Anthony Ottaviani, DO, MPH, Director of Medical Education/Chief Academic Officer and Program Director for the Pulmonary/Critical Care Fellowship has announced that an article written by residents and faculty has been published in the Journal of Medical Case Reports. Collaborating on the article were Keri Brown, DO, Pulmonary Critical Care Fellow, Jeanine Martin, DO, Internal Medicine Resident and Susan Zito, DO, Rheumatology Faculty. Dr. Ottaviani stated that “this article is an example of the many research and publishing projects that residents, fellows and faculty are participating in on our campus. Our residents and faculty have a long history of participation in clinical research and publishing. Our intent is that our graduates leave us with a strong desire to continue with this activity once they graduate."

A Summary of the Study

Severe leukocytoclastic vasculitis secondary to the use of a naproxen and requiring amputation: a case report authored by Keri Brown, Jeanine Martin, and Susan Zito.

Leukocytoclastic vasculitis (also known as hypersensitivity vasculitis and cutaneous necrotizing vasculitis) can present with various manifestations, which often delays the diagnosis and treatment. In order to show the importance of the early recognition of leukocytoclastic vasculitis, we present a case which occurred secondary to the use of a common pharmaceutical, naproxen.

We present the case of a 33-year-old African American woman with below the knee and bilateral digital gangrene from hypersensitivity vasculitis secondary to the non-steroidal anti-inflammatory medication naproxen.

This is an original case report focusing on the rheumatologic management of leukocytoclastic vasculitis. However, other specialties, such as internal medicine, dermatology, infectious disease, general surgery and pathology, can gain valuable information by reviewing this case report. Reporting a case of leukocytoclastic vasculitis secondary to treatment with naproxen will advance our understanding of this disease etiology by adding yet another non-steroidal anti-inflammatory drug to the list of potential causes of leukocytoclastic vasculitis.

The complete article can be viewed at: http://www.jmedicalcasereports.com/content/4/1/204

Are you preparing for hip surgery? If you’ve been suffering from pain or if you’ve had a fracture, you and your doctor may have agreed that total hip replacement surgery is right for you.

If that’s the case, you need to prepare for the surgery, but you also need to be ready for the recovery. Here’s what you can expect after surgery, in physical therapy, and at home.

After Surgery

Once your operation is over, you will be moved to a recovery area. There, your anesthesia will wear off, and nurses will monitor your vital signs and your need for medication. Then you will be moved to a hospital room, where you will spend a few days.

After your procedure, you will be at risk for blood clots in your legs. To prevent this, your doctor will probably recommend that you:

• Move around. Be sure to sit up and be as mobile as you can. You’ll be encouraged to try walking, with the help of crutches or a walker, as early as 24 hours after surgery.
• Wear compression stockings. These look like blood pressure cuffs, but you wear them on your legs. They keep the blood from collecting in your veins and forming clots.
• Take medication. Your doctor may have you take blood thinners to keep your blood flowing well.

In Physical Therapy

You’ll begin therapy while you’re still in the hospital, and then you’ll continue your appointments even after you’re discharged. During physical therapy, your therapist will evaluate your condition and mobility, and he will devise a set of exercises and stretches for you. This will help you:

• Increase your range of motion
• Strengthen the muscles around your new hip
• Improve your flexibility

You will first learn to walk with a cane, crutches, or a walker. Then you will gradually be able to walk on your own.

At Home

Once you are home, you’ll need to continue the exercises that your physical therapist has taught you. In addition, here are some ideas to help you as you regain your strength.

• Talk to an occupational therapist about ways to make your home easier to navigate. You might consider a toilet seat or chairs or that are higher than standard ones.
• Avoid storing items in low places. Instead keep frequently used materials at waist level, so you don’t have to bend as often.
• Arrange to have meals delivered for a while or ask a friend or family member to help you out. Your first days at home will be easier if you don’t have to cook.
• Try to eat a balanced diet, even if you experience some loss of appetite. Drink plenty of fluids and take an iron supplement to help your tissues heal.
• Until your stitches or sutures are removed (usually two weeks after surgery), treat your wound with great care. Avoid getting your wound wet until it is completely sealed.
• When you sleep at night, place a pillow between your legs. This will keep your hips better aligned.

