Prisma Health Magazine

Inspire health. Serve with compassion. Be the difference.

Vol ume 1, I ssue 1

M A G A Z I N E

Y O U C A N C O U N T O N U S S O U T H C A R O L I N A

Children’s Hospital of Greenville Health System (GHS) is located in Upstate South Carolina. Board-certified physi-

cians care for more than 400,000 infants, children, and adolescents each year. From primary care to specialty care,

we are dedicated to providing outstanding medical care for every child. We are committed to serving not only the

patients well-being, but the well being of their families.

Pediatric radiologists and anesthesiologists are on-site around the clock, providing expert care specifically tailored

to the needs of children, including critically ill and premature newborns.

Physicians, nurses, therapists and other clinicians approach patient care through the eyes of a child. From pediat-

ric sized medical equipment to patient room decor, innovative care is delivered in a child friendly environment.

www.ghschildrens.org

IN THIS ISSUE

Issue 1.1 March 2020

Welcome to Welless

Approaching Health Care with a PRISMATIC Outlook................................. 4 Better Outcomes for Cancer Care on the Horizon................................. 6

Our patients have told us they need

high-quality, accessible health care

and they’re concerned about rising

health care costs. To meet their needs,

GHS and Palmetto Health have come

together to create a new, not-for-profit,

Keep it Moving.................. 8

multiregional health organization that’s

designed to improve the health and

'Watching' Over Atrial Fibrillation.......................... 12

well-being of the communities we serve.

We’re confident that together we will continue to make great strides

to improve the patient experience, clinical quality and access to care,

Keeping the Faith When Faced with Prostate Cancer.............. 14

while addressing rising health care costs. By unifying under one brand,

we want to make it easier for our patients and their families to under-

stand who we are and what we do when they need our services. The

sacred relationships between patients and their physicians/advanced

Don't Ignore the Snore........................... 16

practice providers will not change.

Living in the Stone Belt.......................... 19

BOARD OF DIRECTORS

James a. Bennett Shaniece Criss, ScD, MPH, MPA Edward duffy Jr., MD Jean E. Duke Calvin H. Elam, CLU, ChFC Frances DeLoache Ellison George S. King, Jr.

Jerome D. Odam, PhD Michelle B. Seaver Rev. Thomas E. Simmons

A Breathtaking Journey..............................22

James E. Wheeler Richard Wilkerson Dwayne Wilson

PRISMA HEALTH MAGAZINE

By Victoria Pujdak APPROACHING HEALTH CARE WITH A PRISMATIC OUTLOOK

In the past few months, South Carolina Upstate locals may have had a similar experience when walking into a GHS emer- gency room or primary care office. This leads to the question: “What is Prisma Health?” The unique name arose out of the organization’s desire to reflect – similar to the multifaceted refractories of a prism – their energetic vibe, new outlook on modern health care and their purpose: “Inspire health. Serve with compassion. Be the difference.”

A vibrant swirl of purple, orange and red flashed by my peripheral vision as I was wheeled into a local Greenville Health System hospital after an unfortunate tangle with a shower door and a slippery tile floor. Just as my chair was parked in the waiting room, my eyes began to roam over the lobby for the curious rainbow of sunset colors that had briefly caught my attention earlier. I scanned over the expansive room and locked my vision on a large banner with a tagline, “Greenville Health System and Palmetto Health are becoming Prisma Health.”

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“Inspire health. Serve with compassion. Be the difference.”

patient experience, expanding access to care and addressing rising health care costs,” said Isley. In 2017, both organizations announced the creation of SC Health Company, with former Palmetto Health CEO Charles Beaman and former GHS CEO Mike Riordan at the helm as co- CEOs. The creation of SC Health Company was crucial to the initial development of Prisma Health by leading the organiza- tion through the regulatory, financial and legal steps to form the new union. Throughout 2017 and 2018, the SC Health Company teams worked tirelessly to shape the identity of Prisma Health. In September 2018, the company announced its new name, and, in January 2019, Prisma Health launched as the largest not-for- profit health organization in South Carolina, serving over 1.2 million patients with 30,000 team members. “Now is the perfect time to introduce Prisma Health to our communities. Patients and providers across the country are beginning to look at health care differently, from exploring new ways to deliver and receive care to an emphasis on keeping people well rather than simply treating once they are sick. We want to be at the forefront of that positive change for this industry,” said Isley. Despite the rebranding and formation of Prisma Health, pa- tients will still retain their primary physicians and the hospitals and physician practices that were previously associated with GHS and Palmetto Health. For additional information on Prisma Health, visit www.prismahealth.org.

