Step:Ith forBaby-

HEALTHS1yleSpring 1995

CON TEN T 5

page 4

F EAT U RES

LEHIgnvAILEYHOSPITAL

1 Stroke: The "Brain Attack" You Can't IgnoreEvery year in America, 550,000 people suffer a stroke. Newresearch about how and when brain cells die during a "brainattack" is altering the way physicians treat and manage strokes.

Board of TrusteesSam Bub, MDJoseph A. CandiD, MDJohn E. Castaldo, MDC. McCollister Evarts, MDRichard FlemingRev. Daniel G. Gambet, OSFSRobert L GoodmanIrwin GreenbergRev. Dr. Grant E. HarrityGeorge W. Hartzell, MDDavid J. KeplerRobert X. Murphy, Jr., MDFrank J. RyanRev. William A. SeamanFrederick SherrerdDonald T. Shire, Esq.Charles D. SnellingEllwyn D. SpikerKathryn A. StephanoffElliot J. Sussman, MDKathryn P. Taylor

Elliot .J. Sussman. MDPresident &Chief Executive OfficerLehigh Valley Hospital

Editorial BoardMichael W. Kaufmann, MD

Department of Psychiatry

Judith N. SabinoCommunity Health

Marketing, Planning &Public Affairs

John C. StavrosSenior Vice President

Mary Alice CzerwonkaDenise Y. GolantSusan J. HoffmanKerri L. Puskar

James A. SantanastoKathleen E. ScaiefRobert K. StevensKenneth Szydlow

HealthStyle is published fourtimes a year by Lehigh ValleyHospital and the Lehigh ValleyHealth Network. Its goal is tohelp its readers to maintain ahealthy lifestyle by providinginformation and education.Information appearing in thispublication is not intended forself-diagnosis and/or treatment.If you have a health problem,please contact your primarycare physician or call(610) 402-CARE for furtherassistance. Any commentsconcerning this publicationmay be sent to:HEALTHSHLEMarketing, Planning andPublic Affairs1243 S. Cedar Crest Blvd.Suite 3115, Allentown, PA 18103or you may call (610) 402-CARE.

© Lehigh Valley HealthNetwork,1995.All rights reserved.

Produced byWECO Communications2715 Richcreek RoadAustin, Texas 78757-2140

Cover Photo: © 1995, Michael KrasowitzFPG International Corp.

B The first Step to Good HealthThe Perinatal Partnership is working to reach every pregnantwoman who needs help getting prenatal care in the Lehigh Valley.

9 Dr. forrest Moyer Has Touched the lives of Manyfamilies-and PhysiciansForrest Moyer, MD, has played a major role in the growth ofpediatrics at Lehigh Valley Hospital.

D E PAR T MEN T 5

'L~~of 54)'

a stroke, The~:, . 6kuded vitalityas Gomez, tFle"head of the ~ovies' 'Addams Family, had been felled by whatmedical experts now refer to as a "brainattack" The phrase "brain attack" isnow in use because doctors todayrecognize that strokes are medicalemergencies requiring prompttreatment, much like heart attacks.Individuals should be rushed to ahospital emergency room ~s soon asthey experience symptoms.

"New research about how and whenbrain cells die has forced the medicalcommunity to re-examine its attitudetoward stroke," says John E. Castaldo,MD, director of neurosciences researchat Lehigh Valley Hospital. "We now

regard TIAs and strokes as medicalemergencies. "Most people know aboutgetting to the hospital immediately ifthey think they're having a heart attack,"says Eckert. "But with a brain attack, thebrain doesn't come back If you waitaround for symptoms to disappear anddo not get to the hospital fast, preferablywithin an hour of symptom onset,damage continues to progress rapidly."

Although strokes are most prevalentamong the elderly, everyone has somedegree of stroke risk, includingadolescents and even children. Nearlyone-third of stroke victims are youngerthan 65. Yet, most people have theattitude of "It won't happen to me." In arecent Gallup poll 97 percent could notname a single warning sign of stroke.

continued on next page

The Brain AttackYou Can't Ignore

know it's possibleto treat stroke, not

. just manage itscomplications. "Stroke occurs

when a blood clotor burst arteryinterrupts the bloodsupply to part of thebrain, causing brain

cells to die from lackof oxygen and blood-

borne nutrients. Thefunctions these cells

control-speech, musclemovement, breathing-may

be permanently impaired or lostaltogether.Strokes can take place suddenly, or

give advance notice as transient ischemic

attacks or TIAs-warning signs that theblood supply to the brain has beentemporarily interrupted. A TIA cancause blindness in one eye-a "blackout"or "whiteout" of vision, or somethingoften described as a shade being pulleddown over the eye. Sometimes it occursas sudden numbness or weakness ortingling in one arm or leg. A TIA canlast a few minutes or up to 24 hours, butit should not be ignored. Thirty-sixpercent of those who experience a TIAwill go on to have a full stroke-half ofthem within a year. If you think you areexperiencing a TIA, seek immediatemedical attention.

Nancy Eckert, RN, the hospital'sneurosciences research nursecoordinator, helps to educate LehighValley "first responders," such asparamedics, firemen and policemen, to

Stroke symptoms are subtle and often painlessIt's important to learn them so that you can callfor emergency medical attention if you everexperience them or see them in someone else.The most common symptoms of stroke are:

V' One-sided weakness, tingling, numb-ness or paralysis of face, arm or leg

V' Temporary vision loss, or dimness inone eye, or double vision

V' Inability to talk or understand language

V' Unexplained headaches

V' Difficulty swallowing or unexplainedchoking on a drink or your own saliva

V' Falls, temporary blackouts, dizziness orunsteadiness

For more information about whatyou can do to prevent strokes.

call (610) 402-CARE.

