed arises.”

As a further benefit, thepacing tube and pacing wirecan be removed simultane-ously. And if the chest wireneeds to remain after thetubing is removed, the design still permits the wires to stay longer. �

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Good SamaritanPhysician Patents New Device BenefitingOpen-Heart SurgeryPatients

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The days are getting shorter, andthere is a crispness in the air. Autumn is here, and its arrivalbrings distinct health concerns.Sucha Kim, M.D., PulmonaryDisease and Critical Care spe-cialist at Good SamaritanHospital, says that two majorhealth issues relating to autumnare allergies and the start of fluseason.

Allergies“The airborne flower pollenfound during spring and summermay have dissipated, but fallbrings allergy triggers that cancause just as much misery,” saysDr. Kim. “Sneezing, stuffy orrunny nose, itchy eyes, nose andthroat and trouble sleeping areamong the symptoms experi-enced by those who suffer fromallergies. Some may also haveasthma attacks.”

One of the biggest allergy culprits is ragweed, a weed thatgrows throughout the United

States. Although the plant onlylives one season, it can produceup to one billion pollen grains.

Another allergy trigger is mold,which can thrive in damp indoorareas—such as bathrooms—andoutdoor areas—such as piles ofwet leaves. Dust mites, whichmay also trigger sneezing, can getmixed into the air when you turnon your furnace after a longbreak. Along with mold and dustmites, chalk dust can also aggra-vate asthma in children.

“Prescription corticosteroids,antihistamines and decongestantscan bring some relief from symp-toms,” says Dr. Kim. “It’s best tospeak with your doctor first to determine the right medicationsfor you.”

Flu SeasonFall also marks the beginning offlu season, which can start asearly as October.

“The best strategy for avoidingthe flu is to get a flu vaccine assoon as it is available,” says Dr. Kim.

Flu shots can be given to anyone over six months of age,and they are particularly recom-mended for the followingindividuals:

� Adults age 50 and older

� Children six months to fouryears old

� Residents of nursing homesand other long-term care facilities

� Pregnant women

� Family members, medical personnel and others whocome into contact with thoseat high risk for fluThe viruses that cause the flu

change frequently, so the flu vac-cine is updated every year. Whilethe vaccine may not offer com-plete protection, those whodevelop the flu will have a muchmilder case than others who werenot inoculated. There are alsoprescription drugs that canshorten the flu’s duration whentaken within the first two days ofdeveloping symptoms. �

For referral to a Good Samaritan physician,please call 1 (800) GS-CARES (1-800-472-2737) or visit www.goodsam.org.

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Two ThingsYou Need to Know

This Season

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Yoga and stretching. Bothare good for our health,right? Marc Samson, M.D.,an orthopedic surgeon affiliated with GoodSamaritan Hospital, notesthat yoga and stretchinghave benefits as well aspotential disadvantages.When pursuing these ac-tivities, it’s best to proceedwith caution.

The GoodYoga, which involves a series of poses along withcontrolled breathing, canhelp with stress manage-ment and relaxation. Ithas other benefits as well.

“People who practiceyoga may improve theirbalance, flexibility, rangeof motion and strength,”says Dr. Samson. “That,in turn, makes them lessprone to injury from otherphysical activities.”

Additional benefits ofyoga include helping withsleep problems, fatigueand mood. It can evenhelp reduce heart rate andblood pressure.

Similarly, stretchingcan help improve postureand flexibility, which canimprove athletic perfor-mance and decrease therisk of injury. Stretchingalso increases blood flowto the muscles.

The BadMore than 7,369 yoga-re-lated injuries werereported in 2010, accord-ing to the U.S. ConsumerProduct Safety Commis-sion. Common injuriesincluded repetitive strainto and overstretching ofthe neck, shoulders, spine,legs and knees.

“When people try topush past their limits, theyrisk serious muscle dam-age and injury,” notes Dr. Samson.

As in the case withyoga, stretching incor-rectly can potentially domore harm than good.

