Medical directionsuwhealth.org/MDNews • Vol. 8 • Issue 3 • 2012

PA-3

3045

-12

P5

Bursts of heat-energy, cameras the size of a pill and specialized instruments that illuminate the darkest corners of the gut are all part of the toolkit that UW Health gastroenterologists use to manage complex and chronic disorders of the gastrointestinal tract, pancreas, liver and bile ducts. Seven members of the UW Health advanced endoscopy team combine their training and experience with sophisticated technology to diagnose and treat thousands of patients each year.

Recent developments in small bowel imaging have revolutionized the diagnosis and evaluation of many digestive diseases such as obscure gastrointestinal bleeding, Crohn’s disease, celiac disease and small bowel tumors.

With capsule endoscopy, patients swallow a pill-sized camera that captures thousands of digestive tract images, allowing physicians to visualize the entire small bowel in real-time. Double balloon enteroscopy (DBE) uses an inflatable balloon to improve visibility and access to lesions in the distal small intestine identified by capsule endoscopy.

Endoscopic retrograde cholangiopancreatogram (ERCP) combines endoscopy and X-ray imaging to diagnose and treat benign and malignant biliary and pancreatic disease by visualizing bile and pancreatic ducts. ERCP is used by UW experts for:

• stone removal from the biliary or pancreatic ducts• dilation of the biliary or pancreatic ducts• duct stent placement• choledochoscopy• lithotripsy• sphincter of oddi manometry

Endoscopic ultrasound helps provide earlier diagnosis of malignant tumors of the pancreas, intestines and lymph nodes adjacent to the gastrointestinal tract, avoiding surgeries in some patients. It allows UW Health gastroenterologists to:

• examine the lining of the intestinal tract• evaluate pancreas mass lesions, chronic pancreatitis and bile duct

abnormalities• sample fluid or cells from lesions, such as enlarged lymph nodes

deep inside the abdomen

Updates in technology improve digestive Health care

Minimally invasive surgical techniques to treat esophageal and Gastric cancersIn addition to continuing to provide minimally invasive esophagectomy for esophageal cancer,

the Department of Surgery has expanded its services to offer laparoscopic total and sub-

total gastrectomy with an extended (D2) lymph nodal dissection to treat selected patients

with proximal and distal gastric cancers. In August 2012, Guilherme M. Campos, MD, PhD

an associate professor at the University of Wisconsin School of Medicine and Public Health

(UWSMPH), successfully performed the first two laparoscopic total gastrectomies for gastric

cancer at UW.

Dr. Campos is a gastrointestinal and laparoscopic surgeon who specializes in traditional

and minimally invasive techniques to diagnose and treat esophageal and gastric cancers.

Dr. Campos’s research has focused on treatment outcomes after minimally invasive and

endoscopic procedures for esophageal and gastric diseases. He has authored or co-authored

more than 50 peer-reviewed articles and chapters in books and has presented his work at

more than 100 national and international meetings.

As part of a multidisciplinary team of medical and radiation oncologists, Dr. Campos and James Maloney, MD will evaluate

patients with esophageal and gastric cancers in the Esophageal Cancer Clinic at the UW Carbone Cancer Center. Dr. Maloney is

certified by the American Board of Surgery and by the American Board of Thoracic Surgery. He specializes in general thoracic and

oncologic surgery. His practice includes minimally invasive surgery, including treatment of esophageal cancer, mediastinal disease,

thoracoscopic lobectomy and endoscopic sympathectomy.

Laparoscopic gastrectomies and minimally invasive esophagectomies result in fewer peri-operative complications, less pain and a

reduced hospital stay, while preserving essential oncologic principles of cancer removal.

Continued on page 5

Medical Directions is published by UW Health Marketing and Public Affairs Department, 301 S. Westfield Road, Suite 250, Madison, WI 53717.Copyright 2012, UW Hospital and Clinics Authority Board

Editor: Nicole Barreau Design: Melissa Rodriguez Production: Michael LembergerPhotographer: John Maniaci, Andy Mannis

600 Highland AvenueMadison, WI 53792 Md

Read more stories and sign up for the electronic version of Medical Directions at: uwhealth.org/MDNews

Digestive Health from page 1

Each year, 70 million computed tomography (CT) scans are performed in the United States, which can result in more accurate diagnosis and appropriate treatment leading to better health outcomes. Because ionizing radiation kills cells - even healthy ones - radiation overexposure can be harmful. Although the exact risks of repeated exposure to ionizing radiation from medical imaging remain unclear, the UW Department of Radiology has made radiation exposure awareness a top priority.

