MyGeorgetownMDWinter 2017

A MedStar Georgetown University Hospital Publication

IN THIS ISSUE 2 New Breast Reconstruction Technique:

Less Pain, Easier Recovery and More Natural-Looking Outcomes

3 Removing Esophageal Cancer With Minimally Invasive Techniques

5 Abdominal Pain: Common, But Not Simple

First-Ever MedStar Georgetown Kidney Transplant Patient Returns for Second Kidney TransplantBy Jennifer Davis

Forty years ago, at the age of 17, Brenda Hudson of Owings, Md., was the first person ever to receive a life-saving kidney transplant from a living donor at MedStar Georgetown University Hospital. Her sister, Michelle, donated a kidney to save Brenda’s life.

The average life of a living donor kidney is 17 to 18 years, but Brenda’s kidney lasted a staggering four decades before failing in 2015. She began dialysis but was in need of a new kidney. Now, at the age of 57, her husband of seven years, Dana Hudson, stepped forward. Last

summer, he gave Brenda her second life-saving gift—a new kidney, 40 years after her first transplant surgery.

“It works beautifully,” Brenda says. “As soon as you get that new kidney in, you start feeling better right away. To be fortunate enough to get this gift continued on page 7

Photo courtesy of Yvette Rattray

To be fortunate enough to get this gift from a second living donor—I am still in disbelief.

Brenda Hudson, Patient

continued on page 6

New Ankle, Renewed Quality of Life By Emily Turk

At just 54 years old, Brian Wallace was far from ready to shut the door on his active life. But his constant ankle pain was threatening his ability to function. “I would wake up in the middle of the night in excruciating pain,” Brian says. “It became so debilitating, and it was difficult to walk.”

When multiple trips to the chiropractor and shots of cortisone finally proved useless, Brian asked his uncle, an orthopaedic surgeon in New York, for a referral. “He told me to see Paul Cooper, MD, at MedStar Georgetown University Hospital, and I’m very glad I did,” Brian says. “I thought I would have to have a joint fusion. But then Dr. Cooper told

Photo courtesy of Brian Wallace

4 Novel Heel Surgery Saves Patient’s Foot for the Across the Bay 10K

Brian Wallace, in his industrial shop, is now happily living, working and walking pain-free following an ankle joint replacement performed by MedStar Georgetown foot and ankle specialist Dr. Paul Cooper.

Dana Hudson, left, donated his kidney to his wife, Brenda. This was Brenda’s second living donor kidney transplant at MedStar Georgetown—40 years earlier she was the hospital’s first-ever kidney transplant patient.

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New Breast Reconstruction Technique: Less Pain, Easier Recovery and More Natural-Looking Outcomes By Marianne Worley

Kelly Chapman, a school teacher from Alexandria, Va., was 33 in the spring of 2016 when she was diagnosed with stage II breast cancer. When she and her physicians decided that the best course of treatment would include a double mastectomy, she was presented with a new reconstruction technique that promised an easier recovery and a more natural-looking result.

“The technique is called the pre-pectoral reconstruction,” says Troy Pittman, MD, Kelly’s plastic and reconstructive surgeon at MedStar Georgetown University Hospital. “I often call it the ‘nearly painless’ breast reconstruction. It has been a game-changer for my mastectomy patients.”

With standard reconstruction after a mastectomy, the surgeon cuts the muscle that sits on the chest wall to create a pouch beneath the muscle in which to insert the implants. “With pre-pectoral reconstruction, we use a purified human skin product that supports the front of the implant and creates an internal bra to support the implant,” says Dr. Pittman.

“The great news about this technique is that in addition to helping newly diagnosed breast cancer patients, I can also go back and revise surgeries I performed the old way in years past,” says Dr. Pittman. He says recovery from a traditional reconstruction can be very painful and that some women can live with chronic soreness in their breasts for many years after surgery. With the

new technique, recovery is easier on the patient.