According to Malcolm Isley, chief strategy officer at Prisma Health, “These three sentences, eight words in all, describe why our organization was created. Our purpose is nice and

broad with room for all team members to communicate how they live and prac- tice the purpose of Prisma Health.” Prisma Health’s origins are rooted in the big picture problem of South Carolina health care. Currently, in both the Up- state and Midlands of South

Carolina, residents spend over $17 billion annually on health care services; howev- er, the state is ranked 43rd in the nation in general health care, according to America’s Health Ranking. GHS (Upstate affiliate) and Palmetto Health (Midlands affili- ate) were acutely aware that a big picture solution needed to be created in order to successfully combat the dichotomy of rising health care costs and the consistent decline of overall medical care in South Carolina. The solution: GHS and Palmet- to Health would combine their statewide expertise to become a powerhouse health system, and Prisma Health was born. “Our citizens deserve better, and, as the leading health care systems in the state, it is our responsibility to help improve these statistics through improving clinical quality and the Malcolm Isley

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BETTER OUTCOMES FOR CANCER CARE ON THE HORIZON WITH

By James Crawford

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Prisma Health is on a mission to increase access to innovative cancer care and better outcomes after receiving an $8.2-million grant from the National Institutes of Health designed to educate and expand access to Upstate and Midlands patients.

who may not have insurance or have other financial burdens that impact their ability to receive care,” Dr. Chung said. This is but one example of the many types of clinical trials offered, all designed to open the doors for a better quality of life and care for people of the Upstate and Midlands. Once a clinical trial has been determined to offer a superior clinical benefit, it becomes the standard. Many of the clinical trials address systemic challenges, as well as the problems health care providers face that may not directly affect care. Financial challenges, travel, family dynamics – you name it – Prisma is interested in understanding its influence on patients. This grant is an opportunity to study as many compo- nents of cancer care as possible, with new clinical trials being introduced at a frequent rate. “One of the things many people don’t realize is there are thou- sands of types of cancers. If you add them all up, there are more rare tumors than there are common cancers, and the only way we can learn to treat those are through clinical trials,” said Dr. Chung. “So we continue to educate and invite patients to speak to their physicians or visit our website at PrismaHealth.org to see how they can participate in these clinical trials.”

“One of the most important goals is education,” said Dr. Ki Young Chung, principle investigator of the National Cancer In- stitute Community Oncology Research Program (NCORP) of the Carolinas at Prisma Health. “We want patients to know that clin- ical trials are incredibly important to furthering cancer research and their own cancer care delivery and outcomes. We’ve been able to offer immunotherapy to those who otherwise wouldn’t have had access, for example. Anyone can participate in clinical trials, and there are a spectrum of trials available to patients at any given moment.” Many patients believe clinical trials are only for certain people or that they have to forgo more “proven” treatments to partici- pate, but, in most cases, this isn’t true. “There are many types of clinical trials, from finding superior ways to deliver cancer care to trying to understand the financial burdens of patients,” Dr. Chung emphasized. “This year, the rate of cancer death decreased, and this is due to clinical trials, so it’s in the patients’ best interest to reach out to their physician to see if there are any trials they would like to participate in.” With education being such a critical aspect of Prisma Health’s mission to expand clinical trials, Prisma is augmenting its out- reach programs, giving lectures, visiting health care facilities and speaking to providers and patients one-on-one about the incred- ible opportunities they have to not only improve their cancer care outcomes but to get more accurate diagnoses and enjoy a better quality of life while receiving care. “One example of a clinical trial is a ‘longitudinal assessment of financial burden’ in patients with colon and rectal cancer treated with curative intent – which means we do a study for two years on how we can improve access and quality of care to people

“

One of the things many people don’t realize is there are thousands of types of cancers.

If you add them all up, there are more rare tumors than there are common cancers, and the only way we can learn to treat those are through clinical trials.

Although science has made great strides in delivering cancer care, many challenges must still be overcome. There are more than 300 active cancer clinical trials at any given time, and, with this grant, that number will increase along with the efficacy of the trials themselves. Clinical trials are the foundation of many of the groundbreak- ing treatments successfully used today, and, with the $8.2 million grant, Dr. Chung hopes to continue the push toward more access, better cancer-care delivery and better outcomes.

“

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KEEP IT MOVING

EXERCISE WORKS BEST FOR PARKINSON’S PATIENTS By Brian Sherman

PRISMA HEALTH MAGAZINE

Parkinson’s disease is a debilitating malady, cursing its victims with a variety of issues ranging from

involuntary movement to difficulty walking to troubling changes in speaking and

handwriting. And though most Parkinson’s patients are taking medication, many of them also are

fighting back – literally, in some cases – through exercise and rehab programs

and with the help of vibrant support groups.

Parkinson’s is a degenerative disease of the nervous sys- tem that affects cells in the brain which produce the chemical messenger dopamine. Its symptoms can include tremors; loss of sense of smell; very small handwriting; trouble moving or walking; constipation; speaking in a soft or low voice; trouble sleeping; and possibly dizziness or fainting. There’s no cure for Parkinson’s, but the disease itself is not fatal, and several drugs are available that have the potential to enhance a patient’s quality of life, according to Dr. Fredy J. Revilla, chief of neurol- ogy with Prisma Health in Greenville. These include levodopa, dopamine agonists and several other medications. Medications help, but exercising and maintaining an active lifestyle are just as important,

teers and family members. About 80% of the participants are men, Newton said, pointing out that Rock Steady Boxing is a non-contact activity. Boxers work on heavy bags, target mitts, speed bags and double-ended bags and participate in other activities that enhance balance, stability, fall prevention and muscle strength, but no one ever takes a punch. Cognitive function exercises are important as well. “We do things to help keep their brain sharp,” Newton commented. “We try to challenge them cognitively all the time. There’s a rhyme or reason in everything we do.” Some Parkinson’s patients graduate to Rock Steady Boxing after completing the LSVT BIG program. Offered at CORA Phys-

ical Therapy in Mount Pleas- ant, it consists of four intense, one-on-one sessions a week for four weeks. Clinic Man- ager and Physical Therapist Rudy Mosketti is among those certified to offer LSVT BIG. He said even after patients finish the program, they can return to CORA to work on specific issues such as balance. Or, he said, he can send them on to one of the area’s Rock Steady Boxing programs. “Once they reach a certain level of function, I’ll suggest an activity such as Rock

