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| ‘PulseBeat’ Special Looks at Head and Neck Medicine |
Ear, nose and throat specialists (from top to bottom) Jennifer Berge, M.D., Doug Henrich, M.D., and Dean Lyons, M.D., will be featured in the next edition of PulseBeat. |
The signs are
everywhere in our lives – a wife elbowing her husband to stop his snoring, Grandpa turning up the television volume, sinus infections afflicting many of us.
For these and other conditions of the ears, nose or throat, a physician usually refers a patient to an ear, nose and throat specialist. Three ENTs serve the Great River Medical Center area: Jennifer Berge, M.D., Doug Henrich, M.D., and Dean Lyons, M.D.
From advanced head-neck cancers to putting tubes in ears, from delicate endoscopic sinus surgery to voice-box surgery, the ENTs who practice at Great River Medical Center use the same leading-edge procedures as their colleagues at universities and larger clinics.
Ear procedures
The most common procedure ENTs do is the insertion of tubes into a patient’s ears.
“We do them for young kids and for adults,” Dr. Berge said. “It’s usually for the same reasons – recurring infection or drainage problems.”
One ear condition, called tinnitus, is the sometimes debilitating perception of sound without an external source.
“No one has developed the cure for tinnitus,” Dr. Lyons said. “We can offer tinnitus training, masking devices and rehabilitation.”
The ear provides two vital functions, hearing and balance. Disease, injury or infection can cause problems with either function.
For the diagnosis and treatment of balance disorders, an ENT may collaborate with a physical therapist with special training in vestibular rehabilitation, such as Michelle McDowell at Great River Center for Rehabilitation.
“We evaluate what the causes could be through their subjective complaints and their history, their medicines and their symptoms,” McDowell said.
PulseBeat Times and Dates
In health care, technologies and treatments are advancing like never before. PulseBeat helps you keep abreast of these advances and shows you what’s occurring in health care at Great River Medical Center. The next edition of PulseBeat looks at conditions affecting the ear, nose and throat. Watch PulseBeat at the following times, dates and channels:
• 6:30 p.m.
Wed. Sept. 10,
WGEM (NBC)
• 6:30 p.m.
Wed. Sept. 10,
KYOU (FOX 15)
• 6:30 p.m.
Sat. Sept. 20,
KHQA (CBS)
• 5:30 p.m.
Sun. Sept. 21,
KLJB (FOX 18)
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One balance problem that affects about 20 percent of the population is benign paroxysmal positional vertigo. With this condition, particles come loose and float into the balance organs in the ear’s vestibular system.
“With our technologies, we can discover which canal is involved,” Dr. Berge said. “The therapist can position the patient to move the particle so the dizziness ends.”
“For other conditions of the ear, patients have to do the movements that caused them to be dizzy,” McDowell said. “The body adjusts and it lessens the effects.”
One ailment that can cause hearing loss is called a cholesteatoma. Most eardrum perforations heal, but occasionally eardrum skin grows into the middle ear, becomes infected and develops into a noncancerous tumor.
“To remove a cholesteatoma, we do a surgery that goes into the middle ear through the skull bone,” Dr. Henrich said. “After cleaning out the tumor, we often rebuild the little hearing bones, usually using tiny titanium implants.
“Some people lose hearing because they have a congenital fusion of the third hearing bone, the stapes,” Dr. Henrich said. “That requires an operation called a stapedotomy, where we remove the stapes with a laser and replace it with a microimplant.”
“We have screening programs to catch hearing loss problems,” Dr. Berge said. “And our audiologists and nurses are good at picking up newborn screens.”
“Newborns have a hearing test, which takes about 10 seconds, before they leave the hospital,” said Ann Smith, Au.D., a Great River Medical Center audiologist. “When older children and adults need a hearing test, we do the tests in a sound booth.”
“A person might be deaf in just one ear, but hearing aids never worked well for that,” Dr. Lyons said. “Now, a bone-anchored hearing aid – or BAHA – gives hearing to deaf ears.”
“It’s an outpatient procedure. We just lift some skin, put a small titanium screw in and let it down again,” Dr. Lyons said. “They do not have much pain, and they go home the same day.