“Static stretching(where you hold onepose) before exercise canactually cause musclestrains and pulls,” says Dr. Samson. “This type ofstretching should be doneat the end of a workoutsession.”

What You Can Do“People with certain medical conditions shouldtalk to their healthcareprovider before beginningyoga,” says Dr. Samson.“These include balanceproblems, uncontrolledhigh blood pressure, se-vere osteoporosis, artificialjoints, pregnancy and certain eye conditions.”

He also suggests thatbeginners start slowly andlearn the basics. And yogapractitioners of all levelsshould know their limits.

“Don’t try positions beyond your experienceor comfort level,” says Dr. Samson. “Listen toyour body and don’t doanything that causes pain.”

For stretching, dynamicstretching (range of mo-tion movements) can helpincrease body tempera-ture, enhance jointflexibility and increasemuscle elasticity. Thistype of stretching, unlikestatic stretching, may bebeneficial before activity.For static stretching, besure to hold the stretchrather than bouncing asbouncing can cause smalltears in the muscle.

“Try to stretch regularly—at least two to threetimes a week,” says Dr.Samson. “And considerdoing stretches that aretailored to your sport oractivity.” �

For more information, or for referral to a qualified orthopedic specialist, please call 1 (800) GS-CARES (1-800-472-2737) or visitwww.goodsam.org.

THE GOOD& THE BAD

Yoga and Stretching:

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If you’re thinking aboutgetting pregnant, youshould know about twoimportant factors that canaffect your health and thehealth of your baby.

“High blood pressureand diabetes are two condi-tions I see in a lot of mypatients. While both cancause problems, their im-pact can be reduced withhealthy lifestyle choices,”says Bente Kaiser, M.D.,an obstetrician/gynecologistaffiliated with Good Samar-itan Hospital.

High Blood PressureWomen may have highblood pressure before theybecome pregnant or de-velop it after becomingpregnant (gestational hy-pertension). High bloodpressure can reduce theamount of oxygen and nu-trients that reach thedeveloping fetus, slowing

the baby’s growth and in-creasing the chance of alow birth weight. In addi-tion, high blood pressurecan lead to preeclampsia,a condition involving highblood pressure, changes inliver enzymes and proteinin the urine. Preeclampsiamust be treated to avoid serious complications formother and baby.

DiabetesAs with high blood pres-sure, diabetes may occurbefore or as a result ofpregnancy (gestational diabetes). For moms, it canincrease long-term compli-cations such as visionproblems, heart diseaseand kidney disease. Forbaby, diabetes increasesthe chance of prematurebirth, weighing too muchor too little, low blood glucose and other healthproblems.

What You Can Do“Women who are consid-ering getting pregnantshould see their healthcareprovider to make surethey’re in good preconcep-tion health,” says Dr.Kaiser. “And both beforeand during pregnancy,maintaining a healthyweight and diet and getting regular physical activity can reduce com-plications caused by highblood pressure and diabetes.”

What does being activeentail? Most women canaim for 30 minutes or moreof activity most days. Thosewho haven’t been activeshould start with shortertimes and with a less intense activity, such aswalking. Always check with your healthcareprovider about what’s mostappropriate for your situa-tion.

“When it comes to diet,pregnant women should tryto eat foods rich in nutritionevery day,” says Dr. Kaiser.“That means vegetables,proteins, fruits, milk productsand grains. Try to avoidfoods rich in carbohydratesbut with virtually no nutri-tional value, such as soda,french fries and sweets.”

Not all carbohydratesare alike, notes Dr. Kaiser.“Every culture has highcarbohydrate foods—suchas tortillas, pitas, rice andnaan—that may need to be limited. Instead, choosewhole grain breads, cereals and pastas andbrown rice.” �

Getting into healthy habits will help before, during and after pregnancy. For referral to an obstetrician who can help you attaina healthy pregnancy, please call1 (800) GS-CARES (1-800-472-2737) or visit www.goodsam.org.

“Both before and during pregnancy, maintaining a healthy weight and diet and getting regularphysical activity can reduce complications caused by high blood pressure and diabetes.”