Dr. Revilla pointed out. He cited stretching, aerobics, yoga, Pilates and some forms of dancing as excellent options. “Exercise is the only mo- dality that has been proven to delay the disease,” he said. One form of exercise now embraced by more than 43,000 Parkinson’s patients at 871 locations around the world is Rock Steady Boxing, a non-contact activity that of- fers an array of conditioning, strength and cognitive func- tion exercises. Established in 2006 by Scott C. Newman,

Steady Boxing to continue their functional progress,” Mosketti explained. He added that staying active is vitally important for anyone with Parkinson’s disease. “The key is early referral to physical therapy,” he commented. “If you sit at home, function can deteriorate rapidly. You have to move.” There is another promising treatment option, according to Dr. Revilla, especially for patients with advanced Parkinson’s disease. Deep brain stimulation uses electrodes implanted in specific sections of the brain that produce electrical impulses aimed at regulating abnormal impulses. Dr. Revilla said DBS, now widely used in the United States and in other countries, can improve symptoms in Parkinson’s patients who are already

an Indiana attorney who was diagnosed with Parkinson’s at the age of 40, the program found a home at the Medical University of South Carolina Wellness Center in 2017. MUSC is now one of three sites in the Charleston area that offer Rock Steady Boxing. “It’s designed specifically for patients with Parkinson’s disease, and it could slow the progression of the symptoms,” said Wellness Center Director Janis Newton. “We feel that the sooner they start, the better the possibility of results.” Newton said around 40 people currently participate in Rock Steady Boxing at MUSC, generally twice a week. With nine coaches, each boxer gets a lot of attention, and those who need additional help receive it from “cornermen” – volun-

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dealing with motor fluctuations and involuntary movements. He said ongoing studies are looking at using DBS earlier, but he pointed out that there are risks such as infection, bleeding in the brain, stroke and equipment malfunctions. Side effects can include abnormal movements and sensations and worsening of speech and balance. According to Dr. Revilla, Parkinson’s disease is hereditary for only around 5% of patients. He said some genes have been connected to the disease, but he said it’s not practical to test for them because, in most cases, they are not the cause of Parkin- son’s. He added that some studies have shown that risk factors for Parkinson’s might include exposure to welding fumes, working with pesticides and exposure to manganese. He said well water also could be a factor. For many people, sharing their lives with others afflicted with the same disease is almost as important as the physical aspect of fighting the effects of Parkinson’s. Support groups are active in the greater Charleston area and in Summerville, both meeting once a month and both led by retired accountant Jay Phillips and his wife, retired physical therapist Marilyn Phillips. Jay maintains an email list of around 400 addresses and regu- larly sends out newsletters with information about upcoming meetings and seminars. There’s a good reason the Phillips’ are active in the Parkin- son’s community. Jay was diagnosed with the disease in 2010

when they lived in Virginia. His neurologist told him he had Par- kinson’s, but that was about it. He didn’t offer any information concerning support groups or exercise programs. There’s also a good reason they chose South Carolina as their new home. They wanted to be near MUSC, where Professor of Neurology Dr. Vanessa Hinson is the director of the university’s highly-rated Health Movement Disorders Program. The Phillips’ contribution to the fight against Parkinson’s extends well beyond putting together newsletters and organiz- ing meetings. Jay was chairman of the first Moving Day – “A block party for Parkinson’s disease” – in 2018 and again in 2019, events that raised more than $145,000 each. “It’s for family and friends who support someone with Par- kinson’s,” Marilyn said. “It’s a festival, and it’s energizing and educating.” Marilyn pointed out that just like Parkinson’s patients, their partners need support and encouragement. They meet the second Saturday of each month at Ms. Rose’s in West Ashley – without their spouses. “We need a place for community,” she commented. “What we say stays there. We’re the only ones who get it.” To learn more about exercise programs and Parkinson’s support groups in the Upstate, get in touch with the

Greenville Area Parkinson Society by calling 864-905-2574 or visiting www.gapsonline.org. PARKINSON'S By the Numbers

NEARLY 1 MILLION people in the United States are living with Parkinson’s disease, which is more than the combined number of people diagnosed with multiple sclerosis, muscular dystrophy and Lou Gehrig’s disease.