Committed to maintaining the highest standards of patient safety

At UW Health, robust safety measures are in place to reduce or eliminate patient exposure to ionizing radiation during medical imaging. When appropriate, a test that does not use ionizing radiation — such as magnetic resonance imaging (MRI) or ultrasound - will be performed as an alternative. However, “the benefits of CT

examinations usually far outweigh the potential risks of radiation,” says Jeffrey Kanne, MD, associate professor of Thoracic Radiology and vice chair of Quality and Safety at UW School of Medicine and Public Health.

“To ensure patients are not exposed to radiation unnecessarily, the UW Department of Radiology and Department of Medical Physics have designed CT scan protocols that provide images of the highest quality

while delivering the optimal radiation dose to the patient, taking advantage of current image enhancement technologies and radiation dose reduction techniques,” says Dr. Kanne.

UW radiologists are available for consultation if there remain any questions about whether a CT scan should be performed. For more information, to find answers to your questions, or to contact a member of the UW Health Radiology faculty at the numbers below:

Abdominal imaging: (608) 265-7216

Breast imaging: (608) 262-7133

Thoracic imaging: (608) 265-7250

Cardiovascular imaging: (608) 263-1229

Musculoskeletal imaging: (608) 263-6461

Neuroradiology: (608) 263-8623

Nuclear medicine: (608) 263-9308

Pediatric imaging: (608) 263-0670

Vascular interventional radiology: (608) 263-8326

UW Health strengthens diagnostic imaging Protocols, reduces radiation exposure

• drain fluid from cysts in the pancreas or liver• drain large symptomatic pancreas pseudocysts (when combined

with ERCP)• inject pain relieving medicines directly into the nerves of the

celiac plexus, providing sustained pain relief to patients with advanced inflammation or cancer of the pancreas

A new treatment option for patients with Barrett’s esophagus called HALO radiofrequency ablation (RFA) provides bursts of heat-energy in a very precise and controlled manner. This procedure removes pre-cancerous cells from the esophagus without damaging the lining or underlying structures.

The UW Health gastroenterologists who form the advanced procedures team are national leaders. The UW Hospital and Clinics Ambulatory GI endoscopy program has received the highest recognition by the American Society of Gastrointestinal Endoscopy (ASGE). The ASGE Endoscopy Unit Recognition program honors endoscopy units that follow the ASGE guidelines on privileging, quality assurance, endoscope reprocessing and CDC infection control guidelines; and have completed specialized training of principles in quality and safety in endoscopy.

To learn more about these and other procedures available through the UW Health advanced procedure team, visit uwhealth.org/digestivehealth

Guilherme M. Campos, MD, PhD

The advanced endoscopy team left to right in front row: Drs. Anurag Soni, Ryan De Lee, Mark Benson. Back row: Pat Pfau, Deepak Gopal. Not shown: Drs. Mark Reichelderfer and Bryan Magenheim.

“Our expertise with these procedures, combined with our multi-specialty approach

to care, means shorter hospital stays and faster patient recovery,”

— Deepak Gopal, MD

CME Course Update:

• Making the Connection 2013: 2/15/13

• SACME 2013 Spring Meeting: 4/10 – 4/13

• 10th International Symposium on Functional Gastrointestinal Disorders: 4/12 – 4/14

• 4th Annual Current Topics in General Surgery: 4/26 – 4/27

• Wisconsin Osteoporosis Symposium: The Bare Bones of Osteoporosis Care: 6/21/13

To learn more about UW Health’s diagnostic imaging protocols, visit uwhealth.org/MDNews

The UW Department of Surgery is excited to announce that in December, we will have a new Updates in Clinical Care e-Newsletter format which will circulate by email monthly and focus on a single health topic/disease state. With the guidance of our editorial board, staffed by UW and regional primary care physicians, the newsletter will offer education on the latest trends and topics, including sharing tips, evaluation guidelines or how-to's.

Jeffrey Kanne, MD

P4P3

“WisH” – restoring sexual Health after cancer

As few as 10 years ago, when a woman was diagnosed with cancer, her sole concern was survival. Today, with dramatic improvements in survival rates, patients focus on their quality of life after treatment, remission or recovery. New treatments mean women can return to caring for their families, to work, to active lives. And to sex.

“People underestimate the importance of sex to normalcy,” says David Kushner, MD, director of the UW Carbone Cancer Center’s Gynecologic Oncology program. Although women often think about post-treatment intimacy, they may not feel comfortable talking about it.

After initial treatment women tend not to think about sexuality, he explains. However, between three months to two years after treatment they begin to realize they want understanding, need information and deserve help.