“The patient has to wait two to three months until that screw integrates with the bone – titanium and bone grow together,” he said. “Then we just click the BAHA unit on.”
Most ear procedures performed at Great River Medical Center are minimally invasive, and patients rarely stay overnight.
Nose, sinus procedures
The area’s ENTs apply technologies to diagnose and treat nose and sinus conditions. When treating noses, keeping the airways open is their priority.
“The most common things related to the nose would be septoplasty and airway-improvement surgery,” Dr. Henrich said.
ENTs also perform sophisticated procedures to open patients’ sinuses.
“The technology for sinus surgery has changed dramatically, and all the newest techniques are available at Great River Medical Center,” Dr. Lyons said. “In the early ’90s, research found that if ENTs opened sinuses and let them drain, it would be the best thing.”
In 2000, ENTs at Great River Medical Center began doing endoscopic sinus surgery. In 2007, Great River Medical Center updated that technology with a highly accurate three-dimensional image-guided system. The ENTs also use the endoscope and shaver – a device that makes small openings in the sinuses.
The latest technology at Great River Medical Center is balloon sinuplasty, a nearly painless procedure to open a sinus.
ENT physicians may use any of these techniques to treat some patients. Most patients who have sinus surgery go home the same day.
Throat procedures
The ENTs who practice at Great River Medical Center treat their patients for throat ailments ranging from hoarseness to laryngeal cancers. The most common surgery is removal of tonsils and adenoids.
“A technological advancement for removing adenoids and tonsils is a technique called coblation,” Dr. Henrich said. “It uses much lower temperature, causes less pain and cuts healing time to three or four days.”
“Recently there’s been recognition of pediatric sleep apnea,” Dr. Berge said. “More of the tonsils we take out of children are to correct an obstructive problem.”
Sleep apnea has been recognized in adults for some time. Great River Sleep Disorder Center includes three sleep-study rooms to treat patients from throughout the area.
“The ENTs do an excellent job of screening patients for obstructive sleep apnea,” said neurologist Anil Dhuna, M.D., medical director of Great River Sleep Disorder Center. “If sleep apnea is suspected, they refer them for a sleep study.”
During a sleep study, sensors – none of which penetrate skin – monitor sleep parameters from brainwaves to heartbeats and leg movements.
Patients diagnosed with sleep apnea are usually referred to an ENT for further evaluation.
“The gold standard of treatment is CPAP, or continuous positive airway pressure, from a machine worn during sleep,” Dr. Dhuna said.
“Most people with severe apnea do well with CPAP or weight loss,” Dr. Berge said. “For others, there are good surgical solutions.”
To diagnose and treat other throat conditions – from hoarseness to cancer – the ENTs who serve this region use a variety of sophisticated diagnostic tools.
Many times, a patient’s only complaint is chronic hoarseness – the result of anything from shouting to respiratory illness. After examining their vocal cords, the ENTs refer many such patients to a speech pathologist at Great River Medical Center.
Speech pathologist Joyce Wegmann said, “If they have surgery to remove nodules or polyps, the ENTs will order voice therapy so they don’t harm their voices afterward.”
For patients with difficulty swallowing, physicians may order a diagnostic procedure called a video swallow.
“Video swallow is a procedure that radiology does with speech pathology,” said radiologist Steven Davis, M.D., medical director of Diagnostic Imaging at Great River Medical Center. “The patient swallows liquids and solids to simulate eating a meal, and radiologists provide the fluoroscopy – the video X-rays – during that process.”
After a throat surgery, speech pathologists use the video-swallow technique to help patients adapt to their new situation.
Laryngeal stroboscopy is another diagnostic device that helps Drs. Berge, Henrich and Lyons diagnose the tiniest movements in a patient’s larynx. This capability was installed at Great River Medical Center early in 2008.
“It allows is to look at the vocal-cord motion under high-speed stroboscopic light and break down the vocal-cord motion,” Dr. Henrich said.
Head, neck cancers
With head and neck cancer treatment, the ENTs practicing at Great River Medical Center offer a full complement of procedures.
They collaborate extensively with the center’s medical and radiation oncologists. If cancer results in a patient having all or part of his or her larynx removed, ENTs and speech pathologists provide treatment together.
