PRESBYPRESBY BULLETINBULLETINP E N N P R E S B Y T E R I A N M E D I C A L C E N T E R

DECEMBER 2020

“I’m sorry, but there’s nothing else we can do for you,” Ellen Bryant-Patterson recalls her former doctor telling her a few years ago. The 53-year old Philadelphian had just undergone a successful debridement to remove damaged tissue from her foot, but the doctor’s words shattered her hope.

Bryant-Patterson has Charcot foot, a complication of diabetes that causes the foot’s bones, joints, and tissues to weaken. Nerve damage limits sensation, and patients often develop wounds and infections; Bryant-Patterson struggled with a quarter-sized, non-healing ulcer that worsened every time she put pressure on her foot. But though Charcot foot is a progressive condition, it can be managed. As her doctor steered the conversation toward amputation and presented it as the only way forward, she knew it was time for a second opinion.

Her research brought her to the Wound Care Center at Penn Medicine University City (PMUC). The state-of-the-art center is the latest evolution of Penn Presbyterian Medical Center (PPMC)’s wound care program, which has been treating patients since 2007. In 2017, the center at PMUC expanded its footprint and its services, adding two hyperbaric oxygen chambers — and it continues to grow.

“What started as a small clinic focused primarily on lower extremity wound care is now a multi-dimensional wound and hyperbaric medicine center dedicated to limb salvage. We cater to all wound types and customize treatment plans for faster healing,” said Ryan Dougherty, MBA, RN, assistant executive director of PMUC. “Our multidisciplinary team of seasoned wound-certified nurses

and physicians in emergency medicine, vascular surgery, plastic surgery, dermatology, and podiatry works collaboratively to deliver optimal care to patients with the most complex wounds.”

Improving Outcomes with a Team-Based ApproachThe first faces patients see at the center are those of clinical coordinator Kelly Troiano, BSN, RN, MS, and her team of nurses, medical assistants, and patient services staff.

Several of them worked together for years at the now-closed Graduate Hospital. In 2007, they moved as a group to the wound care clinic at PPMC, then again when the services transitioned to PMUC. The team’s extensive collective experience has proven hugely beneficial for both physicians and patients. Because patients are not always knowledgeable about their conditions, the team often needs to do some “detective work” to gather information about the wound and any other medical issues that may be affecting it.

“We’re a small, intimate group, and we’ve worked together for a long time,” she said. “Patients are assigned to a designated physician/nurse team. The patients become comfortable with this because it allows for continuity of care. It’s a really nice dynamic.”

Kelly’s husband, Michael A. Troiano, DPM, a foot and ankle surgeon, took on Bryant-Patterson’s case in December 2019. “As soon as I came to Penn, I was on my way. Dr. Troiano did another debridement, then a reconstructive surgery on my foot. I took antibiotics for the infection, and I wore a boot to relieve pressure and help the wound close,” she said.

Troiano developed an interest in Charcot foot before he even entered medical school. However, he is the first to note that his surgical care is only “one small cog in a patient’s wheel.”

“For a patient like Ellen with a diabetic foot wound, you need an endocrinologist to ensure their A1C is appropriate. You need a nutritionist to ensure they have the albumin for healing. You need a vascular surgeon to ensure their blood flow is adequate. You need the prosthetist to make the brace so that when they heal, they can live happily ever after,” he said. “We have a comprehensive collaboration between experts who are the very best in their fields.”

Regardless of how many specialists are brought onto a case, they all share one goal: Saving the patient’s limbs.

“When someone loses a limb, there’s a 90 percent chance that they will lose a second limb within five years. And within five years of losing that second limb, there’s a 90 percent chance that they will die,” Troiano said. “By saving their limbs, they’re looking at another birthday, another opportunity to dance at a wedding, another chance to take a cruise. We take it very seriously, and our passion drives life-changing and life-saving care for our patients.”

Hyperbaric Medicine Takes Healing to the Next LevelFollowing Bryant-Patterson’s surgeries, Troiano suggested hyperbaric oxygen (HBO) therapy to accelerate the healing process. Though she initially refused, citing claustrophobia, Troiano took her to meet the Hyperbaric Medicine technicians and get a better sense of what the therapy involved.

“There’s a lot of collaboration here because patients require numerous physician specialties to help them with their healing process,” said Mark Binkley, MD, medical director of Hyperbaric Medicine and an Emergency Medicine physician at PPMC. “When a physician has a patient that they think would benefit from HBO therapy, they consult us. We evaluate them and ensure there are no contraindications.” Patients who are eligible come in daily, Monday through Friday, for treatment.

When lying in an HBO chamber, patients breathe 100 percent oxygen at an elevated ambient pressure, which increases the amount of oxygen traveling through the bloodstream to damaged organs and tissue. Diabetic foot wounds are the most common conditions seen at the Wound Care Center, but HBO therapy can also be helpful for patients with compromised skin grafts or injuries caused by radiation therapy.