Women sometimes approach the subject themselves; sometimes they wait to be asked. The majority of questions are based on fear: of pain, of causing pain

for their partner, of triggering a cancer recurrence, of infertility.

A new program, unique to the UW Carbone Cancer Center (UWCCC), called WISH, Women’s Integrative Sexual Health, will provide resources, emotional support and most important, reassurance that no woman is alone.

UWCCC is helping women address the sensitive, and often misunderstood, frightening and embarrassing issues surrounding cancer and sexuality. Women of any age, with any cancer diagnosis, are invited to attend a free 90-minute educational session to learn more about female sexual health and cancer.

MD Online uwhealth.org/MDnews MD Online uwhealth.org/MDnews MD Online uwhealth.org/MDnews MD Online uwhealth.org/MDnews MD Online uwhealth.org/MDnews

a new addition to UW Health’s neuro rehabilitation

UW Health Sports Medicine is one of the few clinics in the Midwest to offer platelet-rich plasma (PRP), an injection therapy that uses a patient’s own “supercharged” blood to heal chronic soft-tissue injuries. PRP is a fraction of plasma that has been isolated and used to enhance regeneration in tendons and other soft tissues. The healing potential of PRP has been attributed to the release of multiple growth factors from the highly concentrated platelets.

In PRP therapy, physicians draw the patient’s blood and concentrate the platelets with a centrifuge. They then inject the platelets directly into the injured area using ultrasound guidance to direct the needle.

Over time, the injected platelets release growth factors that stimulate tendon and tissue healing, and recruit cells that will eventually form new tissue.

UW Health sports medicine physician John Wilson, MD offers PRP therapy primarily to recreational and competitive athletes with chronic soft-tissue injuries,

or people with overuse injuries due to physically demanding jobs.

Clinical outcomes show that PRP may be an effective option for patients who have tried everything else—physical therapy, splints, orthotics—but who are not interested in surgery. Patients typically notice improvement after one or two injections, though total recovery usually takes three to six months, depending on the severity of the condition.

Platelet-rich Plasma injections Help Heal soft-tissue injuries

Only a handful of liver transplant centers in the U.S. share the success rates that the UW Health program has maintained for years. Program wait times for liver transplantation are among the shortest in the country. The team is constantly engaged in initiatives to improve the care of liver transplant recipients, create a new CME module on living liver transplant and participate in national and international clinical trials to research immunosuppressive agents to improve quality of life for recipients.

With federal changes to liver allocation, the number of organs available for transplant in Wisconsin are expected to decrease, widening the gap between organs and the number of patients on the transplant waiting list. Live donor liver transplant helps close the gap so patients receive their transplant before it is too late.

Recent studies show patients with a MELD score of less than 15 have a survival advantage when they receive a liver from a live donor compared to those

listed but who have not received a transplant. Patients with a MELD score greater than 15 who are transplanted with living donor livers also have a survival advantage when compared to those transplanted with deceased donors.

Along with new technology that improves safety for both donors and recipients, the UW Health team has created a consortium with international programs that provides a much larger scale for studying the benefits of live donor liver transplant. Together with Will Burlingham, PhD, they are studying ways to minimize or withdraw immunosuppressive therapy.

Pictured Left: Luis Fernandez, MD, UW Health transplant surgeon, and Alli, a pediatric liver patient, share their secret hello sign.

transplant neurology & neurosurgery cancer

orthopedics

transplant team expands living liver donor Program

Read more online at uwhealth.org/MDNews

When Kristin Caldera, MD, did her physical medicine and rehabilitation rotation in medical school, she saw her future. The mechanics of the body, especially the neuromuscular systems, intrigued her. After further study, she saw opportunities to help large groups of patients with neurological issues who needed special attention and decided to focus her practice on improving functionality for them.

Dr. Caldera brings a unique big-picture approach to patients with stroke, traumatic brain injuries, spinal cord injuries, multiple sclerosis, adult cerebral palsy, spina bifida, ALS and movement disorders. Coordinating various treatment plan elements is an essential part of her work.

“My work goes beyond physical therapy to encompass all parts of the patient’s experience including medical, behavioral and psychological needs, as well as navigation of the care system itself,” says Dr. Caldera. Her philosophy is that earlier and more comprehensive intervention can make a big difference for many patients.

Her process is to personalize their care with an in-depth evaluation of each individual and bringing

in other disciplines such as physical and occupational therapy, psychiatry, speech and swallow therapy, neurology, neurosurgery and others as needed. Treatments for spasticity include rehabilitation programs, medications, botulinum toxin injections and intrathecal baclofen. Neurogenic bowel and bladder patients are also evaluated and treated.