WARNING SIGNS

HEALTHStyle

New StrokeTreatments

and ResearchLast winter a mobile crew from the ABC NewsTV Program 20/20 travelled to Lehigh ValleyHospital. The reason? The crew had come to .film doctors evaluating and treating carotid ath-erosclerosis, a condition that creates athickening, hardening-and loss of elasticity inthe neck's carotid arteries-a major cause ofblockages that can lead to strokes. John E.Castaldo, MD, director of neurosciencesresearch for the hospital, was also interviewedby the crew in his role as principal investigatorfor a major, new, multi-site, national researchstudy, the Asymptomatic Carotid Athero-sclerosis Study, in which Lehigh Valley Hospitalhad participated

The clinical trial was initiated to investigate thebest way to prevent and treat carotid athero-sclerosis. Since up to 25 percent of strokes areattributed to partially blocked carotid arteries,its findings represented a medical break-through in the treatment of the condition,revealing that people who had a significantblockage in their carotid arteries respondedbetter to treatment with surgery than thosewho were treated with just medicine alone.

In fact, results were so significant that they~ere presented ahead of schedule. Accordingto Dr. Castaldo "Lehigh Valley Hospital led thenation in the number of patients in that studyand in performance. The study was terminatedearly when it was clear that the surgical groupdid much better than the medical group."

Castaldo and other researchers at the hospitalcontinue to investigate promising treatmentsfor stroke, including new surgical advance-ments and the effectiveness of Ancrod andother clotbusters, drugs that dissolve clots thatcan cause strokes, and Selfotel and otherneuroprotectors, drugs that prevent therelease of adverse chemicals in the brainduring a stroke episode. Neurologist PeterBarbour, MD, the principal investigator, says:"Ancrod and Selfotel are currently beingstudied to see if early treatment can reducedamage to the brain in the period immediatelyafter stroke." Such research offers hope forfuture stroke prevention and treatment

2 HEALTHStyle

By knowing the symptoms of a brainattack, you can help to minimize strokedamage (see page 1: ''Warning Signs").And, by understanding and managingkey risk factors, you can help to preventstrokes from occurring.

Risk factors for stroke that can't bechanged include age (stroke is mostprevalent in people over 55), gender(men are at greater risk than women),race (blacks face the highest risk) andcongenital defects. But there are otherfactors you can change, includingobesity, a sedentary lifestyle, highcholesterol, high blood pressure, heavyalcohol consumption, smoking anddiabetes. The risk factors are similar tothose for heart attacks. So if you'rewatching your diet, exercising andhaving regular medical check-ups you'llbe helping to prevent both heart diseaseand brain attacks.

"Regular check-ups are importantbecause by keeping track of the patient'shealth and stroke risk factors, such asdiabetes, past history of stroke or TIAs,family history of stroke, evidence ofheart disease or elevated bloodpressure-we can help to prevent strokewith medications and lifestyle changes,"says Will Miller, MD, program directorfor the department of family practice atLehigh Valley Hospital.

Part of any physical exam includes

listening to the neck's carotid arteries for"bruits," a whooshing sound made byblood passing through narrowedarteries. The carotid arteries are thebody's principal means of ferrying bloodto the head and neck. "There's a definitebenefit in detecting carotid blockageearly and intervening surgically," saysMiller. Breakthrough surgicalprocedures that prevent stroke byremoving fatty deposits from carotidarteries are now among the many newalternatives available for preventing andtreating brain attacks. (See sidebar:"New Stroke Treatments andResearch.") Until recently, physiciansfelt they could only manage strokesymptoms; survivors were left to copewith stroke's effects-paralysis, speechloss and impaired memory. Nowpowerful new stroke treatments arehelping to reverse old assumptions.

But since stroke is such a devastatingdisease--everyyear in America, 550,000people suffer a stroke; of this number150,000 will die-it makes more sense toprevent a brain attack from happening in.the first place. You are the number onefactor in preventing stroke and strokedamage. Don't ignore a brain attack.

Evelyn Zamula is a frequent contributor tonational health care publications, including FDAConsumer and Medical Times.

funnybone

Iv

"Halt! Golf Ball Season!! No scurrying on the coursewithout goggles and helmet!! Am I clear??!!"

nutritionally sound so I made changes inmy diet that I could live with," he says.

When providing nutritionalcounseling to his patients, Stellorecommends that they adopt the type ofgradual approach that worked for him."Unless a patient is diabetic or has highcholesterol, I don't rule out all junk foodor fast food," he says. "It's okay to eatthose things in small amounts, but onlyonce in awhile. I try to coach patients tomake healthy food choices. That canmean eating at home more often,cutting down on fatty foods or selectingmore sensible items from a menu whendining out."

Stello emphasizes that motivation isthe key to achieving and maintaining ahealthy lifestyle. "You need tounderstand that whatever you're doing,you're doing it for yourself," he says."That won't be hard to remember whenyou notice that you have more energy,confidence, vitality and feel morerelaxed."

Brian Stello, MD

Brian Stello, MD, a 35-year-oldLehigh Valley Health Networkprimary care physician, practiceswhat he preaches: "I spend quite a

bit of time talking with patients aboutimproving their eating habits, steppingup their levels of activity and makingother positive and appropriate lifestylechanges."

Like most of us, as his career took off,it ~asn't easy for Stello to find time toexercise. He'd been active sincechildhood in such competitive andrecreational sports as baseball, football,volleyball, cycling, racquet sports andweight-lifting. But Stello soon foundmedical school and residency trainingleft little time for athletic pursuits. Junkfood also became a temptation. "I wasso busy, it became too easy to just pickup a hamburger at a drive-throughwindow." After years of living a stressfulmedical student lifestyle, he decided toreverse that trend.