“I had some discomfort after my procedure but wasn’t in any significant pain,” Kelly recalls. “I had my wisdom teeth out three weeks later, and that was worse than my mastectomy and reconstruction!”

In some cases, physicians can also use the nipple-sparing technique. “Women can hardly tell they’ve had anything done to their breasts,” he says. “With Kelly, we were able to use the technique and give her a real-looking outcome.”

“I was more pleased with my appearance than I ever thought possible,” she says. “I only have a small scar on the underside of each breast, and they are already starting to fade.”

Kelly has been working hard on her recovery, working out each day,

stretching and walking, and keeping a positive attitude.

“Cancer has taken away certain things from me, but I get to choose how much ‘cancer sucks,’ and every day I try to find something to be positive about,” Kelly says. “This surgery has been one of those things.”

Following her breast cancer diagnosis and double mastectomy, Kelly Chapman underwent a minimally invasive breast reconstruction. The new technique provides patients with a more natural-looking result and allows for an easier recovery. Kelly and her husband, Alex, were grateful for a surgical option that minimized Kelly’s discomfort and recovery time.

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To learn more about breast reconstruction and the new technique offered at MedStar Georgetown, visit MedStarGeorgetown.org/Prepectoral or call 855-482-6671 to make an appointment.

Visit MedStarGeorgetown.org/PittmanVideo to watch Dr. Pittman discuss options for breast reconstruction.

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I was more pleased with my appearance than I ever thought possible.

Kelly Chapman, Patient

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Edward Eckenhoff recalls putting up with heartburn for many years. He would often take a few over-the-counter medications before a meal to ease his symptoms.

But in February 2016, while on vacation in Florida, he began to experience a new symptom: he suddenly had trouble swallowing.

“I knew right then I had a problem,” recalls Edward. “So I went to a gastroenterologist in Florida who diagnosed me with esophageal cancer. Fifteen to 20 years of acid reflux had resulted in a tumor at the base of my esophagus near my stomach.”

When Edward got back to Washington, D.C., he immediately consulted with physicians at MedStar Georgetown University Hospital. He began a course of chemotherapy and followed up with radiation

before his surgery to remove the cancerous portion of his esophagus.

At most medical centers, surgeons have to open a patient’s chest to gain access to the esophagus, breaking the chest bone, resulting in a long and painful recovery.

At MedStar Georgetown, Blair Marshall, MD, chief of Thoracic Surgery, has pioneered a minimally invasive procedure to remove esophageal cancer in a way that is easier on patients.

“Instead of a large incision that breaks the patient’s chest bone, I use tiny incisions and cameras that allow us to remove the esophagus with the cancer and then make a new esophagus,” says Dr. Marshall. “Patients have less pain, less blood loss, and return to eating normally much sooner than with the standard approach.”

This was an especially desirable option for Edward, who is paralyzed from the waist down due to an accident and uses crutches to get around. “I’m 6'2", a couple hundred pounds and an avid golfer,” he says. “The traditional way of removing my cancerous esophageal tumor would have destroyed the musculature I need to get around. In my case, the minimally invasive surgery meant I was back on my crutches weeks after hospital discharge, and it allowed me to be back on the golf course in 22 days.”

“There are many different types of patients who can benefit from this minimally invasive surgical technique,” says Dr. Marshall. “We have operated on several patients in their early- to mid-80s with excellent results. And Edward was able to maintain his independence on his crutches. The technique might take longer in the operating room but results in a quicker and easier recovery from a very serious cancer.”

Edward, a founder of the MedStar National Rehabilitation Hospital, which has helped empower patients to overcome disabilities caused by disease or injury, is grateful for the minimally invasive surgery option: “I am back to being independent, and I’m on the golf course three to four times a week!”

Removing Esophageal Cancer With Minimally Invasive TechniquesBy Marianne Worley

To learn more about the oncology services offered at MedStar Georgetown, visit MedStarGeorgetown.org/CancerCare or call 855-442-7323 to make an appointment.

