SPRING/SUMMER 2013

THE Surgical Hospital of Phoenix is happy to unveil the first issue of our new quarterly newsletter, ‘Talking Shop’, our latest effort to educate our community about who we are and what we offer. Being a Phoenix native and the new CEO of THE Surgical Hospital (the Shop), I care about our community and the health care that everyone receives.

For this reason, I am quite proud to share our incredible quality outcomes, which place us as a top hospital not only in Arizona but in the nation. Our unheard of infection rates (less than .1%), tremendously low re-admit rates, and off-the-chart patient satisfaction scores are all achieved by having the most dedicated physicians and employees you will find at any hospital.

We are a physician owned hospital and proud to be one. Our physicians own this hospital because they are

committed to maintaining a direct level of involvement of all aspects of patient care, and our results speak for themselves.

We invite you to experience the “new” Surgical Hospital of Phoenix and learn about how we are different from most other hospitals. Later this summer, we will be hosting an Open House to invite the community in to see what we’re all about. We will be providing food, tours and an overview of our services, and will even have the Phoenix Coyotes Howler in house to say hello as we are proud to be the Preferred Health Care Provider of the Coyotes. This will be an excellent opportunity to meet some of the finest doctors, nurses, and employees of any hospital, and we look forward to seeing you there!

INTRODUCING: THE SURGICAL HOSPITAL OF PHOENIX

By: William J. Comer | CEO

WITH THE SURGICAL HOSPITAL OF PHOENIX

RECIPES FOR HEALTHY LIVING

Directions• Keep half and marinate the chicken, blend other half for dressing.

• Marinate chicken and grill until done. Wash and separate lettuce leaves.

• Using a slicer or sharp knife, cut long thin slices from the cucumber. Roll the slices into rings and fill them by arranging the lettuce leaves, strips of bell pepper and green onion in them.

• Serve the chicken warm by slicing it and arranging it on a plate around the cucumber wrap.

• Garnish with the orange and grapefruit segments, and fresh thyme.

• Drizzle with vinaigrette and serve.

Citrus Vinaigrette• Combine the oil, both juices, vinegar, honey, mustard and thyme.

Ingredients3 boneless chicken breasts, cut in half1 cup olive oil ½ cup orange juice ½ cup grapefruit juice ½ cup champagne vinegar ¼ teaspoon mustard 1 teaspoon honey½ teaspoon fresh thyme 1 head Belgian endive 1 head red leaf lettuce

1 head green leaf lettuce1 bunch of arugula1 cucumber1 small red pepper, julienned1 green onion12 orange segments12 grapefruit segmentsFresh thymeSalt and pepper

Warmed Grilled Chicken Supreme

Directions• To prepare the fish, season with salt and pepper and put face side down in a hot pan. Brown on one side and flip over. Cook until the fish is slightly firm and becomes opaque. Squeeze fresh lemon over the top.• For the couscous bring the stock to a boil. Sauté the onion peppers and cucumber in olive oil until tender.• Add the couscous, stock and vegetables together, cover and let stand for 10 min. Fluff with a fork and season with salt and pepper. Add fresh herbs. • Wash and trim bok choy, cut in half and marinate with Italian dressing. Grill each half until tender.• For the sauce, combine onion, garlic, parsley, peppercorn, salt and pepper, white wine and lemon juice. Bring to a boil. Reduce heat and simmer until liquid is like syrup. Add cream and reduce by half. Add seasoning to taste.• When serving, place fish on a generous portion of couscous. Garnish with bok choy and drizzle with sauce.