He soon discovered that was easiersaid than done. "When I decided tomake exercise and nutrition priorities inmy life, I realized that I wasn't going tobe able to pick up where I'd left offwhen I was working out on a regular

Brian StBlIo, MO:"If patients can't see t~at I follow my own a~vice, t~ey're not going to pay muc~ attention to w~at I sa(

basis," Stello says. "I had to take it stepby step."

He kicked off his return to betterhealth by choosing activities thatrequired the commitment and participa-tion of just one person-himself. Hisnew regimen revolved around cyclingand aerobic machines, to increase hiscardiovascular endurance, and weight-lifting, to improve his muscle tone. Thiskind of cross-training-altemating twoor more complementary activities-gavehim a chance to strengthen differentparts of his body on different days.Later, as his physical strength andstamina increased, he expanded hisexercise routine to include calisthenicsand jogging.

He also set about improving his nutri-tional habits by including more grains,pastas, fruits and vegetables in his diet.He admits that while at times hesuffered a fast food setback, he wasmotivated to keep to his new nutritionalcourse. "A steady diet of fast food isn't

SPRINGTIMESpring is in the air. Your bicycle is beckoning.And whether you prefer a road, hybrid ormountain bike, cycling can lead to good timesand good health. It not only conditions theheart and lungs, but it also strengthens bonesand leg and back muscles as effectively aswalking, jogging, aerobic dance and otherweight-bearing activities. It offers a terrificmeans of weight loss and/or control. On theaverage, at speeds between 18-20 mph on aroad bike, a cyclist burns 600 calories perhour. Long, steady rides, in excess of 45minutes, are best if your goal is to lose weight.

Consult your physician first before embarkingon any new exercise plan, and be careful notto push yourself too hard-particularly in thebeginning. Start out slowly and gradually

".CYCLINGincrease your endurance. Give your body achance to rebuild between strenuous rides.Symptoms of overtraining can include feelingrun down, unmotivated and as if you weresuffering from the common cold.

Also, whenever you cycle protect your headand health by a/ways wearing a bicyclehelmet. Look for one that bears a labelverifying that it meets with AmericanNational Standards Institute, Inc. (ANSI)approval. If your bike has been in winterstorage, oil the gears, check the chain andinflate the tires before taking off. With theproper equipment, you'll be more than readyto "spring" into cycling.

For more information about safe cycling andNational Bike Month [in Mayl, call 1610l 402-CARE.

HEALTHStyle 3

"The team that develops the drugformulary reviews each class ofmedications available," Leri says. "Forexample, there are several penicillins onthe market, but it would be veryexpensive and unnecessary to carrythem all in the pharmacy." The clinicalpharmacists ask the assistance of thehospital's infectious disease expertswhich penicillin should be included inthe formulary. Generally, input isgathered from about three differentspecialties before any drug is approvedfor addition to the formulary, Leri says.

Generic versions of a drug alsocontrol costs. These become availablewhen a brand name drug's patent runsout, and they generally cost consider-ably less than the brand namemedication costs. "Generic drugs thatare therapeutically equivalent to brandname drugs are routinely dispensed tocontrol costs at the hospital," Leri says.

lastyear, Americans spent about$54.8 billion on pharmaceuticals,and employers paid a large portionof that bill. In 1992, outpatient

drug benefits cost employers anaverage of $386 for each employee.And the bill is growing. From 1990 to1992, employers saw a whopping 38percent increase in the cost of prescrip-tion drug benefits.There are a number of measures to

optimize and manage the dollars spenton medications, both in and out of thehospital. Pharmacists at Lehigh ValleyHospital and Lehigh Valley HealthNetwork describe some of the waysthey are attempting to manage costs.

"When dealing with costs, you can'tjust look at the price of the drug," saysBarbara Leri, a clinical pharmacist."You must also look at whether aparticular drug will improve thepatient's outcome and perhaps getthem out of the intensive care unit orthe' hospital sooner. Sometimes usingthe higher-cost drug lowers overallmedical costs."

"Ensuring that medications are usedin the safest and most cost-effectiveway possible is an important role forthe pharmacy department. At LehighValley Hospital, clinical pharmacistsare responsible for monitoring appro-priateness, dosage and therapeuticoutcome for specific medicationsidentified by a multidisciplinarycommittee. "We review the patient'smedication profile and discuss potentialalternatives with the patient's physicianwhen appropriate," saysMaria Barr,also a clinical pharmacist.

Clinical pharmacists also assist in theeducation of the hospital's dispensingpharmacists, who review the patient'srecord for possible side effects, allergies

4 HEALTHStyle

Putting a Cap on Rising Orug Costsby Deborah Epstein

and other factors, such as age andpregnancy. In this way, clinicalpharmacists, working with staffpharmacists, help prevent costly, andpossibly life-threatening, problems.

Using Drug Formularies"The pharmacy department doesn't

work alone to cut costs," Barr says.The hospital uses a multidisciplinaryteam that includes physicians, nursesand pharmacists to develop andmaintain a drug formulary. This is alist of medications that have beenapproved by the team on the basis ofeffectiveness, potential side effects andcost. Physicians and pharmacists referto the formulary when prescribing anddispensing medications, to help selectthe most appropriate medication fortheir patients. As a method of keepingcosts under control, formularies areparticularly important as the number ofnew, high-tech and high-cost drugsincreases,

Lowering Costs withOutpatient Drugs

The cost of drugs plays a vital role incutting overall health care costs. Theycan, for example, offer treatment to thegrowing number of patients who leavethe hospital sooner in order to receiveambulatory care.

"Many therapies that were onceadministered only in the hospital cannow be given in the home," saysChristopher Rock, a pharmacist andadministrator for Lehigh Valley HealthServices division. Home care is signifi-cantly less costly than hospital care, andmost patients prefer receivingtreatment at home.