The minimally invasive surgery meant I was back on my crutches weeks after hospital discharge, and it allowed me to be back on the golf course in 22 days.

Edward Eckenhoff, Patient

Following chemotherapy and radiation, Edward Eckenhoff underwent a minimally invasive procedure to remove the cancerous portion of his esophagus. The new procedure, performed by Dr. Blair Marshall, allows for a faster recovery.

Photo courtesy of Edward Eckenhoff Meet Blair Marshall, MD

Dr. Marshall is chief of Thoracic Surgery at MedStar Georgetown. Her areas of clinical expertise include:• Esophagealsurgery• Lungsurgery• Minimallyinvasivesurgery• Thoracicsurgery

Visit MedStarGeorgetown.org/MarshallVideo to watch Dr. Marshall discuss surgery options for treating esophageal cancer.

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Novel Heel Surgery Saves Patient’s Foot for the Across the Bay 10K By Heidi Rosvold-Brenholtz

For 21 years, Ali Wisseman had type 1 diabetes. A kidney and pancreas transplant in 2009 cured her condition, but she still battles many of the chronic effects of diabetes, such as nerve pain and poor circulation, blurred vision and foot ulcers. The medication she takes to support her transplant also makes her susceptible to infection. The deep wound on her right heel caused such severe pain that the 54-year-old dispatcher from Reston, Va., was nearly bedridden.

“I had absolutely no quality of life,” Ali says. “My physician told me my only option was to have my foot amputated. That’s when I went to the Center for Wound Healing at MedStar Georgetown University Hospital for a second opinion.”

Thanks to a new surgical technique developed by podiatric and plastic surgeons at MedStar Georgetown, Ali was spared from having her lower leg amputated. The innovative procedure, called a vertical contour

calcanectomy, got Ali back on her feet again.

The surgical approach used to treat Ali’s heel infection and save her foot solves a major problem associated with traditional heel surgery, according to John S. Steinberg, DPM, FACFAS, chief of Podiatric Surgery and co-director of the Center for Wound Healing. “The traditional surgical approach often doesn’t leave enough soft tissue on the heel to withstand bone pressure from walking or standing,” he explains. New wounds can develop from the pressure and lead to bone infection, repeat surgery and a significantly increased risk for amputation.

“The advantage of the vertical contour calcanectomy is that we can construct a padded and contoured flap from the tissue remaining after the bulk of the bone is removed,” says Dr. Steinberg. “We then can close the wound with the patient’s own tissue

without the need for an artificial tissue graft. This repair can withstand a lot of weight because it is stronger and sufficient bone is removed to create a new walking surface of the heel.” Another advantage is that there is minimal loss of height thanks to the contour created with the heel bone. “We’ve had remarkable results in patients who otherwise would face a below-the-knee amputation,” he adds.

“Ali’s case was complicated because of her medical history and the size of her wound,” says Dr. Steinberg. She’s typical of the type of patient often referred to the Center for Wound Healing. He credits a team approach for her recovery. Full-time physicians dedicated to limb salvage, surgery, infectious disease and vascular surgery are part of the treatment team for patients like Ali.

“I’m walking because of my team at MedStar Georgetown. Before my surgery with Dr. Steinberg, I thought I’d never walk again,” says Ali. In fact, she’s running. A running enthusiast throughout her life, in November 2016, Ali completed the Across the Bay 10K. “I walked a lot of it, but I finished, and now I’m hitting 18,000 walking steps a day. It’s a miracle.”

To show her gratitude, Ali presented her race medal to Dr. Steinberg and fellow wound care specialist Christopher Attinger, MD. “They earned it,” she says.

To learn more about the services at the Center for Wound Healing, visit MedStarGeorgetown.org/WoundCare or call 855-782-3027.

Ali Wisseman, center, is not only walking but running again, thanks to a new procedure that spared her from needing an amputation of her right foot due to complications of her type 1 diabetes. She proudly presented her most recent 10K race medal to Dr. John Steinberg, right, and Dr. Christopher Attinger.