Several weeks after your procedure, your doctor will probably schedule a follow-up visit. At this time, he’ll determine if you’re healing well and he can give you advice about your activity level. If there are certain hobbies that are important to you, talk about when you can resume them.

To learn more about hip replacement and its recovery, contact Largo Medical Center. Visit us online or call Consult-A-Nurse® at 1-877-442-2362. We’ll help you every step of the way.

SOURCES
American Academy of Orthopedic Surgeons
National Institute of Arthritis and Musculoskeletal and Skin Diseases

When you think about occupational therapy, do you think it’s just for working adults? In fact, people of all ages and situations can find it helpful.

What Is Occupational Therapy?

In a nutshell, occupational therapy helps people master their occupations, but those occupations aren’t necessarily work. They can also relate to school, hobbies, playtime, or other activities. An occupational therapist looks at limitations that people have due to illness and injury, and then helps them find ways to be independent. The therapist considers what kinds of environments patients live in, what tasks they need to perform, and what their obstacles are.

Who Should Consider It?

Think about the people in your life. Perhaps an older neighbor suffers from mobility problems. Maybe your child is having trouble writing or communicating. Or maybe you are recovering from an injury. Here are examples of people who could benefit from occupational therapy:

• A person in a wheelchair. Through occupational therapy, someone in a wheelchair can learn new ways to get around. A therapist can also recommend home modifications to accommodate the patient’s individual needs.
• Someone recovering from a stroke. Occupational therapy can help a patient relearn how to dress and feed himself. A therapist looks at how the patient’s home is set up and offers strategies for accomplishing everyday activities.
• A child with development delays. An occupational therapist can help a child focus on fine motor skills. This will help her learn to write, draw, speak, and play. A therapist can also teach a child’s family ways to help her progress at home.
• A worker who has been hurt. When a worker has been injured, occupational therapy can help him recover. Then a therapist can find ways for the worker to regain his productivity and alter his work environment to help prevent future injuries.
• Someone who had recent surgery. As a patient recovers from surgery, he may find that his body is stiff or doesn’t quite work the way it used to. Through occupational therapy, he can learn ways to adapt his body to his everyday needs.
• Someone suffering from depression. When a person is depressed, she often loses interest in her day-to-day life. Working with other medical professionals, an occupational therapist can help such a person balance work and fun. The therapist can help the patient find hobbies that are important to her—activities she can look forward to.

Occupational Therapy or Physical Therapy?

You may wonder if physical therapy and occupational therapy are related. In many ways they are. Both therapies can help patients regain mobility and reclaim their lives. And many patients use both physical and occupational therapists on the road to recovery. However, occupational therapists are seen more as problem solvers. They tailor treatments by looking at their patients’ whole existence, taking into account their work, their environments, and their individual activities.

If you have questions about occupational therapy and how it can help you, contact Largo Medical Center. Visit us online or call Consult-A-Nurse® at 1-877-442-2362.

SOURCES
The American Occupational Therapy Foundation
Occupational Therapy

Congratulations to Chris Edwards, Sr. Technical Analyst at Largo Medical Center-Indian Rocks for earning the Employee of the Month Award! Keep up the great work!

By Kelly Greenwood, RN

Interim ER Director

A huge congratulations to Laura Parr, RN at Largo Medical Center-Indian Rocks for being awarded Nurse of the Year for 2009. This honorable award was presented to Laura at a special ceremony recently at the Main Campus. Laura serves as one of the daytime charge nurses in the Emergency Department at Largo Medical Center-Indian Rocks and played an important role during the transition from Sun Coast to Indian Rocks.  She is dedicated and well respected among her peers.

Congratulations to Laura Parr, our 2009 Nurse of the Year!

Laura strives in service excellence. She is a strong leader that is consistently being tested in the daily challenges of the Emergency Department. Laura came to Largo Medical Center in 2004 as an ED Nurse and then transferred to Indian Rocks in 2009. Outside of her professional career, Laura is currently helping promote and sponsor the Susan G. Komen 3-day walk for Tampa Bay. From all your co-workers across both campuses, we thank you for all your hard work and dedication to te team and congratulate you as the 2009 Nurse of the Year.