"A patient with a bone infection, forinstance, may now receive antibiotictherapy in his own home, and even

continued on page 10

the side, completed the dish. Instead ofpouring the dressing directly on thesalad, Jane minimized the amount of fatand calories normally consumed by justoccasionally dipping her fork tines intothe dressing between bites.judi chose the house salad: a hearty

mix of fresh greens, mushrooms, redcabbage, plum tomatoes, carrots,radishes and garbanzo beans. It was avirtual powerhouse of fiber, vitaminsand even some protein. It wasaccompanied by a light vinaigrettedressing, served on the side.

The waitress also brought a basket ofdelicious, fresh-baked breads. One was agarlic-flavored Italian bread. It was anice change from the fat-laden garlicbread served by many restaurants. Thegarlic flavor had been successfully bakedinto the bread without the added fat ofbutter or oil. The other bread was avery thinly sliced fruit bread. The fruitbread was so delicious and unusual thatwe were tempted to have several slicesand call it dessert.

With the nice springweather upon us, wedecided to take an earlyevening adventure and

explore some of the countrysidesouthwest of Allentown. To our delight,we discovered a wonderful little diningspot: the Geryville Publick House, 1860Geryville Pike, in Geryville Gust outsideof Pennsburg). The menu reads "Failte"(Welcome) at the top, and as we settledinto our seats we were certainly made tofeel welcome by our accommodatinghostess. She shared a bit of Geryvillehistory with us and told us howhistorical records proved that a house ofpublic entertainment had existed at therestaurant's site since 1743.

The restaurant has a colonial feel, butit's very comfortable. Our fellow patronswere casually dressed; the walls arecovered with country artifacts; and freshwildflowers adorn each table. Duringlate spring, summer and early fall, guestsare invited to dine alfresco in "Aurora'sOutdoor Garden." There, miniaturelights glisten in the trees and small,intimate tables surround a bountifulgarden. Its fresh herbs and vegetablesare actually used in the dishes preparedby the restaurant's chefs.

The menu offers an eclectic mix ofEuropean and American cuisines. Asusual, we tried to follow healthy eatingguidelines when making our selections.This wasn't too difficult as both themenu and our waitress were quiteinformative. We passed over suchcaloric and fat-laden spirits as "NuttyNana" (banana liqueur, Frangelico,bananas and cream) and "Piiia Colada,"and kicked off our repast with a non-alcoholic cranberry-apple juice andseltzer concoction. Light in calories, lowin sodium and virtually fat free, it had a

Dining Alfresco: The Geryville Publick Houseby Jane Ziegler, MS, RD and Judi Thieme

sorbet-like fizz--enough to cleanse ourpalates for our simmering appetizer:Tomato Florentine Soup.

The soup was filled with chunks offresh plum tomatoes, spinach andonions, offering a strong complement ofvitamins, fiber and delicious flavor.However, the Fruit and Sherbet Cupmight be a better choice for thoseneeding to monitor their sodium intake.

Next we surveyed our salad selections.The restaurant's dinners come with achoice of the house salad or one of twoversions of a spinach salad. We werepleased to see that one spinach saladversion was very "heart healthy." Thisfruity selection offered a flavorful blendof tender, fresh spinach, sweet purplegrapes, slices of luscious strawberries,tangy kiwi and crisp, golden apples anda small sprinkling of ground walnuts.Jane opted for this salad, which was by

far healthier since its ingredients notonly topped the list for nutrient valuebut were low in fat and rich in fiber. Adelicious poppyseed dressing, served on

continued on page 11

Fresh Herbs~~-" for Good Health"Aurora's Outdoor Garden" offers Geryville Publick House cooks the advantageof fresh herbs, right outside the kitchen door. Whether you have room for anoutdoor herb garden or just want to grow a few sprigs in containers on thekitchen windowsill, fresh herbs add flavor and nutritional value to cooking,salads and teas. What's more, herbs offer a great low calorie, low sodiumalternative to salt and butter for flavoring foods. To help plan your herb garden,here's a quick reference list of the 14 most useful cooking herbs:

Basil, SweetBayChivesCorianderFennel

GarlicHorseradishMintOregano (Marjoram)Parsley

RosemarySageTarragonThyme

HEALTHStyle 5

The Perinatal Partnership is working to reachevery pregnant woman who needs help gettingprenatal care in the Lehigh Valley area.

6 HEALT

BY MALORYE ALLISON

The first steps on a child'sroad to a lifetime of goodhealth are taken longbefore he or she is born.

But many pregnant women neverget adequate prenatal care or onlyreceive it late in their pregnancy.These women have a higher risk forcomplications, and their babies aremore likely to be born prematurelyand to need neonatal intensive careservices,To address the problem, the

Perinatal Partnership was formed inJanuary 1992. The partnership-directed by Lehigh ValleyHospital's Joan Linnander, RN,MA-is a community-based"cooperative" that links thehospital, state and other localagencies and charitable organiza-tions. The partnership's aim is tomake prenatal care available to allwomen. "Women were not gettingcare, and babies were being bornprematurely, requiring specialcare," says James Balducci, MD,chief of obstetrics at Lehigh ValleyHospital. "We had to do somethingto find a practical way to help asmany women as possible get thecare they needed."A number of barriers can keep

women from seeking prenatal care:lack of transportation, overwhelm-ing responsibilities and timeconstraints, language barriers, lackof education, wariness of the health

ocare system, poverty, addiction andsimply not knowing they arepregnant. To address these issuesrequires a number of differentapproaches.

The Perinatal Partnership issupported by several agencies,including the PennsylvaniaDepartments of Public Welfare andHealth, the Pew Charitable Trust,the Howard Heinz Endowment, theDorothy Rider Pool Health CareTrust, the Lehigh Valley ChapterMarch of Dimes Birth DefectsFoundation, the District 18 Kiwanisand Lehigh Valley Hospital.Community partners includeLehigh County Children & Youth,Turning Point, Casa Guadalupe,6th Street Shelter, Pathways andthe•.Salvation Army, with participa-tion from the Allentown Auxiliaryof Lehigh Valley Hospital, variouslocal Kiwanis groups, churches,professional organizations andsororities, the Veterans of ForeignWars Ladies Auxiliary and theJunior League of Women.

