NEWS TIPS FROM SINAI HEALTH SYSTEM
January 1998
To pursue any of the stories listed below, contact Jill Bloom
at 410-601-5025 or by e-mail at [email protected]
Remote Pediatric Anesthesia Puts Patients and Families at Ease
Many medical procedures can be very frightening for children and difficult for their families as well. Children must often be taken to unfamiliar environments, causing a great deal of separation anxiety. But a new way of sedating children makes certain procedures easier and allows children and their families to stay together.
Sinai Hospital is one of the few hospitals to offer remote pediatric anesthesia, an innovative anesthesia program that allows children to be sedated in a nonthreatening environment while in the presence of their family. The program has successfully sedated children for MRIs, CTs, nuclear medicine scans, colonoscopies, angioplasties, minor surgeries and extensive dental procedures.
Children who benefit from the services of the remote anesthesia program begin their visit at Sinai with a stop at the playroom area in the Pediatric Intensive Care Unit (PICU), where oral medication to induce drowsiness is given in the presence of the parents. Then, the child is brought to a nearby bed , where Aaron Zuckerberg, M.D., Director of Pediatric Critical Care Medicine and a board certified pediatric anesthesiologist, uses some creative approaches to completely sedate the child. Some procedures can be performed in the same area where the child is sedated. For imaging procedures, the child is moved after sedation. The child eventually wakes up in the company of his or her parents in the PICU, where the sedation began.
"This method of sedation greatly relieves the anxiety for both the child and the parents and makes simple surgical and imaging procedures easier to accomplish," says Dr. Zuckerberg. "After the procedure is over, children don't remember anything about their hospital experience."
Cataract Surgery Can Now Be Performed Without Needles
An estimated one million people require cataract surgery every year in the United States. Cataracts is one of the leading causes of blindness. While the procedure is relatively safe, the use of needles to give local anesthesia can carry some risks, including bleeding and, in rare instances, perforation of the eye.
Now, physicians at Sinai Hospital are able to provide the surgery without the use of needles. Drops are used to numb the eyes and use of a special knife with a diamond blade make it possible to replace the lens without the use of stitches. "There's no pain during surgery, and patients don't require anything stronger than acetaminophen postoperatively. Plus, there is none of the bruising or swelling that is typical after an injection," says Harold Katz, M.D., an ophthalmologist and director of Cornea/Refractive Surgery at Sinai Hospital.
One of the other benefits of using eye drops instead of an injection is that the eyelid is not paralyzed. Patients go home without a patch and can see immediately. The new approach also reduces operating time.
Cataracts are a clouding of the lens of the eye that occurs in virtually everyone as they get older. Eventually, the lens may become cloudy enough to interfere with vision. Surgery involves removing the cloudy lens and replacing it with an artificial lens implant. Dr. Katz says 96 percent of patients who undergo the surgery have vision that is good enough to allow them to drive a car immediately following the procedure.
Emotional and Behavioral Problems in Older Adults Require Special Care
Each year, between two and three million people over the age of 65 suffer from some kind of emotional or behavioral problem. "Older adults with behavioral issues have special needs that differ from those of a young population," says Myron Miller, M.D., medical director of Levindale Hebrew Geriatric Center and Hospital and director of Geriatric Medicine at Sinai Hospital. "That's why it's important that medical professionals who care for older adults with these kind of problems be able to understand how these mental health problems interact with medical illnesses and disabilities, the aging process, as well as with social, cultural, economic and environmental factors." Dr. Miller helped create the Center for Cognitive, Affective and Behavioral Health to provide geropsychiatric services for older adults and their families.
A number of emotional and behavior problems are associated with older adults, including Alzheimer's disease and other dementing disorders, cognitive, affective and behavioral complications brought on by medical conditions such as stroke or Parkinson's disease, medications, depression and anxiety, adjustment and sleep disorders and emotional problems brought on by bereavement.
According to Dr. Miller, family members or caregivers should look for certain signs that might indicate an elderly person is in need of help. These signs include: depression, insomnia, anxiety, irritability, confusion, memory loss, agitation, loss of appetite, social withdrawal, body aches and pains, loss of motivation, fatigue and suicidal thoughts. Dr. Miller says if one or more of these symptoms persists for more than two weeks, the patient's doctor should be notified.
Weight Loss without Medication is Safer
Millions of Americans struggle with obesity every year. The National Institutes of Health estimates that one in three, or 58 million American adults aged 20 through 74 are overweight. It is known risk factor for a number of diseases including diabetes, heart disease, high blood pressure, gallbladder disease and arthritis.
Recently, two of the most popular diet-drugs, Redux and Pondimin, were taken off the market after they were found to be associated with heart valve damage. "There are safer ways to lose weight and keep it off, that don't require medication," says Annabelle Rodriguez, M.D., an endocrinologist specializing in lipid disorders and medical advisor to the LIFESHAPE program at Sinai WellBridge, Sinai Health System's health and fitness center. LIFESHAPE is a 10-week weight management program that uses behavior modification, proper nutrition and exercise to help participants loss weight. A dietitian, exercise physiologist, health educator and fitness instructor work with participants to work towards a healthier lifestyle. "People who modify their lifestyle have a better chance of not regaining the weight back," says Dr. Rodriguez.
Back Surgery Can Now Be Performed on an Outpatient Basis
Herniated or ruptured discs are one of the most common causes of prolonged back problems and a common reason for back surgeries. One option for treating the problem is a discectomy, or surgical removal of the ruptured disc. In the past, patients were kept in the hospital for several days following surgery, but advances in technique are now allowing patients to go home the same day of surgery.
By using a smaller incision, about 1 to 1-1/2 inches, which allows for minimal disruption of the muscles and ligaments surrounding the damaged disc, Mark Rosenthal, M.D., an orthopedic surgeon at Sinai Hospital, is able to leave the surgical area nearly as normal as it was before surgery. "Performing the discectomy this way, we are able to have the patient's spine be basically stable immediately following surgery. There is the least amount of pain possible and the person tolerates getting up and moving right after surgery," says Dr.Rosenthal, who specializes in the procedure.
Dr. Rosenthal says that getting patients out of bed immediately following surgery, prevents the joint stiffness and weakness that occurs with bed rest. He says a majority of patients do well with the less invasive, outpatient surgery. "In about six weeks, most patients are able to get back to just about every activity they used to do before the surgery," says Dr. Rosenthal. # # #
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