Your wrist aches every time you move your computer mouse. Or you take to the tennis courts and feel a twinge every time you hit a forehand. Ouch. Carpal tunnel syndrome and tennis elbow may not seem related, but they’re both cumulative trauma disorders (CTDs), and they both can be very painful.

CTDs are sometimes called repetitive motion injuries. Often they are the result of common activities done over and over: jogging, throwing a ball, typing, sweeping a floor. If you do the same things every day, you may find yourself with aches and pains that are hard to shake.

In addition to carpal tunnel syndrome and tennis elbow (epicondylitis), other types of CTDs are shin splints, bursitis, and tendonitis. Symptoms include numbness, tingling, swelling, redness, pain, popping of joints, and weakness. And you may feel these sensations in your shoulders, elbows, upper and lower back, wrists, and fingers. If you experience any of these problems for more than a week, be sure to talk to a doctor.

If you want to avoid CTDs altogether, here are some ways to keep them at bay.

• Pay attention to posture: Your mother told you to sit up straight, and she was right. If you hunch over your computer or slouch as you sweep, your muscles will pay the price. Standing or sitting with proper alignment will better distribute weight and take the pressure off your joints. When sitting, be sure to keep your feet flat on the floor or on a foot rest.

• Get the right equipment: Make sure you’re using chairs, wrist pads, and other tools that are ergonomically sound. Adjust your computer screen position and chair height, so there is no pressure on your back and arms.

• Try to relax: If you work with hand tools, don’t grip too tightly. It’s best if your wrists are in a neutral position.

• Take a break: No matter what your activity, allow yourself time to recover each day. Stand up and stretch. Do arm circles or shoulder rolls—anything to release the tension in your overused muscles. If you’re playing tennis or golf frequently, take a week or two off. Let your body recover if you’re starting to feel pain.

• Make a trade: If you can, talk to your co-workers about switching tasks periodically. If you’re each doing something repetitive, discuss a weekly trade (if your supervisor approves).

• Watch your intake: Avoid tobacco and caffeine, since these can reduce blood flow and add to the tension your body may feel.

If you have questions about how to prevent cumulative trauma disorders, contact Largo Medical Center. Visit us online or call Consult-A-Nurse® at 1-877-442-2362. We can help you find ways to work and play—without the pain.

By Tammy Robiconti, Marketing Director

Largo Medical Center has received the American Stroke Association’s Get With the Guidelines® Stroke Bronze Performance Achievement Award. The award recognizes Largo Medical Center’s commitment and success in implementing a higher standard of stroke care by ensuring that stroke patients receive treatment according to nationally accepted standards and recommendations.

“With a stroke, time lost is brain lost, and the Get With The Guidelines-Stroke Bronze Performance Achievement Award addresses the important element of time,” said Largo Medical Center Chief Executive Officer, Richard S. Hatcher.

Largo Medical Center has developed a comprehensive program for rapid diagnosis and treatment of stroke patients who arrive in the emergency department. This includes having the appropriate diagnostic equipment and physician specialists available. The hospital has also received Advanced Primary Stroke Center Certification by the Joint Commission.

“The time is right for Largo Medical Center to be focused on improving the quality of stroke care by implementing Get With The Guidelines-Stroke. The number of acute ischemic patients eligible for treatment is expecting to grow over the next decade due to increasing stroke incidence and a large aging population,” said Largo Medical Center Stroke Coordinator, Wayne Tate, RN.

To receive the Get With The Guidelines-Stroke Bronze Performance Achievement Award, Largo Medical Center consistently followed the treatment guidelines in the Get With The Guidelines-Stroke program for 90 days. These include aggressive use of medications like tPA, antithrombotics, anticoagulation therapy, DVT prophylaxis, cholesterol reducing drugs, and smoking cessation. The 90day evaluation period is the first in an ongoing self-evaluation by the hospital to continually reach the 85% compliance level needed to sustain this award.

“The American Stroke Association commends Largo Medical Center for its success in implementing standards of care and protocols,” said Lee H. Schwamm, MD, Vice-Chair of the Neurology department and Director of Acute Stroke Services at Massachusetts General Hospital in Boston. “The full implementation of acute care and secondary prevention recommendations and guidelines is a critical step in saving the lives and improving outcomes of stroke patients.”