“Patients who have had their entire larynxes removed won’t have swallowing problems, but they’ll have speaking problems,” said speech pathologist Denise Hanks. “Someone who has had part of his or her larynx removed typically is the reverse.”
Dr. Henrich commented, “The facilities at Great River Medical Center for treating our patients are exceptional.”
Dr. Lyons agreed: “I haven’t been in too many towns this size that have this kind of medical facility.”
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Inpatient Rehabilitation Program
Offers a Unique Patient-care Setting
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Great River Medical Center’s Inpatient Rehabilitation Program offers a comprehensive and unique service for patients recovering from major illness or injury. |
Great River Medical Center’s Inpatient Reha bilitation Program is unlike any other treatment area in the hospital – or the entire region that includes southeast Iowa, west-central Illinois and northeast Missouri. It’s a unique place where patients and treatment teams work together to set, reach and celebrate goals for restoring function and learning new skills.
The medical center’s adult, child and adolescent rehabilitation, and stroke rehabilitation programs are
accredited by the Commission on Accreditation of Rehabilitation Facilities. The medical center also was one of the first six hospitals in Iowa to be named a certified Primary Stroke Center by the Joint Commission.
Each day, patients dress and spend several hours working with therapists in Snake Alley Rehabilitation, a large area that includes an automobile, mock grocery store, kitchen, bedroom and bathroom. The area is designed to help patients practice the activities of daily living. It also includes steps, doors and a variety of walking surfaces. The experiences extend to the outdoor courtyard, which has more walking surfaces plus a garden filled with plants to stimulate the senses of smell, touch and sight.
Rest times and evenings are spent in the adjoining 15-bed Rehabilitation Unit. All private and semiprivate rooms overlook beautiful gardens.
The highly qualified rehabilitation team develops programs to help patients regain abilities that have been lost or diminished because of:
- Accidents with multiple injuries
- Amputation
- Brain injury
- Hip fractures
- Multiple sclerosis
- Parkinson’s disease
- Spinal-cord injuries
- Stroke
The rehabilitation team
Great River Medical Center uses a team approach to help patients in the Inpatient Rehabilitation Program regain physical, communicative and social abilities to become as independent as possible. Because the Rehabilitation Unit is in the hospital, team members come from throughout its large staff of experienced health-care professionals. Custom teams are developed based on patients’ specific needs and remain with patients throughout their stays.
Patients and their families are the most important members of the rehabilitation team. The team meets weekly to discuss progress and set new goals. Therapists work together to ensure that skills learned in one type of therapy continue in other therapies. The medical director, case manager and nurse visit patients together Monday through Friday to monitor patient goal progress and medical needs, and to answer questions.
Team members and their roles are:
- Patient – The patient must provide more initiative, hard work and determination than anyone else on the team. Patients have three hours of therapy daily. They are encouraged to do as much for themselves as possible during and after rehabilitation.
- Family – The family is the patient’s major support system. The rehabilitation team will ask family members to participate in care and therapies to help patients achieve maximum results.
- Medical director – The medical director of the Inpatient Rehabilitation Program specializes in neurology, the treatment of diseases and injuries to the nervous system. The medical director oversees patients’ recoveries and prescribes therapies. The medical director may ask physicians in other specialty areas to become part of the rehabilitation team.
- Case manager/social worker – This professional helps patients and their families adjust to and cope with new disabilities, whether short term or permanent. The case manager/social worker also coordinates financial assistance, including insurance, disability payments, and state and federal funding; family education; and discharge planning, including the information and counseling needed to make informed decisions about further care.
- Nursing staff – Nurses in the Rehabilitation Unit help patients achieve as much independence and endurance as possible. Besides providing medical care, they spend time teaching patients self-care skills such as eating, dressing and toileting.
- Physical therapist – A specialist in how the body moves, a physical therapist helps patients improve coordination, muscle tone and endurance to increase mobility from sitting and reaching to walking. A physical therapist may determine whether braces or prostheses are necessary.
- Occupational therapist – Occupational therapists evaluate patients’ perceptions, sensations, motor function and cognition. Then they develop treatment programs in self-care, dressing, eating, homemaking, and muscle strengthening and coordination. They also evaluate the need for special devices to help patients adapt to living at home again.