Photo courtesy of Ali Wisseman

I’m walking because of my team at MedStar Georgetown. Before my surgery with Dr. Steinberg, I thought I’d never walk again.

Ali Wisseman, Patient

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Abdominal Pain: Common, But Not SimpleBy Brendan Furlong, MD, Chief of Service, Emergency Department, MedStar Georgetown University Hospital

When someone complains of pain in the abdomen, most people don’t think anything of it. After all, it’s probably just a stomachache from indigestion or nerves.

However, the Centers for Disease Control and Prevention found that “abdominal pain” is the most common reason for a trip to the Emergency Department (ED). That’s because it’s a complex symptom with many possible causes, and it should never be ignored. But that doesn’t mean every pain should send you to the ED.

Abdominal pain is used to describe pain that occurs between your chest and groin. It can come on suddenly (acute pain) or build slowly; be sharp or dull; and be a symptom of anything from colon cancer to menstrual cramps.

How Serious Is Abdominal Pain?While acute abdominal pain isn’t always a sign of a serious condition—though it certainly can be—a dull, slow-building pain shouldn’t be shrugged off. For example, a patient with

appendicitis, which is life-threatening without immediate treatment, may have low-level abdominal pain for days, making it easy to dismiss. But even minor abdominal pain can be a sign that something is seriously wrong.

Keeping Track of Symptoms and SeverityThe abdomen is home to the stomach, liver, gallbladder, pancreas, kidneys, small intestine and large intestine, so isolating the location of the pain—Is it in the middle of your chest? On the lower right side? All over?—can help narrow down which organs are involved.

Patients should pay close attention to any changes in pain—Does it come in waves? Has it moved from one part of the abdomen to another? Is it worse when you lie down?—and tell their doctors about any history of pain or issues in the abdominal area.

Because the abdomen is home to so many different organs, your doctor will perform a physical exam and may conduct more tests to pinpoint the problem and decide on the best

treatment. Imaging, such as a CT scan or ultrasound, and analyzing blood and urine will help rule out certain conditions.

When To Seek TreatmentIf the pain seems to be from acid reflux, it is generally safe to try an antacid or an over-the-counter H2 blocker. If these are not effective or seem to be needed regularly, you should seek medical attention.

The causes of abdominal pain are very broad and can range from trivial to life-threatening, so it is difficult to give comprehensive advice. If you have any concerns regarding the symptoms and signs discussed above, be sure to reach out to your doctor or get to the ED right away.

Regardless of severity or duration, abdominal pain is not something to be taken lightly. Don’t hesitate to discuss your symptoms with a healthcare professional, or go to the ED to get help.

To learn more about abdominal pain or to make an appointment with one of our physicians, call 855-213-2315. Visit MedStarGeorgetown.org/ED for more information about emergency, urgent and trauma care.

Brendan Furlong, MD, discusses the symptoms and severity of abdominal pain and when to seek medical treatment.

PhotobyLauraBrickley

If you have severe, prolonged or chronic abdominal pain or are concerned about any of your symptoms, see your doctor or go to the Emergency Department for evaluation.

New Ankle, Renewed Quality of Life continued from page 1

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me I could have an ankle joint replacement. I didn’t even know that was available!”

Dr. Cooper, director of the Foot and Ankle Center at MedStar Georgetown, is one of just a handful of orthopaedists in the region who specializes in foot and ankle disorders.

“Often, patients with ankle pain visit a general orthopaedist and are told that joint fusion is their only option,” says Dr. Cooper. “But that’s simply not true. Ankle joint replacement is a very good option for patients with end-stage ankle arthritis—the result of trauma, sports injury or deformity.“

“We have a generation of healthy, athletic baby boomers whose active lives can cause wear and tear on joints that lead to arthritis,” he says. “Cartilage disappears, leaving bone moving against bone, causing significant pain. For patients like Mr. Wallace—who played basketball and football—joint replacement may be necessary to sustain quality of life,” Dr. Cooper notes.