Get With The Guidelines-Stroke uses the “teachable moment,” the time soon after a patient has had a stroke, when they are most likely to listen and follow their healthcare professionals’ guidance. Studies demonstrate that patients who are taught how to manage their risk factors while still in the hospital reduce their risk of a second stroke. Through Get With The Guideliens-Stroke, customized patient education materials are made available at the point of distcharge, based on patients” individual risk profiles. The take-away materials are written in an easy-to-understand format and are available in English and Spanish. In addition, the Get With The Guidelines Patient Management Tool provides access to up-to-date cardiovascular and stroke science at the point of care.

By Christine Hanna, Director of Medical Education

The months of June and July are very important to medical education. June 30 is the traditional end of the medical education academic year, and Jul 1 is the traditional start date. Largo Medical Center will train 108 residents and 32 third-year core medical students during the 2010-2011 academic year. We will also train an average of 35 fourth-year medical students, who will visit us for month-long clinical rotations.

On June 19, 27 new graduates of Largo Medical Center’s residency and fellowship programs were honored during the Graduate Medical Education Graduation Ceremony at Safety Harbor Resort and Spa. Frederick Lippman, RPh, EdD, Chancellor of the Health Professions Division of Nova Southeastern University, was the keynote speaker. The graduates were recognized for their successful completion of their internship, residency or fellowship, and for their dedication to learning and delivering quality patient care while assisting the medical staff and hospital staff in pursuing the perfect patient experience! We are excited for and proud of these well prepared graduates as they advance out into the world. We are also extremely appreciative of the faculty and program directors who gave their time and knowledge to prepare these graduates for a lifetime of excellence in patient care.

The new class of 63 residents began orientation on June 25 and commenced their clinical duties on July1. The new residents are graduates from 17 different Osteopathic Medical Schools and are all eager to get to know the faculty, staff, patients and volunteers. Some of our new residents trained will be hosting around 35 additional fourth-year medical students each month! Medical students are with us not only to have a rewarding clinical experience, but also to determine if they want to apply to a Largo Medical Center residency program for their future training. We are honored to provide the medical students with a rewarding patient focused clinical experience.

In addition to the graduates and incoming residents and students, we also had residents promoted to the next level of training on July 1, and other graduating students who began fellowship training on July 1. We are proud of the residents who have achieved this milestone and are increasing their knowledge while serving our patients!

The term “cancer” encompasses hundreds of individual conditions. The conditions are linked by the body developing more cells in one particular area than it needs. The body produces additional cells as needed to stay healthy. Sometimes too many cells are produced in combination with not enough cells dying. In the event that this takes place, and the extra cells affect the surrounding tissue in a negative manner, a cancer has unfortunately developed.

Treatment options for cancer vary depending upon type of cancer, its severity and the medical team that is helping the patient combat the disorder. One new form of treatment is gaining popularity amongst medical professionals. This new treatment is exercise. While doctors and nutritionists have recommended exercise as part of a healthy lifestyle for years, they did not always recommend it to cancer patients. Due to the debilitating effects of the disease and the side effects of some other forms of treatment, many doctors prescribed rest. Taking it easy was traditionally looked at as a way of letting the body recuperate and heal. Now the medical community is taking a different stance on exercise for cancer patients. They are starting to see the benefits in their individual patients and through scientific studies.

Benefits of Exercise as a Cancer Treatment

• Increased Energy- Ask any doctor, nutritionist or personal trainer and they will tell you that regular exercise conditions the body and is a means of increasing energy. Many cancer treatments leave patients felling tired so exercise is a way of fighting off fatigue.
• Increased Lifespan- The sad truth is that cancer takes the life of many of its victims. Studies have shown that patients who have survived multiple types of cancer live longer if they exercise. A study on prostate cancer showed that men who exercised vigorously for a half hour a week had a 35% lower chance of dying. Men who did more vigorous exercise- power walking for 90 minutes a week- showed an astonishing 51% lower chance of dying than men who did not exercise.
• Lower Risk Of Recurrence- Many studies have been done in an attempt to prove that exercise can stave of cancer from returning after successful treatment has been performed. The amount of body fat that a patient has is linked to the return of cancer. In essence, the more fat that a patient has on their body, the more likely they are to suffer from cancer again. Exercise keeps the body in shape and reduces if not eliminates unnecessary fat.
• Strengthens the Body- Exercise naturally makes the body stronger. Cardiovascular exercises (running, biking, etc.) make the heart stronger increasing circulation. Resistance exercises (weight lifting) increase muscle mass and make the body stronger all over. Cancer attacks the body and unfortunately some of the necessary treatment options, such as chemotherapy, can weaken it as well. Exercise is a means of building up the body, making it tougher and more resilient which serves patients well when fighting the disease.