Approximately 60,000 AMERICANS are diagnosed with Parkinson’s disease each year. and therapeutic surgery can cost UP TO $100,000 per person. MORE THAN 10 MILLION people worldwide are living with Parkinson’s disease. The incidence of Parkinson’s disease increases with age, but an estimated 4% of people with the disease are diagnosed BEFORE AGE 50 . Men are 1.5 TIMES more likely to have Parkinson’s disease than women. Medications alone cost an average of $2,500 A YEAR,

The combined direct and indirect cost of Parkinson’s, including treatment, Social Security payments and lost income, is estimated to be NEARLY $52 BILLION per year in the United States alone.

Source: Parkinson’s Foundation.

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Center for Success in Aging is the headquarters for all activities of the Division of Geriatrics.

• Initial Memory Health Assessment to include diagnosis, treatment recommendations, education, and resource

information. Feedback will be provided to the referring physician.

• Level of Care Assessment to identify the appropriate environment for the patients safety.

• Neuropsychological testing referral option to assess cognitive functioning and aid in treatment planning.

• Evaluation of suspected mild cognitive impairment (MCI) (changes in thinking abilities).

• Coaching for patients, caregivers, and/or family members in office visits.

• Community education initiatives including classes on dementia related topics provided by a range of health care

professionals and a resource library for caregiver education and wellness.

• Resource Library which is open to those involved in the Memory Health Program.

• Coordination of all services that are provided through the Division of Geriatrics.

To help in obtaining a referral from your doctor, call

864-454-8120.

https://www.ghs.org/healthcareservices/medicine/geriatrics/centerforsuccessinaging/

PRISMA HEALTH MAGAZINE

‘WATCHING’ OVER ATRIAL FIBRILLATION

By Janet E. Perrigo

According to the Centers for Disease Control and Preven- tion, approximately 700,000 Americans are hospitalized annu- ally with atrial fibrillation as their primary diagnosis. Without intervention, these patients become five times more likely to experience debilitating and deadly ischemic strokes, which are caused by blockage of blood flow. Atrial fibrillation occurs when the upper and lower cham- bers of the heart aren't regulated properly because the elec- trical impulses governing heart activity have malfunctioned. Beating too quickly, too slowly or irregularly produces disuni- ty among the chambers. Blood is not fully emptied from the

heart, and lingering blood cells can pool together and clot. If a clot escapes to the brain, it can block blood flow, causing a stroke. Unfortunately, 30% of nonvalvular atrial fibrillation patients struggle tolerating the prescribed blood thinners. However, thanks to a relatively new and minimally invasive surgery known as the WATCHMAN implant procedure, at-risk patients have an alternative course of action. Backed by a decade of clini- cal studies and trials, and with FDA approval since 2015, the WATCHMAN device has proven itself to be a safe and effective procedure with minimal recovery time.

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"I know that by offering the

WATCHMAN therapy, I can potentially improve my patients’ quality of life as well as help decrease one of their biggest fears."

rest, patients are up and walking, kept overnight for observa- tion and released the following day with minimal discomfort. They are asked to avoid heavy lifting or exertion for a week and then are fully recovered. Rejection rates are rare enough to be considered insignificant. If there is one physical health challenge that most seniors truly dread, it is the prospect of having an unexpected stroke. Mental pictures of someone struggling to drag a lifeless foot across the floor, awkwardly cradling the weight of a useless arm and speaking in halting, sometimes barely distinguishable words is the stuff of elderly nightmares. Dr. Patel, who is with Prisma Health’s Carolina Cardiology Consultants-Greenville, is keenly aware that when he performs the WATCHMAN proce- dure, he is not only improving his patients’ health and quality of life but also giving them hope that they will be able to enjoy their later years. When asked how he feels about his work, he simply respond- ed, “I know that by offering the WATCHMAN therapy, I can potentially improve my patients’ quality of life as well as help decrease one of their biggest fears.” Ideal candidates for the WATCHMAN procedure have atrial fibrillation not caused by a heart-valve problem, are at high risk of stroke and have not been able to tolerate blood thinners well. Active atrial fibrillation patients may also wish to switch because they fear the increased risk of falling or being injured while taking blood thinners. The WATCHMAN procedure offers the opportunity both for better health and peace of mind.

Chetan Patel, M.D., an interventional cardiologist with Prisma Health, said, “Today, WATCHMAN is available at many hospi- tals, and more than 100,000 of these implants have been done across the country. Greenville Memorial Hospital was the first health care facility to offer it in Greenville.” Prisma Health-affiliated hospitals have performed approxi- mately 450 WATCHMAN procedures since 2017. When a newer WATCHMAN FLX device received FDA approval last month, once again, Prisma Health became one of the first health care systems in the Carolinas to begin using it. The improved version is considered safer, easier and more efficient. It also is manufactured in a wider variety of sizes, making it available for a broader group of patients. Like its predecessor, the new device offers relief to those who cannot tolerate the side effects of blood-thinning medications. Cur- rently, Greenville Memorial is the only hospital in the Greenville County area to have transitioned to WATCHMAN FLX. To perform the WATCHMAN procedure, Dr. Patel inserts a tiny, malleable metal device up the main vein of the groin, sim- ilar to a heart catheterization or ablation procedure. The device is placed in the left atrial appendage, the location from which more than 90% of clots are formed in nonvalvular atrial fibril- lation patients. With time, the heart cells encase the device in tissue, effectively closing the area to future clot dispersion. This one-time procedure has significantly reduced the risk of stroke. At Greenville Memorial Hospital, the typical WATCHMAN implant surgery averages less than an hour under general anesthesia. After approximately four additional hours of bed