At MedStar Georgetown, nearly all of Dr. Cooper’s patients receive the STAR™ joint. Dr. Cooper was the first surgeon in the U.S. to implant this revolutionary joint in a patient. The STAR™ implant more closely mimics the three bones that make up the ankle joint. It is a three-piece, mobile-bearing ankle made of metal and polyethylene—older implants consist of just two parts.

“The parts move independently for increased mobility and movement that is closest to the real ankle,” Dr. Cooper adds. “It also wears better and is easier to upgrade.”

Fortunately, Brian was an ideal candidate for the implant. During the 45-minute procedure, Dr. Cooper made a three-inch incision at the ankle, cut bone at the joint and inserted the new ankle joint.

Brian has been a model patient at his physical therapy appointments—and his persistence has paid off. “I’m pain-free for the first time in years—walking my dog and planning to replace my roof,” he says. “Now when I see people suffering from ankle pain, I enthusiastically tell them to go to Dr. Cooper.”

Alexandra Learned Preston and her husband, John Preston, were longtime residents and supporters of the Georgetown community. That support also extended to their hospital, MedStar Georgetown University Hospital. Their commitment to the hospital and its staff grew as both John and Alexandra experienced firsthand the compassion and unwavering dedication MedStar Georgetown staff have for each patient.

Both John and Alexandra enjoyed long and successful careers, and in 2003, they retired to Georgetown— a community that they loved and cherished.

In 2006, John was diagnosed with liver failure. John and Alexandra turned to the MedStar Georgetown Transplant Institute for treatment options. Inspired by the care he received, the Prestons gave annual donations of over $100,000 in cumulative giving. Despite a successful living donor liver transplant, John was diagnosed with cancer and passed away in 2008.

Alexandra continued to support the Institute in gratitude for the care that John received. In 2016, while battling cancer herself, Alexandra made the decision to provide a $1,000,000 estate gift to the Institute. The gift, as directed by Alexandra, will underwrite a research position over several years and will support the

hospital’s continued research, medical advancements and the principle of cura personalis—caring for the whole person.

“The Prestons were part of our family here, as philanthropic supporters, as patients, as members of the community,” shares Thomas Fishbein, MD, executive director of the MedStar Georgetown Transplant Institute. “Their gift and generosity is impactful and will allow the Institute to continue to make advances in the science of transplantation.”

$1 Million Gift Advances MedStar Georgetown Transplant Institute By Jennifer Thayer

To learn more about the Foot and Ankle Center at MedStar Georgetown, visit MedStarGeorgetown.org/FootInjury or call 855-415-5476 to make an appointment.

To find out more about ways to give, visit MedStarGeorgetown.org/Support or call the Office of Philanthropy at 855-590-9558.

Meet Our Foot and Ankle Specialists

Visit MedStarGeorgetown.org/PCooper to learn more about Paul Cooper, MD, and his areas of clinical expertise.

Visit MedStarGeorgetown.org/FMcGuigan to learn more about Francis X. McGuigan, MD, and his areas of clinical expertise.

I went into the hospital one day and was discharged the next. I’m walking pain-free for the first time in years.

Brian Wallace, Patient

from a second living donor—I am still in disbelief. I didn’t think it would happen.”

MedStar Georgetown transplant surgeon Seyed Ghasemian, MD, says Brenda is a two-time miracle. “The miracle of her first transplant is that it lasted so long,” he says. “And then to get a second from another living donor is just wonderful. Now she has a perfectly functioning kidney again.”

“I am so blessed,” Brenda agrees. “It’s just so hard to believe there were two people willing to do this for me.”

The experience has given Brenda a unique view of medical advancements in the world of transplants over the last four decades. “The tools available now are so much simpler than 40 years ago,” she says.