A Community BaseEach of these partners brings

knowledge and resources to thepartnership. The key to theprogram's success is that it iscommunity-based. Two parts of theprogram, A Better Start andOutreach for Mothers andNewborn Infants (OMNI) supporta multicultural network of outreachworkers. The outreach workers

meet prospective patients oncommon ground, such as the CasaGuadalupe Latino communitycenter, the Sixth Street homelessshelter, drug rehabilitation centers,shelters for abused women or thestate's office for transitionalhousing. This strategy helps themfind women early and build trustamong those they are trying tohelp. "It is not just physicalbarriers, such as not having a car,that keep women from going to thedoctor," explains Edward F.Meehan, executive director of theDorothy Rider Pool Health CareTrust. "It helps to show womenthey can trust the system and to letthem know we will be sensitive totheir cultural issues."

Cultural sensitivity is particularlyimportant because so many of thesewomen are already facingtremendous challenges. "We see alot of women with seriousproblems," says Damarie Lugo, acommunity outreach worker for thePerinatal Partnership. Theseproblems include homelessness,depression, abuse, drug and alcoholaddiction and being a teenagesingle parent. Teenagers give birthto one of 10 babies born in theLehigh Valley region, and morethan a third of these young womenreceive no prenatal care. "I've seengirls as young as 11 drop out ofschool to have a baby," she says."And lots of the women we'retrying to help are addicted to drugsor in a bad relationship."

Essential CareThe program is already having an

impact. The goal for the first yearwas to reach 200 girls and women,but the program is averaging over400 such contacts a year, and morethan 1,000 women have been caredfor overall. The percentage ofwomen who are learning about theprogram early, while they are stillin their first trimester continues toincrease. "When you can help oneof these women have a healthy babyand then get her life back on track,it's the best feeling in the world,"Lugo says.

Outreach workers offer under-standing and a friendly ear, but theycan also point women to socialassistance agencies (the food bank,shelter, etc.) or free servicessupported by the partnership. Thefirst such service is pregnancytesting, which is made available,right where she is, to any womancontacted who thinks she might bepregnant. Women can also getanswers to their questions aboutpregnancy, either through thehospital or from materials, such aspamphlets and videos, distributedthrough the March of Dimes. "Wehave information for teenagers,women and men," says Mary EllenKoval, executive director of theMarch of Dimes Lehigh ValleyChapter. "One of the mostimportant is our 'Think Ahead'

continued on page 11

HEALTHStyle 7

support staff members provide patientcare in the unit. Ambulatory surgeriesperformed include such procedures astonsillectomies, breast biopsies, carpaltunnel, skin cancer, gynecologic,cosmetic and eye surgeries and-ofcourse-hernia repair.

Today's surgical options for herniasinclude not only the latest refinementsto the classic hernia operation but alsolaparoscopic hernia repair-aninnovative technique using long,slender instruments inserted through atiny incision in the navel and guided byminiaturized video cameras.

"While every patient may not be acandidate for laparoscopic repair,selected patients achieve excellentresults," says Lehigh Valley Hospitalsurgeon Richard Boorse, MD. "Withthe new laparoscopic procedures,patients have considerably less pain andare usually back to work in one to twoweeks rather than six weeks."

Whatever treatment patients andtheir doctors choose, Boorseemphasizes, the important thing is notto put it off. "Hernias don't get betterby themselves," he says. "They only getbigger, more painful and harder to fix.And untreated, the risk of a herniasuddenly becoming trapped, and itsblood supply squeezed off-apotentially life-threateningemergency-never goes away."

by Bruce Grant

icture an inner tube ballooningthrough a weak spot in a tire.Now picture the same thinghappening inside the body, with

soft internal parts squeezing throughthe muscle or bone that's supposed toprotect them. That's a hernia.

Hernias can strike anyone-over 20million Americans, from newborns to

Hernias: Today's Treatments [ase the Strain of Hospitalizationand the Pain of Recovery

between the abdomen and the scrotumis naturally vulnerable. Even a slightamount of muscle weakness (oftenpresent from birth), plus themomentary stress of heavy lifting,hard coughing, prolonged straining orjust laughing or crying can be enoughto cause a "blowout."

Most patients tell the same story: apainless lump appears suddenly in thefold between the thigh and abdomen,

it bulges out withcoughing and gets smallerupon lying down.

Sooner or later mostturn to surgery to replacedelicate tissues andreinforce weakenedmuscles. At over 100,000procedures a year, herniarepair is one of America'smost frequent operations.But where only a decadeago, hernia surgery meantover a week's stay in thehospital, most patientstoday don't even stayovernight.

"Outpatient surgery nowaccounts for over half of alloperations in America,"says Lehigh Valley

Hospital surgeon Walter Okunski,MD, "and for good reasons. It savesmoney. It helps reduce patient anxietyabout surgery and it enables patients torecuperate at home instead of in ahospital bed."

For patients at Lehigh ValleyHospital's new Ambulatory SurgeryUnit, outpatient surgical services arenow consolidated in one convenientlocation on the second floor of thehospital's 17th & Chew site. Over 100surgeons and 95 professional and

At lehigh Valley Hospital-17th & Chew, outpatient surgicalservices have been combined at the new Ambulatory Surgery Unit.

seniors, are estimated to live withthem-and they can affect almost anypart of the body, from the brain to thebowels. But mostly they happen in thelower abdomen-and mostly to men.