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studies show that many older men – and even some younger men – who died of other causes also had prostate cancer that never affected them, according to Cancer Society officials. Dr. Brisson acknowledged the simplest form of treatment for prostate cancer is “watchful waiting,” or active surveillance, for men with slow-growing, early-stage cancer. Should it worsen, more aggressive options include surgery to remove the pros- tate or radiation, he said. “The key determinant for me is the grade of the prostate cancer,” Dr. Brisson said. “If you have high-grade prostate cancer, unless you’re over the age of 80, you’re going to need that treated.” The Cancer Society said the main type of surgery is a radical prostatectomy, through which the surgeon removes the entire prostate gland and some of the tissue around it. In anoth- er approach, known as robotic prostatectomy, laparoscopic surgery is conducted using a robotic system. The surgeon sits at a control panel in the operating room and moves robotic arms to operate through several small incisions in the patient’s abdomen. Dr. Brisson, who treats diseases of the urinary system and male reproductive system – including the prostate – has done more than 2,000 robotic surgeries in the past 10 years on differ- ent types of cancers. KEEPING THE FAITH WHEN FACED WITH PROSTATE CANCER By David Dykes

M

ichael Allan of Summerville came home from the Vietnam War and eventually found himself in a

new type of battle. For Allan, 73, it was prostate cancer. After he left military service, he worked different jobs, including being a bodyguard for 38 years. At one point, a PSA test showed elevated levels of prostate-specific antigen in his blood, so his family doctor referred Allan to Dr. Theodore Bris- son, a Charleston urologist. Once the cancer was confirmed, robotic surgery followed. Then came radiation treatments, overseen by Allan’s radiation oncologist, Dr. William Collins. These days, Allan monitors his PSA levels and takes a hor- mone shot every four months to keep any cancer in check. Other than skin cancer, prostate cancer is the most common cancer among men in the United States. The American Cancer Society estimates that this year there will be about 174,650 new cases, and 31,620 people will die of the disease. But the Cancer Society said more than 2.9 million U.S. men who have been diagnosed with prostate cancer at some point are still alive. Most prostate cancers are first found during screening with a PSA blood test or a digital rectal exam. If cancer is suspected based on results of screening tests or symptoms, a prostate biop- sy is needed to confirm the diagnosis. Some prostate cancers can grow and spread quickly, but most grow slowly. In fact, autopsy

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patients. The procedure delivers high doses of radiation to the prostate with a high degree of accuracy and precision. Patients treated with SBRT only need five treatments of approximately 20 minutes each, compared with other courses of as many as 40 to 45 treatments over eight to nine weeks, Dr. McTyre said. “We follow the PSA long-term after treatment,” he said, “and when patients get 10, 15 years out and the PSA has dropped to a low value and is not increasing, we know they are probably cured.” As he looks back, Allan focuses on what the disease taught him, especially about instilling hope in other cancer patients. “A lot of them are so scared – cancer scares them half to death,” Allan said. “I tell them if you believe in a higher being, like God, and if you have faith, you can go through anything. Cancer is not a death sentence.” Other than skin cancer, prostate cancer is the most common cancer among men in the United States. The American Cancer Society estimates that this year there will

“I know of no study that’s been able to show conclusively that there are higher rates of recurrence with one way or the other,” he said of open surgery versus robotic surgery. “The biggest advantage of the robot is that you get quicker recovery and less blood loss.” The major possible side effects of radical prostatectomy are urinary incontinence – being unable to control urination – and erectile dysfunction, according to the Cancer Society. Those can also occur with other forms of treatment, including radiation therapy. Radiation therapy uses high-energy rays or particles to kill cancer cells. The main two types are external beam radiation therapy and brachytherapy, also called seed implantation. “In most cancers, there’s one proven best treatment depend- ing on the type of cancer and the stage,” said Dr. Collins, a Charleston physician who treats cancer with radiation therapy at Trident Medical Center. “For prostate cancer, you have either surgery or radiation therapy. And the reason you have those options is that they’re equally effective.” Technological advances have yielded new, improved radi- ation treatments in the last 10 years, Dr. Collins said. One is intensity modulated radiation therapy, or IMRT, an advanced form of 3D therapy. It is the most common type of external beam radiation therapy for prostate cancer and allows doctors to deliver an even higher dose to the cancer. Dr. Emory McTyre, a radiation oncologist with Prisma Health in Greenville, advocates a technology called SBRT – stereo- tactic body radiation therapy – as an option for appropriate

be about 174,650 new cases, and 31,620 peo- ple will die of the disease. But the Cancer Society said more than 2.9 million U.S. men who have been diagnosed with prostate cancer at some point are still alive. PROSTATE CANCER By the Numbers

Prostate cancer develops mainly in older men and in African-American men. About 6 CASES IN 10 are diagnosed in men 65 OR OLDER , and it is rare before AGE 40 . The average age at the time of diagnosis is ABOUT 66.