Minimizing Pregnancy

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“Many of theseconditions canbe avoided orpostponed bymaintaining

tight control ofblood sugar.”

Understandingthe Potential Challenges of Diabetes

control, diabetes cancause a host of complica-tions.”

Many of these compli-cations stem from circula-tion problems. As a result,just about every system inthe body can be affected.

Heart “High blood sugar in-creases the chance ofheart attack and stroke,”says Dr. Chai. “Heart at-tacks may be painless—they’re sometimes re-ferred to as ‘silent’ heartattacks—because the painis masked by nerve dam-age caused by diabetes.”

Diabetes can also in-crease the incidence ofheart failure, where theheart loses its ability topump blood. It can alsoincrease risk of congestiveheart failure, a buildup offluid in the lungs thatmakes breathing difficult.

KidneysDiabetes interferes withthe kidneys’ ability to filter waste from the foodwe eat. Waste productbuildup can lead to kidney failure.

Nerves“Diabetes reduces thesupply of blood to thenerve endings,” says Dr. Chai. “This causes aloss of sensation, whichmeans injuries aren’t

always noticed. As a result, damage and infection can occur. On top of that, woundhealing abilities are decreased for people with diabetes.”

EyesPeople with diabetes are40 percent more likely tosuffer from glaucoma and60 percent more likely todevelop cataracts. Dia-betic retinopathy refers todamage to blood vesselsof the retina. It is the lead-ing cause of blindness inworking-age Americans.

“While this is a daunt-ing list of problems, thegood news is that many of these conditions can beavoided or postponed bymaintaining tight controlof blood sugar,” says Dr. Chai. “This can beaccomplished withlifestyle modificationssuch as a healthy diet, regular exercise andweight loss. In addition,medication such as pillsor insulin may be used to help control bloodsugar.” �

For referral to a qualified physician who can help you manage your diabetes, pleasecall 1 (800) GS-CARES (1-800-472-2737) or visitwww.goodsam.org.

Diabetes is a lifelong con-dition involving highlevels of sugar (glucose)in the blood. More than25 million people in theU.S. have been diagnosedwith diabetes, and an-other 18.8 million havethe condition withoutknowing it.

“Many people have diabetes but don’t realizeit because the symptomscan be subtle,” says Alex Chai, M.D., an in-ternal medicine physicianaffiliated with GoodSamaritan Hospital. “It’simportant to have regularcheckups so that if you dohave diabetes, it can be diagnosed and treatedpromptly. Without tight

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When Dean Crawfordstubbed his left big toe inDecember 2010, he didn’tthink much of it. The 78-year-old retiree kept activeas a carpenter and handy-man. But Dean hasdiabetes, which not onlyslows healing, but can alsomask pain from decreasedcirculation in the footknown as peripheral arterydisease, or PAD.

Just a few days later, thetoe began to hurt. By thetime Dean saw the doctor,his toe had become blackfrom gangrene and had tobe removed.

Unfortunately, the infec-tion had spread to the othertoes, and the whole foot was in danger of becominginfected. Dean’s physician,Phillip Bland, M.D., aninternist on staff at GoodSamaritan Hospital, knewurgent intervention was

necessary for Dean to keepthe foot. “Dean’s family feltvery strongly, and we prom-ised we’d do everything wecould to save it,” says Dr.Bland.

“It would kill him tohave his foot amputated,”said Dean’s daughter, Deborah Crawford-Clark.“He’s a proud man, and hewouldn’t want to live if hecouldn’t walk.”

Deborah and hermother, Hortense, are bothregistered nurses and run a24-hour facility for individu-als with cognitive andphysical challenges. Theyknew they could help withthe recovery process if onlyDean’s foot could bespared.

A Team EffortDr. Bland referred the fam-ily to Good Samaritanphysicians Guy Mayeda,M.D., an interventionalcardiologist, and orthopedicsurgeon Jonathan Saluta,M.D. The two physiciansworked tirelessly for oneand a half years to salvage

as much of Dean’s foot aspossible. Dr. Saluta care-fully removed the dead,damaged and infected areas, and cleaned the re-maining tissue. Dr. Mayedaperformed two vascular procedures to open blockedarteries in Dean’s left leg,once in December 2010and again in December2011, to restore blood flow to the left foot.