- Speech/language pathologist – Speech/language pathologists help patients regain speaking, understanding, reading and writing skills that may have been lost because of stroke, surgery or injury. Speech/language pathologists also evaluate swallowing disorders and design treatment programs to promote the return to a normal diet.
- Therapeutic recreation specialist – Therapeutic recreation specialists use a variety of activities to meet patients’ social, emotional and physical needs, and personal interests. They encourage patients to develop new skills while helping them adapt to new ways of enjoying longtime interests. The program emphasizes the importance of leisure to maintain a healthy life after illness or injury.
- Psychologist – Psychologists are professionals who specialize in cognitive and psychological evaluations. They counsel patients and family members, and help them adjust to changes that occur when a person has a disability. Psychologists also advise the other team members on treating patients who have difficulty with emotional or cognitive behavior.
- Dietitian – Clinical dietitians oversee patients’ nutrition. They teach patients and families about specialized diets, and work with other team members to ensure that meals are nutritious and appropriate for patients’ levels of ability to prepare and eat.
- Chaplain – Chaplains help patients and their families use their spiritual resources when dealing with life-changing disabilities. A chaplain is available to answer questions and, if desired, help establish advance directives such as a living will and durable power of attorney.
After discharge
Rehabilitation doesn’t end when patients are discharged from the hospital. The inpatient rehabilitation team may recommend continuing outpatient therapy at Great River Center for Rehabilitation. Inpatient and outpatient
therapists discuss patients’ progress to avoid lost time and repetition.
Other programs and services offered by the Center for Rehabilitation include:
- Cognitive therapy
- Custom splinting
- Driver retraining
- Health fitness
- Low-vision therapy
- Pain Clinic
- Vestibular rehabilitation for balance problems
- Wound and Hyperbaric Clinic
If patients prefer – and if they meet specific criteria – they may receive rehabilitation therapy at home through Great River Home Health Care.
Referrals and more information
The Inpatient Rehabilitation Program welcomes referrals from physicians, social workers, family members, insurance representatives, case managers and patients. Most medical insurance carriers, including Medicare, cover the program’s services. For more information, to make a referral or to arrange a tour, please call (319)
768-4200, or send e-mail to grmcrehab@grhs.net.
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Hospital Opens Great River Cardiology;
Interventional Cardiologist Named Clinic’s Medical Director |
Interventional cardiologist Abdullah Alwahdani, M.D., has been named medical director for Great River Cardiology and Great River Heart and Vascular Center. |
Great River Medical Center has opened Great River Cardiology, a new physician clinic for the treatment of heart-related conditions. Interventional cardiologist Abdullah Alwahdani, M.D., is medical director for Great River Cardiology and Great River Heart and Vascular Center.
Dr. Alwahdani joined Great River Medical Center’s medical staff in 2006. He received his medical degree from the University of Jordan, Amman, Jordan. Dr. Alwahdani then completed his residency and fellowships in cardiology and interventional cardiology at the University of Iowa Hospitals and Clinics. He is certified by the American Board of Internal Medicine in internal medicine, cardiovascular disease and interventional cardiology. Dr. Alwahdani had been with Southeast Iowa Cardiology Associates, West Burlington, since 2006 before joining Great River Cardiology.
Dr. Alwahdani has been providing cardiac and peripheral angioplasty services to patients at Great River Heart and Vascular Center for the past two years. Angioplasty is a procedure to open clogged vessels using inflatable balloons or stents.
Great River Cardiology provides diagnostic and treatment services for a range of conditions including congestive heart failure, coronary artery disease, high cholesterol and peripheral artery disease. Services offered include:
- Carotid angiography
- Coronary angiography
- Echocardiography and transesophageal echocardiography
- Electrocardiography
- Event and Holter monitoring
- Heart vessel balloon, stent and atherectomy procedures
- Nuclear cardiology
- Peripheral angiography/angioplasty
- Segmental pressure measurement
- Stress testing
Great River Cardiology is in Great River Heart and Vascular Center at Great River Medical Center, 1221 S. Gear Ave., West Burlington, Iowa. For more information or to schedule an appointment, please call (319) 768-1820.
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| Great
River Health Systems
1221 S. Gear Ave.
West Burlington,
IA 52655
(319) 768-1000 |
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