Each patient should be considered on an individual basis. Ask your doctor about how exercise could help you or a loved one that is fighting the disease. Moderate exercise is generally recommended while the patient is undergoing treatment. The goal is to keep the body active and strong without over doing it. After other treatment options have run their course, it is recommended that the intensity of exercise sessions increase. Exercise as a form of treatment can include something as simple as taking a walk several nights weeks. Seeking the advice of the attending physician is always necessary.

If you would like to learn more about cancer treatment, visit Largo Medical Center online. If you would like to speak with someone about a medical concern call our Consult-A-Nurse® program at 1-877-442-2362.

Lymphedema is a condition that often affects patients who have cancer. It causes swelling of the limbs and promotes the development of infection. If lymphedema is caught early enough, it can be treated. Knowing the symptoms, risk factors, and treatment options of lymphedema can help patients feel more secure about their medical care, and protect their health from more serious complications.

What is lymphedema?

The body’s lymphatic system contains its own special fluid. This fluid can “pool” in the limbs of the body, causing swelling. Usually the lymphatic fluid collects in the arms or legs. Over time, the fluid changes the body’s tissue, first making it spongy, and eventually making it harder. If the condition is diagnosed early, doctors can control other medical conditions associated with lymphedema, such as infection and complications with wound healing.

How can I identify lymphedema?

Usually patients with lymphedema begin to feel a sort of fullness or weight in their limbs. The skin may get tight, and it might be difficult to wear jewelry like rings and watches. Clothing often feels tight around the affected limbs, and joints in that limb begin to lose some flexibility. If you notice consistent swelling or signs of infection (rash, redness, or hot skin), seek medical attention immediately. The condition develops in stages, and the last stages cause irreversible damage. It’s important to catch lymphedema as early as possible.

What causes lymphedema?

The condition can be either primary or secondary. Patients with primary lymphedema were born with an abnormal lymphatic system. They may be missing lymphatic vessels (commonly called lymph nodes), or have other disorders that cause the system to function incorrectly. Secondary lymphedema is much more common. This occurs when the patient’s lymphatic system is altered in some way, usually as a result of another medical treatment. For instance, a patient’s lymph nodes may have to be removed due to the presence of cancer.

How does lymphedema develop?

Any change to the lymphatic system, including the formation of scar tissue on lymph nodes, alters the way that the body can process lymphatic fluid. Once that normal flow has been interrupted, the liquid simply builds up in the body’s extremities.

Which treatments raise a person’s risk for lymphedema?

Although many cancer patients get lymphedema, not all do. It depends on whether lymph nodes must be removed as part of treatment. Patients who take Tamoxifen have elevated risk for lymphedema, along with blood clots and deep venous thrombosis (DVT). Radiation treatment can cause scarring on lymph nodes, resulting in interrupted lymphatic flow and increased risk for lymphedema.

I’ve been diagnosed with lymphedema. What are my treatment options?

Proper treatment depends on the cause of lymphedema. Sometimes it starts with an infection, and requires antibiotic treatment first. Otherwise, doctors usually follow a protocol called Complex Decongestive Therapy (CDT). This therapy includes multiple treatment approaches, including drainage, bandaging, and the use of compression garments like stockings or sleeves. Patients will be advised to take good care of their skin and maintain a proper diet. They may also do specific exercises and learn how to drain and bandage if appropriate.

If you’d like more information about lymphedema or cancer care, please contact us at Largo Medical Center. Visit us online, or call Consult-a-Nurse® at 1-877-442-2362 for free physician referrals, answers to your questions, and details about lymphedema support groups.