“We still weren’t out ofthe woods at that point,”says Dr. Saluta. “Ourwound care team providedexceptional care to Dean after his surgery. AndDean’s wife was diligent inperforming wound care andkeeping him off his feet after he was released fromthe hospital. It was a realteam effort.”

As an outpatient, Deancame to Good SamaritanHospital for wound carethree times a week. In con-junction with hyperbaricoxygen therapy at a localhyperbaric wound center,Good Samaritan physicaltherapist and wound care

specialist Ma. Esperanza S. Herrera, PT, CWS, per-formed conservative sharpdebridement (removal ofdead tissues using sharp instruments) and used alow-intensity laser to facilitate healing.

“It was a challenge, but it was all worth it,” says Herrera. “The wound wasabout the size of a 6-inchsub sandwich when Mr.Dean Crawford came here.Now it’s completelyhealed!”

Dean’s wife describesthe transformation. “Myhusband is now walkingwith a cane,” she says.“He’d been so depressed before, just putting his headin his lap. Now he’s talkingagain and coming out of hisdepression. I thank God forDr. Mayeda and Dr. Salutaand Marie. They listened tous and worked as a team toget us where we are.” �

For referral to a Good SamaritanHospital physician, please call1 (800) GS-CARES (1-800-472-2737) or visit www.goodsam.org.

PREVENTING AN AMPUTATION

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Non-Profit Org.U.S. Postage PAIDLos Angeles, CAPermit No.15937

1225 Wilshire BoulevardLos Angeles, CA 90017(213) 977-2121www.goodsam.org

Each day in theUnited States, morethan 10,000 babyboomers reach the ageof 65 and become eli-gible to participate inMedicare. But untilnow, those who live indowntown Los Angelesand surrounding areasdid not have the option of joining Care-More Health Plan, aMedicare AdvantageProgram serving sen-iors in the Southwest.

This has nowchanged, thanks to anew alliance betweenGood Samaritan Hospital and Care-More Health Plan tobenefit area seniors.The groundbreaking

partnership offers sen-iors a new, integratedcare model that in-cludes access to theCareMore Health Planalong with the special-ized services of GoodSamaritan Hospital.Medicare beneficiariesin areas including central and mid-cityLos Angeles, Holly-wood, Koreatown andHancock Park will benefit from the newoption.

Comprehensive Care CenterNot only has Care-More selected GoodSamaritan Hospital asits preferred providerin the central Los

Angeles area, but themanaged care plan isconstructing a newComprehensive CareCenter—located nearthe hospital—designedto be a one-stop med-ical home for seniors.

“Our unique ap-proach to caring forseniors with chronicdiseases will be sup-ported by the high-quality patient servicesat Good SamaritanHospital, which hasconsistently rankedamong the top hospi-tals in the nation,” saidKen Kim, M.D., chiefmedical officer of Clinical Programs forCareMore.

Andrew B. Leeka,

president and chief ex-ecutive officer of GoodSamaritan Hospital,also hailed the alliance.“We share CareMore’sphilosophy of providinga continuum of care tosupport seniors, and weare proud to have beenselected as their pre-ferred hospital for theirnew network,” he said.

Services Important to SeniorsGood Samaritan Hospital has beencommitted to servingseniors in its servicearea for over 125 years.Our acclaimed pro-grams include sevennationally recognizedcenters of excellence

along with other specialties supportedby distinguished physi-cians with nationaland international reputations. Centers of Excellence of particular importanceto seniors include the Heart Center; Orthopedic Program;Pancreatico-BiliaryProgram; Tertiary Retinal Surgery Program; and The PeterD. Fugelso, M.D.,Urology Center. �

For referral to a Good Samaritan Hospitalphysician, please call1 (800) GS-CARES (1-800-472-2737) or visitwww.goodsam.org.

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New Care Option for Seniors

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