Fish6 Ounce sea bass per person

Couscous 1¼ cup chicken stock 1 teaspoon olive oil¼ cup diced onion ¼ cup diced red pepper ¼ cup diced cucumber 1½ cup couscous 1 teaspoon fresh sage 1 teaspoon parsley 1 lemon half Salt and pepper

Pan-Seared Sea Bass with Herbed Couscous, Grilled Bok Choy and Lemon Sauce

Lemon Sauce 2 teaspoons chopped onion 1 teaspoon garlic 1 teaspoon parsley 1½ cup white wine4 peppercornsJuice from two lemons2½ cups heavy creamSalt and white pepper6 stalks of bok choy, cut in half1 cup Italian dressing

By: Doug Blankenship | Executive Chef

By: Doug Blankenship | Executive Chef

STAYING ACTIVE

Is Rotational Training Good For Your Lumbar Spine?By: Scott Radomski | PT, CSCS

For years there has been much debate over the efficacy of rotational exercises for patients with lower back pain. Should those with lower back pain do exercises that require them to twist? Is it safe to rotate and try to stretch your lower back?

For decades rehabilitation has focused on uni-planar exercises, with emphasis on supine and prone exercise routines to treat lower back pain. Only recently has the emphasis switched to more multi-planar exercises designed to mimic normal functional activities.

The exercises have become more dynamic with more rotational movements involved.

In order to understand rotation, we first must give a quick overview of the lumbar spine and its ability (or lack thereof) to rotate. According to many experts, the overall range of motion for lumbar rotation is a TOTAL of 13-16 degrees. The rotation between each segment from T10 to L5 is reported to be just two degrees, with the greatest rotation between L5-S1 at five degrees.

Now, imagine a ninety degree angle. If you shade in less than twenty percent of that angle, that is how much rotation that can occur at your lumbar spine. That is not much at all. Structurally, the lumbar spine is designed to control and prevent rotation - not allow for rotation. So where does our rotation come from when our lumbar spine allows us so little rotation? The answer is the joints above and below the lumbar spine, notably the hips and thoracic spine.

Studies have shown that the thoracic (mid) spine accounts for 60-70 degrees of rotation. With this being said, why should we focus on increasing the rotation of our lumbar spine with stretches? How many times have we had patients say they need to stretch out their lower backs and one of the favorite stretches is some semblance of a twist stretch? Instead, the focus must be on increasing our thoracic spine and hip flexibility, and decreasing the motion in our lumbar spine. For the lumbar spine, the ability to resist rotation may in fact be more important than the ability to create it.

Now that we know about the rotational expectations of the lumbar spine, we can get back to the original issue of whether or not rotational exercises are safe for your

lumbar spine. The rotation is not the concern, where the rotation takes place is the concern. We need to do rotational training to prepare our patients for their everyday activities. Think about how much you rotate and twist on a daily basis just going about your daily routine. If a patient’s body is not trained to rotate properly, they will continue to have dysfunction and pain. If hip mobility and thoracic spine mobility are compromised, then the lumbar spine is called upon to move in ways it is not designed to. Take for example a recreational golfer with tightness in their hips and/or upper back.

During a golf swing, a majority of the rotation generated is in the hips and thoracic spine. If one or both of these areas are restricted, then the lumbar spine will have to pick up the slack and be called upon to rotate more than it should to complete the swing, thus potentially leading to a lower back impairment. A majority of mechanical lower back issues can be linked to restrictions in mobility above or below the lumbar spine.

The bottom line is rotational training is necessary, but we need to educate the patient regarding rotation and where it should actually come from. We need to improve lumbar spine stability, and increase mobility in the thoracic spine and hips. Patients must be able to prevent lumbar spine rotation while allowing the rotation to come from their hips and upper spine.

Rotational exercises are a necessity to restore proper function and recovery, as long as the rotation is not coming from your lumbar spine.

Have questions or feedback? Email sradomski@thesurgicalhospital.com for more information.

By: Doug Blankenship | Executive Chef

By: Doug Blankenship | Executive Chef

CORNERED BY PAIN

Today everyone expects a safe passage, when boarding the plane, the train, or having a surgical procedure. Developments in the science of perioperative medicine have made the process of going through a surgery as safe as many other routine activities in life. This record of safety is a product of the thoughtfulness exhibited by the perioperative team through its three main periods in patient care: preoperative, intraoperative and postoperative. Here we examine some important points and the unique advantages that smaller hospitals have in providing care throughout these periods.