Prostate cancer begins when cells in the prostate gland start to grow UNCONTROLLABLY . ALMOST ALL prostate cancers are adenocarcinomas. These cancers develop from the gland cells. About 1 MAN IN 9 will be diagnosed with prostate cancer during his lifetime.

.

About 1 MAN IN 41 will die of prostate cancer.

Source: American Cancer Society

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Do you snore when you sleep? Does your bed partner? You’re not alone. Almost from time immemorial, nocturnal noise-making has been so common that it has created such familiar expressions as “sawing some wood” and even the euphemism for sleeping – “catching some Zzzs.” DON’T IGNORE THE SNORE…

at Hillcrest Memorial Hospital in Simpsonville, agreed that dental appliances can be a good treatment option for the right patients. Particularly for patients diagnosed with mild to moderate sleep apnea, “a dental appliance fitted by a skilled dentist with plenty of experience can also be very effective.” One of these qualified dentists is Dr. Dana Blalock, a diplo- mate of the American Sleep and Breathing Academy whose Sleep Better SC practice is on Daniel Island. While acknowledging that CPAP therapy remains “the gold standard” for OSA treatment, Dr. Blalock stated that “oral appliances can very effectively treat patients with mild to moderate sleep apnea and are a wonderful alternative for those who cannot tolerate the mask.” That said, Dr. Healy always starts his sleep apnea patients with the CPAP as it is “still the most effective treatment with decades of data documenting effectiveness in ameliorating daytime sleepiness and improving blood pressure along with potential reduction in heart attack and stroke in certain pa- tients.” To determine whether a patient suffers from sleep apnea and whether that condition is mild, moderate or severe, Dr. Healy relies on a one-night, in-lab sleep session or a similar “at- home” session. Both testing methods, he believes, can be effective diag- nostic tools, although the in-laboratory sessions gather more

Snoring is a frequent subject of humor. But, in reality, it’s not a laughing matter. Sleep-disordered breathing can have a host of health and even life-threatening side effects, among them morning headaches, dry mouth, overall fatigue and even drowsiness that can lead to such negative outcomes as industrial accidents and automobile crashes. Worse yet, snoring can be a marker for the condition ob- structive sleep apnea, which can be a factor in diabetes and heart disease and can lead to death. The good news is that not all snorers will develop OSA. On the other hand, most OSA sufferers also snore. Snoring is a symptom that indicates your airway is closing off or diminishing. There are a number of possible causes for this, ranging from the size and shape of your tongue and tonsils to fat accumulating in the area of your windpipe. For most patients diagnosed with OSA, the conventional treatment has been the CPAP (continuous positive airway pressure) device, a full or partial face mask worn during sleep that forces a stream or pressurized air into the airway, helping to keep it open. Many patients acknowledge the benefits of CPAP therapy but for various reasons cannot wear the mask consistently. For these OSA sufferers, relief may be as close as their properly certified dentist. Dr. William Healy, a specialist in pulmonary critical care and sleep medicine practicing at the Prisma Health Lung Center

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PRISMA HEALTH MAGAZINE

Among his simple tips for a better night’s sleep are keeping all electronics out of the bedroom, dimming all lights, follow- ing a set bedtime routine and working to reduce stress in your daily life. Dr. Healy further noted that physical activity and weight loss are frequently positive factors in reducing or even eliminating OSA. “I feel that one of the hallmarks of a good sleep medi- cine doctor is that he or she discusses with each patient the importance of diet and exercise in dealing with their OSA and explains that in certain cases sleep apnea responds positively to simply adjusting one’s sleeping position from the back to the side,” he said. Until fairly recently, the doctor observed, “people didn’t think of sleep medicine as a distinct specialty. Some patients even today are surprised to learn that it exists.” So why did he choose to focus on diagnosing and treating OSA? “Because it is really rewarding to help people feel better during their waking hours. Treating OSA brings great benefits in terms of energy and quality of life," he said. And how about all those TV and radio commercials touting certain mattresses and pillows as critically important to a good night’s sleep? You might as well stick with what you’re used to because Dr. Healy stated “we just don’t have the data to show that any of those claims are true.” And the next time you’re having your teeth cleaned, mention any sleep issues to your dentist.

data by monitoring such factors as brain-wave activity and leg movements during sleep. If dental intervention is recommended, the patient is fitted with one of several styles of appliance, all of which are similar to the mouthpieces worn by many athletes in sports such as football and boxing. Each is custom-fitted, fabricated to each individual patient, worn only at night and discreet and convenient to use. Dental sleep medicine experts such as Dr. Blalock always work hand-in-hand with sleep medicine physicians. Dr. Blalock frequently accepts referrals from these doctors and also refers her dental patients to the same specialists when she detects oral anomalies that might contribute to OSA. She said that she estimates 15% to 20% of the patients she sees on a regular basis are potential OSA patients. She added that OSA is serious business. Dr. Blalock noted that untreated, OSA “can kill.” The condition and the reduction in oxygen intake it causes make the heart work harder, which can lead to heart failure or stroke. It can also cause elevated blood pressure and has been linked to the development of Alzheimer’s disease. Dr. Healy clearly does not disparage any technical advances in treating OSA. However, he notes a general inclination among both medical professionals and the general public to always be looking for that silver bullet for improving sleep. “We often focus on the most complicated solutions to medi- cal problems when there may be simple, albeit less glamorous, techniques that can work very well,” he said.