Dr. Caldera addresses bracing and equipment needs such as orthotics and wheelchairs as essential parts and improving the function of these patients and making their lives easier. She works closely with primary care physicians as part of an overall care team helping patients with chronic disabilities who need long-term care plans.

Dr. Caldera can be contacted at (608) 263-8412/(800) 323-8942.

Other Neurology and Neurosurgery Story: UW Cerebrovascular Service Offers Comprehensive Resource

Read more online at uwhealth.org/MDNewsOther Cancer Story:

UW Surgeons Specialize in Multiple Breast Reconstruction Options

For more information about the WISH program, call (608) 263-1434

Other Transplant Story: Living Liver Transplant Gives Teen a Second Chance

compartment syndrome: diagnosis and treatment increasingWilliam Turnipseed, MD has been treating patients with compartment syndrome since 1980, the year that he redesigned the surgical treatment for the condition. Since then, UW Health vascular surgeons have treated more than 2,100 patients who have muscles, nerves and blood vessels compressed within enclosed spaces of their lower leg.

Compartment syndrome is prevalent among athletes and presents as swelling, isolated muscle cramping and pain, and is not relieved by medication or elevation. Chronic cases often occur among track, cross-country and soccer athletes in their late teens and early twenties, and 70 percent of cases are female. Acute compartment syndrome is less common and may be the result of blunt or penetration trauma.

Surgical treatment is available for acute and chronic compartment syndrome. Small skin incisions are made and sections of fascia are removed to release pressure.

UW Health’s success rate for compartment syndrome is more than 90 percent. Dr. Turnipseed notes that five to six percent of patients may experience a recurrence, and another 20 percent may develop compartment syndrome in another muscle group.

Dr. Turnipseed says that when compartment syndrome was first diagnosed it was often more than two years after the symptoms began. Today, most diagnoses are made within six months. He adds, “The key is to have an index of suspicion. If you have young healthy adolescents and adults without obvious physical injury or circulatory problems, but have isolated muscle cramping and sensation changes in the tops or bottom of their feet, they may have compartment syndrome.”

heart, vascular & thoracic

Other HVT Story: Dr. Hamden is New Cardiovascular Medicine Chair

Read more online at uwhealth.org/MDNews

P2

two new Pediatric surgeons Join UWDaniel Ostlie, MD, has been named surgeon-in-chief at American Family Children’s Hospital in Madison. Dr. Ostlie joined the UW faculty after 12 years at Children’s Mercy Hospitals and Clinics in Kansas City, MO, where he also completed his pediatric surgery fellowship. His medical degree is from the University of North Dakota School of Medicine & Health Sciences. While completing his general surgery residency at the Mayo Clinic Scottsdale, he performed a surgical research fellowship at Cambridge University in England.

Dr. Ostlie specializes in minimally invasive and laparoscopic procedures for most congenital and acquired surgical problems in children. He also specializes in complex neonatal surgical diseases and difficult problems with the esophagus and gastroesophageal reflux. Dr. Ostlie’s research interests are focused on evidence-based pediatric surgery. He has served as the primary investigator or co-investigator in more than 20 prospective randomized controlled trials in infants and children.

Dr. Ostlie can be reached at (608) 263-9419 or ostlie@surgery.wisc.edu

Patrick McKenna, MD, is the new chief of pediatric urology at UW Health. He had served as chair and professor in the Division of Urology in the Department of Surgery at Southern Illinois University. He received his medical degree from George Washington University. He completed his urology residency at Naval Regional Medical Center in Portsmouth, Virginia and later completed a Clinical/Research Fellowship in Pediatric Urology at the Hospital for Sick Children in Toronto.

He is a Specialty Diplomat of the American Board of Urology, immediate past president of the Society of University Urologists, chair of the Judicial and Ethics Committee of the American Urologic Association, and secretary of the North Central Section. He also has a career interest in quality improvement. Dr. McKenna’s special interests are complicated urologic reconstruction, Wilm’s Tumor, antenatally detected urologic problems, disorders of sexual development and minimally-invasive treatments. His innovative use of computer games and conservative, noninvasive approach to managing pediatric urinary incontinence and urinary tract infections have been widely adopted nationwide.

Dr. McKenna can be reached at (608) 262-0475 or at mckenna@urology.wisc.edu

UW Health physicians David Bernhardt, MD and John Wilson, MD are now providing sports medicine services at UW Health East Clinic, 5249 East Terrace Drive. Appointments can be scheduled by contacting the UW Health East Clinic at (608) 890-6560.

Other Orthopedics Story: Promising Research, Future Investigation

Read more online at uwhealth.org/MDNews

Daniel Ostlie, MD

Patrick McKenna, MD