Preoperative Care:Most often, the surgeon and the primary care physician guide the perioperative preparations. Anesthesiologists should be consulted when questions arise. Although the goal of perioperative preparations is to optimize a patient for surgery, it is not unusual to discover long neglected chronic disease during this workup. Preoperative workup can steer a patient toward getting proper preventative care. Testing is done to identify medical issues that need to be addressed prior to surgery.

Better understanding a patient’s medical condition and status can help determine the best surgical solution for

them and the proper facility for the surgical procedure

to be performed in.

In choosing the proper facility for a surgical procedure, the decision needs to be made by considering the patient’s needs. Having a procedure done in the largest hospital is often not the best choice for a great majority of patients. Smaller surgical hospitals provide certain advantages that larger facilities may not have. A large hospital, with a large active emergency department, may have advanced services such as a cathlab, interventional radiology and others readily available. If the surgical patient needs the services it is to her advantage to have such in-house services. Unfortunately, such advantage does not come without a cost. Large hospitals house a number of severely ill patients, thus large hospitals have a higher risk of nosocomial infections. As a result, patients going in for low risk surgery may be exposed to antibiotic resistant bacteria.

Intraoperative Care:After proper optimization, we enter the intraoperative period. An anesthesiologist, a highly trained specialist, will watch every breath and every heartbeat of a surgical patient. Their expertise is meant to minimize the risks of

Perioperative Success: Unique Advantages of Specialty HospitalsBy: Dr. Hafez Azadeh, MD | Chairman of Anesthesiology

Visit the Maryland Elementary website at http://maryland.wesdschools.org/home to learn more about this fantastic school that is right here in our community.

surgery and assure comfort of the patient. Intraoperative and emergency decisions made by the anesthesiologist are often guided by the perioperative workup. The surgery is made even safer when the surgeon and anesthesiologist are familiar with each other’s procedures - a unique situation that is very common in specialty hospitals.

Postoperative Care:Care of the postoperative patient is mostly dependent on the highly specialized and trained nursing staff. Every surgical procedure requires its own set of nursing expertise. Staff training becomes challenging when many different procedures are performed across specialties. Postoperative units in larger hospitals care for a mix of patients with varied surgical procedures. The staff is cross-trained to care for a trauma patient next to a urological surgery patient, next to a spine surgery patient - none of whom gets the specialized care given in a specialty hospital with specially trained staff.

Small surgical hospitals do a relatively small variety of procedures to the point of perfection. The training of staff is made easier when the variety is limited.

Nurses in a specialized hospital are familiar with both common and rare problems associated with procedures done in their facility and are very familiar with the few surgeons that perform the procedures in their hospital. They have open lines of communication with the surgeons which directly manage their patients. It is the direct, personal relationships and specialized care that sets specialty hospitals apart from larger multi-specialty hospitals.

THE HOSPITAL IN YOUR COMMUNITY

In addition to taking excellent care of our patients, THE Surgical Hospital of Phoenix takes care of the children of Maryland Elementary School. With students from 25 countries that speak 23 different languages, Maryland Elementary School, located off of 21st Avenue, celebrates diversity. The school continues to grow and THE Surgical Hospital of Phoenix is always seeking out fun, creative ways to help the children in our own backyard.

In 2012, we hosted a “Backpack Drive” that collected over 40 backpacks with a variety of school supplies for children

Backpack DriveBy: Maggie Voss

in grades K-8. This year, we set a goal to collect 100 backpacks to give back, calling on the support of our doctors, the community and the compassionate associates of our hospital.

Want to get involved and help make a difference?

Please e-mail Maggie Voss at mvoss@thesurgicalhospital.com and we will gladly supply a donation box to display at your place of business. The supplies we hope to collect include (but are not limited to):• Backpacks • Paper • Tape • Rulers • Markers • Crayons • Pencils • Pens • Glue • Hand Sanitizer • Clorox Wipes

Hafez Azadeh, MD

Cardiothoracic Anesthesiologist

Chairman of Anesthesiology

Founder Grand Canyon Anesthesiology Consultants

602-343-2900

Specializing in neurosurgery, THE Surgical Hospital’s Governing Board Chair, Dr. Daniel Lieberman understands the correlation between pain and the brain. For a brief look into his expertise, we sat down and learned a little more about his practices, and the

cornerstones of the care that neurosurgery provides.