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Providing the most effective care, close to home

At the Cancer Institute of Prisma Health, our core philosophy is anchored in providing the most effective, most

targeted cancer care available in the world. We are dedicated to enhancing the quality of life for those with cancer

in our community and beyond through clinical excellence and research.

We understand that cancer care is about comfort, compassion and enhanced access to care, so we focus on

treating the whole person, not just the disease. This means patients do not have to leave the Upstate to receive

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Contact Us: 864-455-7070

www.ghs.org/healthcareservices/cancer/

DRINK MORE;

SUFFER LESS

By Brian Sherman LIVING IN THE STONE BELT

PRISMA HEALTH MAGAZINE

“We don’t know why, but it probably has to do with it being hotter and more humid here and people are more likely to be dehydrated. We think humidity makes a difference. “The Southern states are the stone belt,” Dr. Gabriel Fiscus of Prisma Health in Greenville added. The two urologists agree that dehydration is a major factor in determining whether stones form in your kidneys. The most common type, calcium oxalate stones, show up when the normal concentration of water, salts and minerals found in your urine is out of balance. In addition to heat and humidity, diet and exercise most likely help decide whether you develop kid- ney stones. Dr. Wingo pointed out that to avoid this possibly painful issue, you should drink lots of water, moderate your salt intake and stay active. He said high-oxalate diets that include

They generally aren’t innately painful, but the pressure they are capable of creating if their journey through your urinary system is in any way interrupted can be uncomfortable at best and excruciating at worst. They might not be hereditary, but, if your family members have them, there’s a good chance you will share the suffering. And, if you aren’t serious about changing the way you eat and drink once you get them, you are likely to have to deal with them again. They are kidney stones, and they are more common in South Carolina and the rest of the Southeast than in any other region of the United States. There’s a big difference in geography. We have the highest incidence of kidney stones than anywhere else in the country,” said Dr. Marshall Scott Wingo of Lowcountry Urology Clinics.

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PRISMA HEALTH MAGAZINE

stones, including extracorporeal shock wave lithotripsy, or ESWL. Sound waves generated from outside the body, pin- pointed using X-ray imaging, break up a stone into pieces small enough to be eliminated with urination. Another option uses a miniaturized digital camera mounted inside a small, flexible tube and a laser inserted through the penis or uretha into the bladder. Pulsed laser energy breaks the stone up into small pieces. In both procedures, the patient is asleep. How does a physician decide which method would work best? It depends on the location and size of the stone, Dr. Wingo pointed out. For those that are of the smaller variety and closer to the kidney, lithotripsy works fine, but he said he probably would use pulsed laser energy for larger stones. Dr. Fiscus said for very large stones, patients can be treated with percutaneous nephrolithotomy, or PCNL. A small incision is made in the patient’s back, and the physician uses a scope and an instrument that allows him to pluck or vacuum the stones. If you have kidney stones once, are you more likely to have them again? Dr. Wingo pointed out that if you don’t make any changes in diet or lifestyle, you have at least a 50% chance of this problem recurring.

large amounts of tea, coffee, soda and dark vegetables aren’t helpful. Dr. Fiscus added that peanuts, rhubarb and spinach are high in oxalates and suggested a heart-healthy diet with “everything in moderation.” He said citrus fruits inhibit stone formation, so adding lemon or lime to your water is probably a good move. He said kidney stones are associated with issues such as obesi- ty, hypertension and diabetes, as well as consuming too much sodium and animal protein. People sometimes pass small stones, the size of a grain of sugar or a little more substantial, without knowing it. Larger stones, especially those that make their way from the kidneys to a ureter, a narrow duct that leads to the bladder, can cause intense back pain that might radiate around to the abdomen; nausea; vomiting; and painful urination. According to Dr. Wingo, good hydration is the best strategy to help avoid kidney stones, along with a 24-hour urine col- lection that should reveal what’s going on with kidney function and the level of electrolytes in the patient’s urine. Potassium citrate tablets and thiazide diuretics such as chlorthalidone, a drug that reduces the level of calcium in the urine, are options, as is tamsulosin, which can be used to help a patient pass a small stone. The drug relaxes the ureter and increases the chance of passing a stone of less than 5 mm in diameter. If none of this relieves the symptoms, it’s probably neces- sary to attack the stones. There are two main options to treat

“If you make modifications, you can reduce your risk to near zero,” he concluded. “It just depends on how aggressive you are with your modifications.” KIDNEY STONES By the Numbers 3 TIPS to avoid kidney stones: drink more water; reduce sodium and animal protein in your diet; maintain a healthy weight. – MySouthernHealth.com If you drink a lot of water, most kidney stones pass through the urinary tract on their own within 48 HOURS . – www.medicinenet.com Most urinary stones develop in people between the ages of 20 AND 49 . – www.medicinenet.com About 11% OF MEN and 6% OF WOMEN in the United States have kidney stones at least once in their lifetime. – U.S. Department of Health and Human Services