Encouraged by her family and care team, Bryant-Patterson ultimately underwent HBO therapy for 47 treatments. “The other doctor gave up on me, but Penn was trying to help, and it was time for me to help myself,” she said. “I was a nervous wreck, but it paid off. HBO was the key to my success.”

The quarter-sized ulcer that once threatened to claim her leg shrunk to the size of the dime, then fully healed. Bryant-Patterson regularly follows up at the center to treat her diabetes and monitor her Charcot foot condition, and she is diligent about keeping pressure off her foot. Though she can’t yet go without her trusty scooter, she is satisfied to take her recovery one day at a time.

“When I came to Penn, I was in bad shape. My foot was infected, I was frustrated and embarrassed by having to change my dressings twice a day for years, and I was depressed,” she said. “Dr. Troiano said, ‘I can’t make any promises, but I will do everything I can to get you through this.’ That was all I needed. Now, a year and a half later, I’m doing so much better. This experience has been a blessing, and I’m so grateful for him and for the staff at Penn.”

PRESBYPRESBY BULLETINBULLETINP E N N P R E S B Y T E R I A N M E D I C A L C E N T E R

APRIL 2021

IN THIS ISSUE

How PMUC Heals Wounds, Saves Limbs, and Transforms Lives

Celebrating the Efforts of an Extraordinary Educator

Our Shining STARs

Women’s History Month 2021: Lauding PPMC’s Women Leaders

HOW PMUCHEALS WOUNDS, AND

SAVES LIMBS

TRANSFORMS LIVES TRANSFORMS LIVES

Now, a year and a half later, I’m doing so much better. This experience has been a blessing, and I’m so grateful for Dr. Troiano and for the staff at Penn.

Shining

STARsOUR

Every month, PPMC staff members who embody Service, Teamwork, Achievement, and Respect, are named Presby STARs. In addition to earning recognition from their colleagues, these outstanding all-stars also receive a certificate from CEO Michele Volpe and a $100 award.

STARs like radiology technician Sue McPaul-Curran understand that sometimes the simplest gestures can make someone’s day. When a young man required surgery following a motorcycle accident, she quickly bonded with him over an unexpected coincidence: The patient and McPaul-Curran’s husband are from the same county in Ireland. Because COVID-19 prevented his loved ones from visiting, McPaul-Curran took it upon herself to stop by the patient’s room each night with some Irish tea. Her kindness, generosity, and willingness to go above and beyond to share some of the comforts of home were deeply appreciated.

And it’s not just patients who notice that PPMC’s STARs consistently go the extra mile. Maria Strack, a clinical resource coordinator on the Case Management/Social Work team, was nominated by the HUP Emergency Department team after she assisted them in tracking down the family of a frequent patient who was struggling with homelessness. Strack discovered that he had been missing from home for months, and his family — who lived in a different state — had been searching for him to no avail. Strack helped the patient’s father travel to Philadelphia and, on her day off, contacted the EDs throughout the health system to ensure that if the patient came in, he could stay there until his father picked up him. Strack’s empathy, determination, inter-departmental collaboration, and advocacy paved the way for the patient to be safely reunited with his family and reconnect with his primary medical team.

Thank you to all of our STARs for your unwavering commitment and compassion. You are an inspiration to your patients, colleagues, and community!

WHAT HAS YOUR JOURNEY TO LEADERSHIP BEEN LIKE?“My journey has been both exciting and challenging. My career at PPMC started when I was hired to help open the Trauma ICU. While there, I was mentored and realized I had the ability to mentor others on a leadership level. When I advanced into my current position, it meant so much to me. This position was a great opportunity for me not only as a woman, but a woman of color. There have been obstacles, but I have an outstanding team.” — Helena D. Pittman, BSN, RN, CCRN, nurse manager of Scheie 4

WHAT OBSTACLES AND ACHIEVEMENTS HAVE YOU EXPERIENCED?“Ten years ago, I wouldn’t have imagined myself in Informatics. However, I volunteered to be part of our PennChart rollout in 2013, and that set me on course. This role has provided me with the opportunity to optimize the electronic health record and implement innovative technologies. Last spring, I was enrolled in school for Informatics Certificate… in a computer programming class no less! Working while in school — with small children, during a pandemic — was the greatest obstacle, yet greatest achievement of my nursing journey.” — Julie Thomas, MSN, RN, CPAN, director of Nursing Clinical Information Systems

WHAT ADVICE WOULD YOU GIVE TO WOMEN PURSUING LEADERSHIP CAREERS?“Don’t ever doubt that you can do it. Ever. Know your skills, and if there is something you want to do, figure out what you need to add to your toolbox to make you successful. I have found that keeping a strong network of women (and men) — to provide advice, offer support, share contacts, and even just help me laugh — has been very helpful in challenging times.” — JoAnne Resnic, MBA, BSN, RN, director of Quality & Patient Safety

Read more responses online.