Blame it on their anatomy. Otherfactors, like a family history of hernias,previous abdominal surgery andcarrying too much weight (or losing ittoo quickly) increase the risk of herniasfor men and women alike.

But men are 10 times likelier to getgroin hernias, because the opening

8 HEALTHStyle

If you're considering hernia surgery orwould like more information aboutprocedures that can now be done on asame-day basis at the AmbulatorySurgery Unit's convenient 17th & Chewlocation, call (610) 402-CARE.

Bruce Grant is a Philadelphia-based health carewriter.

l

DR. MOYERHAS TOUCHEDTHE LIVESOF MANYFAMILIES-ANDPHYSICIANS

by Kathryn Hobbie

When Martha

Donley was

born in Allentown in

1.950, her chances of

survival were slim.

The tiny, fragile infant

was several weeks

premature and the

scienceof neonatal

(newborn) intensive

care was still a long

way in the future.

One brand-new technologyappeared to offer hope for prematureinfants: the use of oxygenatedincubators to stimulate lung function.As it happened, Martha's father,Edward Donley, was familiar withthis technology. He was an engineerwith a fledgling company called AirProducts, which produced oxygen forindustrial and medical uses.

"I was enthusiastic about thepossibility of oxygen treatment andasked our pediatrician, Dr. ForrestMoyer, about it," says Donley. "Buthe was reluctant. He felt thetechnology was too new and untriedto be worth the risk."

Day after day as the hospital workedto keep Martha alive, Donley visitedMoyer's office for an update on herchances. Day after day the answer was"Fifty-fifty." Finally, at the end of theweek, Donley heard good news. "Iwalked in and before I could even askDr. Moyer said, 'Sixty-forty.'"Martha Donley had been saved-

and Moyer, as it turned out, had beenright. Within a year it was discoveredthat while oxygen improved survival

rates, it often resulted in irreversibledamage to the eyes. "In short,"Donley says, "the babies lived, butthey were blind."Today, 45 years later, Martha

Donley Robb is a psychologist with aPhD. "I remember the day shegraduated from college," her fathersays. "Another woman in her classreceived her diploma flanked by aseeing-eye dog. She had also beenpremature, but she was not asfortunate as Martha; she had not beenborn at The Allentown Hospital andcared for by Dr. Moyer."In the years since Martha Donley's

birth, Forrest Moyer, MD has playeda major role in the growth ofpediatrics at Lehigh Valley Hospital.Chief of the department for morethan 20 years, he was instrumental inthe creation of such programs as theoutpatient clinics and the neonatalintensive care unit, which was namedin his honor in 1981.

The l1).anyyoung doctors trained byMoyer "have a deep respect not onlyfor his high professional standards,but for his personal devotion to

continued on next page

HEALTHStyle 9

,.

patients," says John VanBrakle, MD,chairman of pediatrics today. "Hewas a tireless worker. Many sharestories of home visits with closebedside attention and Dr. Moyerpersonally delivering polio vaccinedoor-to-door."The Donley family remembers the

"loving atmosphere" in Moyer'soffice. "He had a fish tank and hisbeautiful photographs on the walls,and a rocking horse-it was a funplace for a child to go," Marthasays today.

"Forrest Moyer," VanBrakle says,"is one of those people that youencounter during your training andhope you will some day be like. Hetruly taught by his example."To Moyer himself the pediatrics

program has been strictly a teameffort. "I have had wonderful supportfrom the fine young people who cameto do pediatrics with me," he says,"and from the nurses and the rest ofthe Lehigh Valley Hospital staff. Thisprogram is not one person's, butmany people's doing."

GRATEFUL DONLEYS DONATEENDOWED CHAIR TO HONOR

OR. MOYERHow does a family say "thank you"

to the doctor who saved their infantdaughter's life? In the case of Edwardand Inez Donley, the answer was tomake a gift of an endowed chair forLehigh Valley Hospital-a gift thatwill not only honor Dr. ForrestMoyer, but benefit the entirecommunity.An endowed chair is a permanent

sum of money that provides income,which is used to fund the activities ofa distinguished educator/researcher.The Forrest G. Moyer, MD,Distinguished Chair in Pediatrics atLehigh Valley Hospital-formallyannounced at a dinner April 27-will

10 H E A L T H Sty ) e

support the activities of a distinguishedphysician at Lehigh Valley Hospital.

"This is a rare opportunity for us,"says John VanBrakle, MD, chairmanof pediatrics. "It is unusual for acommunity hospital to have anendowed chair; they are typicallyfound in a university hospital ormedical school. Dr. Moyer's strengthand Mr. and Mrs. Donley's generositywill continue to touch the lives ofcountless children in our communityfar into the future."

Lehigh Valley Hospital is not, headds, a typical community hospitalwhen it comes to medical education.Through its affiliation with PennState University's Hershey MedicalCenter and in cooperation withseveral others, the hospital educatesmore than 45 medical students and 85residents annually. The endowedchair will allow for an enhanced levelof teaching and learning.It will also help create ongoing,

permanent linkages betweenpracticing doctors and medicalschools, making it easier for localphysicians to stay up-to-the-minuteon the latest scientific developments.

"I have always believed that a well-educated professional work force isvital in my own fields of engineering,science and business management,"says Edward Donley, who is pastpresident and chairman of AirProducts and Chemicals, Inc. and along-time hospital board member."It is certainly just as important in themedical field-and I hope this giftwill inspire others to create endowedchairs for the hospital."

Kathryn Hobbie is a freelance health carewriter based in Battle Ground, W A.

DRUG COSTScontinued from page 4

return to work during the treatment,"Rock says. Providing this importantand often critical therapy requiresnurses and pharmacists who are well-trained in pharmacy home care.