80% OF KIDNEY STONES are calcium oxalate stones; 10% TO 15% are classified as struvite; 5% TO 10% are either calcium phosphate or uric acid; and 1% TO 2% are cysteine. – www.medicinenet.com Southerners are up to 50% MORE LIKELY to develop kidney stones than people in other parts of the country. – MySouthernHealth.com

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PRISMA HEALTH MAGAZINE

A BREATHTAKING Journey By Victoria Pujdak

lungs at Nationwide Children’s Hospital in Columbus, Ohio. After 15 months of riding a thin line of survival, Matthew was resettled in his resident hospital, Prisma Health Children's Hospital - Upstate, two weeks before his second birthday. Ten days later, the Barbiers received a much-anticipated birthday gift: Matthew set foot in his home for the first time. Bringing a medically complex child home comes with certain challenges. However, the Barbiers and Matthew’s doctors worked tirelessly to formulate a way of life in which the youngster could flourish and to create a safe sense of normalcy as he continued to grow. “Since returning home, Mom and Dad have flawlessly managed Matthew’s care. Bringing a child home with medical equipment like a tracheostomy tube and ventilator means having to be pre- pared for an emergency at any time, 24/7, potentially while you are alone with your child. Working with this family has been an ab- solute pleasure as their primary concern is always what is best for Matthew, which is, of course, my primary concern as well,” said Dr. Michael J. Fields of Prisma Health Children's Hospital - Upstate. While a fatal emergency can occur at any moment, Barbier has chosen to focus on the daily triumphs in Matthew’s life. “He went to vacation bible school this summer. It was a very big deal because this is quite a medically complex child. We went Monday through Friday. We participated in almost all of the activi- ties. It was wonderful for him,” said Barbier. As Matthew continues to grow and prog- ress, Barbier’s

Resting across his father’s lap, Matthew Barbier slept soundly during his Sunday af- ternoon nap. The faint whirring of an oxygen machine filled the living room with a lulling white noise. Matthew’s 4-year-old sis- ter, Eliana, instinctually hopped over the thin, clear oxygen tubes that weaved around the furniture as she played with her baby dolls.

After Frida Barbier’s water broke at 22 weeks, she and her doctors wait- ed with hopeful yet bated breath

for her unborn son, Matthew, to remain in the womb for a few more weeks.

Three weeks later, he came into the world as a micro-preemie — infants who are born weighing less than 1,000 grams — and was ushered into the infant neonatal intensive care unit at Prisma Health Children's Hospital - Upstate. “Three days after Matthew was born, our adopted daughter, Eliana, was born a healthy baby girl, and we brought her home from the hospital while Matthew remained in the NICU. We were living a dual life – a hospital life with a very sick baby boy and a home life with a very healthy baby girl. This was our life for eight months,” said Barbier. Due to the early loss of amniotic fluid, which is essential to the proper development of an infant's' organs, Matthew’s lungs were unable to fully evolve and function independently without aid, and he was introduced into a world of ventilators and oxygen. At 4 months, Matthew underwent surgery to implant a tracheotomy and gastrostomy tube to give him a second way of living. Matthew remained an extreme case and was transferred to a special unit that focuses on treating premature infants with sick

primary goal is to provide an envi- ronment where her son can live life to the fullest. “We have come such a long way. We could talk for weeks about the strug- gles we have overcome to get

to where we are. For some people, we might look silly because he signed ‘mama’ or ‘daddy’ and we get so excited because that is a really big deal for him. So we praise that.”

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You can count on us, South Carolina

As South Carolina’s long-time healthcare system, Prisma Health is dedicated to being here for your health needs. We continue to provide essential services for coronavirus symptoms and your other medical needs. Our team of experts is here to care for you.

Ways to access care

Call your current Prisma Health provider. Call the practice directly and talk with the team to determine the best way to receive care — online, on the phone or in person. Please call before visiting.

Find a provider with Prisma Health GO. For non-coronavirus conditions or symptoms, download Prisma Health GO on your smartphone (Android or Apple) to find a provider online or to schedule a Virtual Visit.

Schedule a Virtual Visit. Get quick, convenient care for many common conditions using your computer or mobile device.

Use our 24/7 hotline or symptom checker. If you have COVID-19 symptoms, such as dry cough, fever or shortness of breath, and you don’t have a primary care provider, we can help. Call 1-833-2PRISMA (277-4762).

With a provider’s order (required) for COVID-19 testing, you can visit our drive-thru sites.

Learn more: PrismaHealth.org/Access

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The mission of the Heart & Vascular Institute of Prisma Health-Upstate is to provide the highest quality, most efficient cardiovascular care for our patients. Through collaboration and a commitment to excellence, we care for patients in the Upstate of South Carolina and throughout the region. The Institute is composed of board-certified physicians, certified physician extenders, certi- fied nurses and technicians who offer state-of-the-art care in the fields of adult and pediat- ric cardiology, cardiac and vascular surgery, and vascular and endovascular medicine. We work together to provide high quality, comprehensive care and the most advanced treat- ments known to medicine. www.ghs.org/healthcareservices/heart