“There wasn’t as much known back then about transplants, and people were very wary,” explains Matthew Cooper, MD, director of Kidney and Pancreas Transplantation at the MedStar Georgetown Transplant Institute. “Back then, Brenda had her own special nurses and was practically wrapped in a plastic bubble because there was such a fear of the unknown.

Her sister also had a much larger incision than we use now.”

After her first transplant surgery, Brenda was in the hospital for a month. This time it was just five days, and she started feeling better right away. Her husband, Dana, spent only three days in the hospital following his procedure as her donor.

Dana says he recovered quickly from a surgery he describes as painless. Surgeons made only four incisions, all 1 cm or less, to laparoscopically remove his kidney. He encourages anyone who might be interested in becoming a living donor to consider the benefits of this life-saving surgery. “It makes me feel so good,” he says. “I know what she was going through on a daily basis, and I am so glad I could help her.”

Brenda is now seeing just how far post-transplant care has come. Instead of large amounts of steroids,

she is taking a more advanced immunosuppressant medication to reduce the risk of the body rejecting the organ, which she says is much easier on her system.

“It’s so exciting how far we’ve come in 40 years,” Dr. Cooper says. “When patients take their medication and stay in touch with their doctors about post-operative care, results are excellent.”

Brenda says her life hasn’t just returned to normal—it’s gotten better. She’s now planning to travel and apply for her first-ever passport. “Now that I feel so good, I have to get one and travel,” she says. “I feel awesome.”

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First-Ever MedStar Georgetown Kidney Transplant Patient continued from page 1

To learn more about living donor transplants, visit MedStarGeorgetown.org/GiveLife or call 855-218-5229 to make an appointment with one of our physicians at the MedStar Georgetown Transplant Institute.

Brenda, right, received the first living donor kidney transplant at MedStar Georgetown when her sister, Michelle, left, donated her kidney. Nearly 40 years later, Brenda returned to MedStar Georgetown for her second kidney transplant.

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Pancreas Transplants Can Cure Diabetes By Jennifer Davis

Pancreas transplants are not only saving patient lives—they are also curing some people of diabetes.

They are generally performed on people with type 1 diabetes, a condition where the pancreas produces insufficient amounts of insulin or none at all.

“The fundamental benefit of a pancreas transplant is that you are cured of your diabetes,” explains Peter Abrams, MD, an assistant professor of Surgery at the MedStar Georgetown Transplant Institute. “Your glycemic control is perfect, your blood sugars normalize, and your secondary complications from diabetes like peripheral vascular disease, coronary artery disease and eye disease are improved or progression is virtually stopped.”

During the surgery, the new pancreas is implanted in the pelvis, and the native pancreas remains to aid in digestion. The transplanted organ then begins producing insulin in response to the patient’s internal needs.

“People go from being low energy, on the verge of losing their eyesight, suffering from disabling nerve pain and in some cases having amputations— to getting a new lease on life,” Dr. Abrams says. “The transplant has a profound impact on a patient’s health.”

To learn more about pancreas transplants at MedStar Georgetown, visit MedStarGeorgetown.org/Panc or call 855-218-4986 to make an appointment.

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MyGeorgetownMD A MedStar Georgetown University Hospital Publication

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WritersJennifer DavisBrendan Furlong, MDHeidi Rosvold-BrenholtzJennifer ThayerEmily TurkMarianne Worley

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Welcome New Physicians

MedStar Georgetown is pleased to welcome the following clinicians:

Family MedicineKathryn Hart, MD

PediatricsLeonidDubrovsky,MD

Plastic and Reconstructive SurgeryDavid Song, MD

Free Lecture: Shoulder Pain ManagementMay 3, 2017Time: Registration begins at 6:30 p.m.

Lecture from 7:00 to 8:30 p.m.Location: Bethesda Marriott

5151 Pooks Hill Rd. Bethesda, MD 20814

To register, visit MedStarGeorgetown.org/ShoulderLecture or call 202-295-0510.