The first step in understanding pain, as we experience it, is recognizing the brain’s role as the common pathway for all pain signals. Beyond that, it is key to understand the correlation between the physical and emotional effects of pain. While the physical impact may present itself more prominently, emotional responses with fear and anxiety play an important part in how we deal with pain.

In his years as a neurosurgical specialist, Dr. Lieberman has seen three main types of patients; those in pain that don’t know why, those who know something is wrong with their spine, and finally, those who know they need surgery and are looking for the right surgeon.

Before planning surgery with any new patient, Dr. Lieberman insists that all options for pain reduction be explored. Like many of his colleagues at THE Surgical Hospital, he believes that anyone considering neurosurgery should explore non-operative options before surgical options. Surgery should be carefully considered, and is appropriate only after all other alternatives have failed.

For those who choose or are advised to move forward with surgery, Dr. Lieberman makes immediate relief from pain possible with minimal access surgical methods. Patients who undergo this type of surgery have exceptionally low infection rates and recover more quickly as a result of the minimal tissue damage that occurs during this less invasive surgery.

As for advice on the best preventative measures people can take to avoid the need for surgery? Dr. Lieberman suggests

PHYSICIAN SPOTLIGHT:

Dr. Daniel Lieberman – Understanding Pain

Arizona Center for Neurosurgery Phone: 602-256-2525 | www.arizonacns.com

that maintaining core strength is one of the most important things a patient can do, even over other important preventative measures such as weight control and receiving the proper nutrition. To read more about the importance of maintaining core strength, visit palindromespinecare.blogspot.com.

When a patient does undergo surgery, it is imperative that they make strides toward advancing their recovery with post-operative care. For example, Dr. Lieberman encourages discontinuing the reliance on any/all pain medications and working to increase activity tolerance. Often times, patients tend to take it too easy after surgery. Commonly made mistakes include not being proactive with rehab efforts and not actively working to push through pain barriers.

Dr. Lieberman is a board certified Neurosurgeon specializing in treatment of complex brain, spine and nervous system conditions in adult and pediatric patients. He has special interests in the surgical treatment of movement disorders, brain tumors, epilepsy, pain and minimally invasive treatment of spinal disorders. He graduated from Pepperdine University with honors and earned his medical degree from the University of Arizona. Dr. Lieberman trained in Neurosurgery at the University of California at San Francisco, and completed a fellowship in movement disorder research at the National Institutes of Health. He is also married and the father of three children.

As an active contributor to the Medical Community, Dr. Lieberman balances being a successful surgeon, President of the Maricopa Medical Society and a father of three children by managing his time between work, family and taking care of himself.

He keeps active by participating in triathlons and doing many other physical activities.

Have a peek into the life of Dr. C. Yeung – our resident sports fanatic and orthopedic surgeon for the Arizona Diamondbacks. How does he treat athletes and non-athletes alike? In a recent Q&A session, Dr. Yeung discusses pre and post surgical

care and injury prevention.

You work with the Arizona Diamondbacks. What inspired you to work with professional athletic teams?

I’ve always been a sports fanatic and that is one of the reasons I went into orthopedic surgery. I wanted to sub specialize and was torn between spine and sports medicine. I ended up getting the best of both worlds and chose do a spine Fellowship with Dr. Robert Watkins, who is considered the expert in sports spine injuries. Because of this background, it was natural for me to become involved in the local Arizona teams.

Do you find recovery time a challenge when working with athletes during the season?

Athletes are incredibly frustrated by losing time to injury. They always want to get back to their sport as quickly as possible and help the team, but don’t want to jeopardize their career by coming back too soon. As the surgeon, I have to give the player the best scientific advice that I can to help make the best and safest decision on when they can return to play.

What can your average patient learn from athletes you’ve treated?