Outpatients can receive help withtheir pharmaceutical needs throughLehigh Valley Home Care, a service ofLehigh Valley Health Network. HealthSpectrum Pharmacy Services, locatedin the John and Dorothy MorganCancer Center, a full-service outpatientpharmacy dedicated to pharmacy needsoutside of the hospital, is also availableas an outpatient resource.The walk-in pharmacy staff includes

four registered nurses, four pharmacistsand a number of pharmacy technicians.A pharmacist and nurse are available24 hours a day. The service even hasthe capability to place intravenouscatheters and administer intravenoustherapy, under professional supervision,right in the facility.

Services provided by the pharmacyrange from administering antibiotics topreparing patients for surgery. Otherhome services include intravenousfeeding, pain management for termin-ally ill patients and chemotherapy.The pharmacy also provides

specialized products, such as kneebraces, breast prostheses and bloodproducts for hemophiliacs, andlaboratory work is available on-site forpatients taking drugs that require closemonitoring. "We also offer trainingand pharmacy services to nursinghomes," Rock says. "Their ability tocare for more critically ill patients andto gain the confidence of the hospitaland medical staff in referring thesepatients to their facilities is enhancedby the way they work closelywithHealth Spectrum Pharmacy Services."

Deborah Epstein is a freelance health carewriter and former senior editor at DrugTopics.

FIRST STEPcontinued from page 7

I~

program, which talks about precon-ception planning and what you needto do for your baby's health evenbefore you get pregnant."

Help with BasicsThe free information starts women

thinking about their health, but it'seven more important to get them tothe doctor's office. "Preventing com-plications is the most critical part of

prenatal care," Balducci says. "Weneed to see these women so we canexamine them and try to prevent anyproblems." Some simple, but criticalservices are available to help makesuch visits possible. The KiwanisDistrict 18 provides a free transporta-tion van, and pediatric clinic hoursare extended.

For low-income women, thePennsylvania Department of PublicWelfare sponsors Healthy BeginningsPlus, a program that provides low-income women comprehensiveprenatal care. The program uses acase management approach, in whicheach woman is assigned a carecoordinator who monitors thepatient's progress. Other services,such as exercise classes andcounseling, are also part of theprogram.

And help from the partnershipdoesn't stop once a baby is born.OMNI, for example, provides classesfor new mothers, such as educationon breast feeding. Services forchildren through age three are alsoprovided through OMNI, so that

important preventive health measures,such as immunizations, are notoverlooked.

"By removing barriers, we hope thatall women will have increased accessto prenatal care," Linnander says.And, as many more women get goodprenatal care, babies are alsobenefiting. Over the last two years,fewer very low-birth-weight babieshave been born at Lehigh ValleyHospital, and fewer babies are endingup in the neonatal intensive care unit."This is the classic 'win win'situation," Meehan says. "Mothersand babies are getting care, andsociety benefits because these familiesare healthier in the long run." Havingseen the success of the program inAllentown and surroundingcommunities, Meehan thinks it's thetype of plan that should be madeavailable everywhere. "I would like tosee outreach services expand acrossthe region."

Malorye Allison is a frequent contributor tohealth publications and the editor of LivingHealthy and Heart Research News.

EAT SMARTcontinued from page 5

The menu's list of entrees was quitelengthy, as was the blackboard listing ofdaily specials. Although we were surethe chef would have accommodatedspecial requests to modify entrees bywithholding cream or butter sauces, Janeopted for a low-fat entree, BlackenedCatfish, while Judi made a specialrequest for Broiled Chicken withAsparagus. Both were served with aplentiful portion of wild rice pilaf, whichprovided additional fiber. Wewere impressed that judi'sspecial request did notpresent a problem for thekitchen. Should a similaroccasion arise, we feel

confident that Geryville Publick Housewould make every attempt to meet allspecial dietary needs and requests.Jane's tender catfish was served with

fresh basil and topped with a homemadefruit salsa, providing a nice counterpointto the fish's spicy flavors. Judi's chickenwas equally delicious. The bonelessbreast was stuffed with fresh asparagusand laced with a light white wine andlemon sauce. The chef added some

fresh dill which enhancedthe mix of fresh flavors. Both

entree portions were sizeable,so one could easily order afull entree and save on calories

and fat by eating only apartial amount.

Dessert choices were almost asextensive as the entree selections, but wedeclined to indulge. However, if there'sroom for dessert, we would recommendsharing a fruited ice cream parfait.

As dinner came to a close, we felt thatwe had received more than a "Failte"from the Geryville Pub lick House. Wehad enjoyed a memorable evening. Welook forward to returning soon to dinealfresco in "Aurora's Outdoor Garden."

Jane Ziegler, MS, RD serves as director,Clinical Nutrition Se-rvices,Lehigh ValleyHospital, and Judi Tbieme as NutritionProgram Coordinator, Health Promotionand Disease Prevention Department,Lehigh Valley Hospital.

H E A L T H Sty I e 11

preservation of patient-provider rela-tionships; a geographically dispersednetwork of services to ensure access tocare for a company's employees nomatter where they live; and market-competitive prices.

And how does an organizationdeliver a high-quality, cost-competitiveproduct? Lehigh Valley Hospital andHealth Network, faced with the samesort of pressures that have drivenother business transformations, hasresponded in kind. Our version of"work redesign" means devising newways to provide care to people, to getthem what they need more quickly,more effectively, more efficiently andin the most appropriate setting, so theyrecover faster.

It's the driving force behind ourdecisions to invest in new technologyand information systems, and inretraining and deploying our workforce. It's the catalyst for transformingour facilities, ultimately and appropri-ately reducing the number of beds tocreate services like an ambulatorysurgery center; the John and DorothyMorgan Cancer Center, combining allneeded services for patients andfamilies; a transitional unit for hospi-talized patients to recover in relaxed,homey surroundings; model labor anddelivery suites; and rapidly expandinghome care services.