Since 1987, the United States has designated March as Women’s History Month. The month offers the opportunity to shine a spotlight on the substantial contributions of women across every field, including science and medicine. In addition to recognizing the impact made by women of the past, the month-long celebration also reminds us to continue uplifting women’s voices long after March 31st has passed.

Last month, PPMC’s Committee on Diversity and Inclusion honored some of the hospital’s women leaders who are working tirelessly to not only ensure the best experience for patients, but also to promote equity, diversity, and inclusivity in the hospital and beyond. Here are some of their insightful responses:

WOMEN’S HISTORY MONTH 2021: Lauding PPMC’s Women Leaders

PRESBYPRESBY BULLETINBULLETINEDITORIAL STAFF MaryKate Wust Editor

Trissy Laurito Graphic Designer

ADMINISTRATION Patrick Norton Vice President, Public Affairs

Holly Auer Associate Vice President, Communications

Rachel Ewing Editorial Director

Sally Sapega Director of Internal Publications

CONTACT PRESBY BULLETIN AT: Department of Communications 3600 Civic Center Boulevard 5th Floor, Suite 500 Philadelphia, PA 19104-4310 phone: 215.662.6183 email: Mary.Wust@PennMedicine.upenn.edu

Presby Bulletin is published monthly for PPMC employees. Access Presby Bulletin online at PennMedicine.org/PresbyBulletin.

PRESBYPRESBY BULLETINBULLETINEDITORIAL STAFF MaryKate Wust Editor

Trissy Laurito Graphic Designer

ADMINISTRATION Patrick Norton Vice President, Public Affairs

Holly Auer Associate Vice President, Communications

Rachel Ewing Editorial Director

Sally Sapega Director of Internal Publications

CONTACT PRESBY BULLETIN AT: Department of Communications 3600 Civic Center Boulevard 5th Floor, Suite 500 Philadelphia, PA 19104-4310 phone: 215.662.6183 email: Mary.Wust@PennMedicine.upenn.edu

Presby Bulletin is published monthly for PPMC employees. Access Presby Bulletin online at PennMedicine.org/PresbyBulletin.

Throughout his career, Wilson Szeto, MD, has earned numerous awards in recognition of his superior expertise, leadership, and patient care. For example, Szeto — who serves as chief of Cardiovascular Surgery at PPMC, vice chief of Clinical Operations and Quality for the division of Cardiovascular Surgery, and surgical director for Transcatheter Cardio-Aortic Therapies — has ranked among Philadelphia magazine’s “Top Docs” every year since 2012. But he recently was surprised with “a tremendous honor” that blew him away.

At the annual meeting of the Society of Thoracic Surgeons (STS), Szeto was presented with the 2021 Socrates Award by the Thoracic Surgery Residents Association (TRA). Each year, the STS and TSRA celebrate a faculty member in cardiothoracic surgery who has demonstrated a remarkable commitment to resident education and mentorship. As Michael Ibrahim, MD, PhD, chief resident in Cardiac Surgery, noted, “Dr. Szeto is one of the best surgical educators I have had. His patience, kindness, and standard of unremitting excellence make him truly special.”

Though he is passionate about passing on his knowledge and sharing his experience, Szeto is also committed to developing meaningful relationships and fostering residents’ personal growth. As he gets to know his trainees through hours of shoulder-to-shoulder work in the OR, they become like family, and he is inspired by their excitement and energy. In turn, he champions professionalism, respect, work/life balance, and ongoing education.

“I make them better, and they make me better,” he said. “There’s so much to learn in a limited time, but soon enough, we’ll be colleagues, and they’ll be taking care of patients in a very intense field. I can’t decide to not do my job to the best of my ability, then turn around and expect them to go above and beyond. That’s what drives me to be the best role model and educator I can be.”

Just as Szeto considers it a privilege to be a patient’s surgeon, he feels it is an honor to work alongside residents who are willing to take on the most complex and resource-intensive cardiothoracic surgery cases. “Some residents might have a perspective that, ‘Boy, we’re fortunate to be a Penn and learn to do the highest risk cases,’” he said. “But I would respond that one of the reasons that we can do these high-risk cases is because we have such an excellent team with excellent residents.”

“I’m very grateful for this award,” Szeto continued. “But I don’t think of it as a reflection of my personal achievements. It’s a reflection of what a great place PPMC is and of what a great training program we have. This isn’t for me; this is for our team.”

EXTRAORDINARY EDUCATORCELEBRATING THE EFFORTS OF AN