When athletes get hurt they put in a lot of work to get back in playing shape. Surgery is often only the first step in recovery. Surgery can rapidly alleviate the acute pain from a compressed nerve, but to return to an elite level of performance and prevent further injury athletes must rehabilitate intensively to counteract any atrophy from nerve damage or simply from disuse. All patients should embrace core trunk stabilization to help recovery from surgery and to prevent further injury.

PHYSICIAN SPOTLIGHT:

Dr. Christopher Yeung – Getting Down to the ‘Core’

DISC – Desert Institute for Spine CarePhone: 602-944-2900 | www.sciatica.com

Arizona Center for Neurosurgery Phone: 602-256-2525 | www.arizonacns.com

What can the average patient do to prevent injuries?

Patients need to have strong core stabilizers to help protect their spine. Yoga and Pilates are excellent activities to help with this in addition to formal physical therapy. Aerobic low impact activity also helps nourish the relatively avascular discs by promoting diffusion of nutrients across the vertebral endplates.

What lifestyle changes do you recommend to avoid major surgeries?

Patients need to control their weight to avoid that “spare tire” around their waist. Drink more water and if you need something sweeter, try diluting the drink by mixing 2 parts water. Even the “healthy” sports drinks and flavored waters can pack serious calories. Patients should also try to get more daily exercise. Try adding little activities like taking the stairs instead of the elevator, walking to your colleagues’ office to talk rather than just calling on the phone, and engaging your core muscles many times per day randomly.

What do you find is the goal of your patients when coming to see you?

Most patients are in pain and simply want to be out of pain. It is my task to find the cause of the pain and help them eliminate it.

Dr. Christopher Yeung was magna cum laude at the University of California San Diego and graduated in the top 5% of his class at the University of Southern California School of Medicine. He is a board certified, fellowship trained orthopedic spine surgeon, with a special interest in minimally invasive spine surgery techniques with a philosophy of choosing the least invasive yet most effective method to treat spine problems. He has been the principal investigator in many FDA studies, including Flexicore lumbar artificial disc replacement, Cervicore cervical artificial disc replacement, and DASCOR total nucleus replacement.

When not working, Dr. Yeung enjoys travel, golf, SCUBA, sport fishing, camping, volleyball, snow skiing, water skiing, tennis, basketball, and time spent with his family.

Pain: no one wants it, and when you have it you dream of a life without it. Fortunately, there are many methods to manage pain; through therapy, medication monitoring, treatment and surgery. Unfortunately, our community has developed an epidemic that we as a hospital feel responsible for addressing.

Our partnership with PeaceHealth Laboratories was made official on May 9th, 2013, and we are proud to announce that the beginning of this exciting partnership is helmed by PeaceHealth’s patented pain medication monitoring program with the industry’s highest levels of accuracy. “Patient Protect” will be available to detect prescription pain medication and identify potential negative drug interactions in your patients before they occur.

After being approved by our MEC (Medical Executive Committee), Pt Protect™ will be available through our laboratory outreach program to improve monitoring of prescribed, controlled medications.

These testing panels help determine whether your patient is:

By: Jacob Stokes | Director of Laboratory

DID YOU KNOW?Did you know that THE Surgical Hospital of Phoenix has a department called THE Support Center?

The quality of internal communication with our patients is very important to us, and we want to our patients, doctors and families to know how much we care. Scheduling, pre-op and admitting are all housed together to keep our hospital’s communication processes moving fast and efficient for THE Complete Patient Experience - from start to finish.

• Taking or potentially diverting pain medications currently prescribed • Taking pain medications that are not prescribed • Using drugs of abuse

• Kristen Hartzel, Director of Business Development • Jacob Stokes, Director of Laboratory• Dr. Arthur Sitelman MD, Medical Director Laboratory

The PtProtect team at THE Surgical Hospital of Phoenix includes:

Please call Kristen at 602-319-6995 or email her at khartzel@thesurgicalhospital.com for more information.

6501 N. 19th Ave | Phoenix, AZ 85015

602.795.6020 | admin@thesurgicalhospital.com

GOT PAIN?