Its beneficiary is the community whohas entrusted this valuable healthresource to our care, and whose adviceand participation we will continue toseek in creating the health system forthe future.

Louis Liebhaber

he winds of change aresweeping into the Valley. Butlet's call them gentle breezes.For now. In other parts of thecountry, the twin health careimperatives of cost and quality

are dramatically affecting the wayhealth care is paid for and provided.The bottom has dropped out of thehealth care system's traditional sourceof revenue-the inpatient stay.Fewer people are admitted tohospitals, and those who are stay lesstime. More care is provided in lesscostly outpatient settings, and moretime is spent on protecting healthand preventing illness. These areclear market trends that are nowbeginning to have a significant impactin our region.

To that I can only say, it's time. AndI hear a loud echo from the localbusiness community who cannot afforddouble digit rates of increase and stillremain competitive.

12 H E A L T H Sty I e

Winds of Changeby Louis Liebhaber, Chief Operating Officer, Lehigh Valley Hospital

At Lehigh Valley Hospital andLehigh Valley Health Network, wehave recognized the changing require-ments of the marketplace, and areseeking the involvement and supportof business and industry to seize whatwe view as a unique opportunity.Other parts of the country have beenoverwhelmed almost overnight by ahealth care revolution. But here wehave the chance to build a health caresystem for the future, one that isresponsive to the views and needs ofpurchasers but designed and managedby those who provide the care, tocause the least disruption to the all-important relationship between patientand physician. That deliberate andthoughtful process bodes well forcontinuity of care and quality of life,and ensures the development of asystem that is both high-value andlocally based.

And why is that last component soimportant? The impact of the so-called "globalization" of the economyis not lost on our business community.Several local industries-textile, steel,automotive manufacturers-face globalcompetition and have been severelyaffected by it. So it is with health care.National insurance companies and for-profit hospital chains take income outof the local community and put it inthe pockets of stockholders andcorporate leadership. They have nolong-term interest in the ongoinghealth-economic or otherwise-ofthe Lehigh Valley and the surroundingregIOn.

Our local effort, on the other hand,has those concerns at its core and fourcharacteristics as its central focus: aconsistently high level of quality;

Ingersoll Rand has selected LehighValley Hospital and six otherhospitals nationwide to providecardiac services, including open heart

surgery, angioplasty and heart catheteri-zation, for its 28,000 employees andtheir dependents. The machinery manu-facturer's selection of the seven hospitalproviders followed an extensive reviewof the quality, costs and outcomes oftheir heart procedures. Cardiac servicesis the first area in which Ingersoll Randhas awarded exclusivemanaged carecontracts ...

Robert]. Laskowski, MD, has beennamed senior vice president ofclinical services at Lehigh ValleyHospital to coordinate the activities

of the hospital's clinical departments,monitor the delivery of medical servicesand oversee medical education andquality assurance programs. Prior toassuming this position, Dr. Laskowskiserved as group medical director andpresident of Northeast PermanenteMedical Group, Farmington, Conn.,and as a member of the medical facultyat the University of Connecticut ...

lehighValley Hospital is serving asone of 200 research centers nation-wide investigating the effectivenessof various hypertension drugs in

preventing stroke, heart attacks anddeath. Sponsored by the NationalInstitutes of Health National Heart,Lung and Blood Institute, the studyfocuses on four classes of newer andmore costly FDA-approved medicines.More than 40,000 patients, aged 60 andover, with diagnosed high bloodpressure and another risk factor such asdiabetes will be monitored during theeight-year trial. Nelson Kopyt, DO, a

I

nephrologist, is serving as principalinvestigator of the study at LehighValley Hospital ...

Lehigh Valley Hospital's Neonatal Intensive Care Unitand the Perinatal Partnership are two programs thathave benefitted from the over $300,000 March ofDimes' local chapter has donated to the hospital.

With an emphasis on diet, lifestylepractices and regular medicalcare, Linda Lewis, RN, isincreasing access and awareness

of maternity care for low income,Latino, homeless and battered women.Lewis is the new community educatorfor the Perinatal Partnership, acommunity project of Lehigh ValleyHospital, the March of Dimes and othercommunity organizations. The ultimategoal of the partnership is to reduce theincidence of infant mortality in thegreater Lehigh Valley...

Herbert "Chuck" Hoover, MD, asurgical oncologist specializing incomplex cancer procedures, hasbeen appointed chair of surgery at

Lehigh Valley Hospital. In addition toperforming surgery, he is also trainingmedical students and residents whilefurthering the development of allsurgical disciplines and research at thehospital. Hoover previously provided

surgical oncology services at theMassachusetts General Hospital inBoston and served as an associateprofessor of surgery at Harvard MedicalSchool ...

As an approved affiliate of theMilton S. Hershey Medical Centerfor gynecologic oncology groupstudies, Lehigh Valley Hospital

offers patients access to the latestgynecologic cancer treatments underinvestigation. The gynecologic oncologygroup is a cooperative research groupsponsored by the National CancerInstitute to conduct clinical trials. Theprincipal investigator for group studiesat Lehigh Valley Hospital is SergioPerticucci, MD, gynecologiconcologist ...

John F. McCarthy, DO, has beennamed medical director ofMedEvac, Lehigh Valley Hospital'semergency flight program. Dr.

McCarthy completed his residencytraining and a fellowship in emergencymedicine at Albert Einstein MedicalCenter. He previously served as assistantmedical director of MedEvac ...

Incooperation with the AllentownSchool District, Lehigh ValleyHospital is serving as an off-campusclassroom for Allen High School

students. One day each week, fromNovember through June, junior highstudents at risk of dropping out ofschool are mentored by members of thehospital staff in various departments.While encouraging students to continuetheir education, the "Cities in Schools"program also introduces them toprospective careers in health care.

H E A L T H Sty I e 13

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