Pentucket Medical Health Bulletin
May 1, 2009

Swine Flu: Common Sense and Precautions for Prevention

Pentucket Medical is aware of the ongoing Swine Flu alert. Our Infectious Disease Specialists, Joseph Gross, MD, and Karen Mello, MD, advise you to keep the following in mind:

1. Do Not Panic! Currently, confirmed cases of Swine Flu do not indicate that it is more or less severe than any other type of flu.
   
   By Way of Perspective: more than 37,000 people in the US die in the United States during the annual flu season. To date this year, the WORLDWIDE death toll from Swine Flu is in the low hundreds. Additionally, according the Centers For Disease Control, this flu appears to be treatable with TamafluTM and RelenzaTM. As with any disease outbreak, the situation is developing and staying informed is an important part of prevention.
   
   
2. Each of Us Has A Part to Play in preventing the spread of Swine Flu and other infectious diseases. Practicing the following behaviors will stop the spread of germs that make you and others sick!

   • Cover your mouth and nose with a tissue when you cough or sneeze or cough or into your upper sleeve, not your hands. Dispose of used tissue in a wastebasket.
     
     
   • Wash hands with soap and water for 20 seconds or clean with an alcohol-based cleaner. Sing “Happy Birthday” twice while washing your hands!!!

   For more information, please see: http://www.cdc.gov/swineflu/swineflu_you.htm

View on Boston.com website here

Birth and joy midflight
Girl is delivered on plane to Logan
By Michael Levenson, Globe Staff | January 1, 2009

It seems fair to say that the passengers who boarded Northwest Airlines Flight 59 in Amsterdam yesterday did not expect that by the time they landed in Boston seven hours later they would have new faith in themselves, and almost certainly not in the state of humanity. But as they jubilantly disembarked at Logan, they clapped one another on the back, hugged, and talked of life-changing experiences and renewed beliefs in the goodness of people.

"The spirit of America is alive," beamed Dr. Natarajan Raman, a radiation oncologist from Minneapolis.

The reason was the unexpected, and rare, midflight birth of a 6 1/2-pound baby girl named Sasha.

"Everybody was there to help," said Raman, who helped deliver the child. "People offered baby food, people brought things, people vacated their seats. All I need to let you know is that despite the recession, we're still progressive in our thinking."

The baby and mother, a Ugandan woman, were whisked to Massachusetts General Hospital, where they were reported to be doing well. "It's wonderful," said Dr. Paresh Thakkar, the medical director of the Methuen Health & Rehabilitation Center who also helped with the delivery. "Happy New Year for everyone in the family! Good Christmas gift for everyone in the family!"

Before the delivery it had been a sleepy, packed international flight, full of exhausted passengers returning from Europe and India. Most of the 124 passengers on board were dozing after six hours in the air. Then, somewhere over Halifax, the crew made an unexpected announcement: there was a medical emergency. Were there any doctors on board?

Thakkar, who was half-asleep, still tired from celebrating a wedding in India, leapt from his seat. So did Raman, who was returning from his 25th medical school reunion in India. Running to the rear of the plane, they found a woman doubled over in row 33, moaning in pain. "She was in distress," Thakkar said. "She had lots of pain and cramps in her abdomen and so when I examined her she said, 'I'm 8 1/2 months pregnant.' "

The flight crew asked Thakkar to make a split-second decision. "They asked me, 'What do you want to do, doctor? Do you want to land the plane immediately somewhere?' " Thakkar said. "I said, 'No, let me examine her first. I examined her and the head was coming out. So I said, 'No, it's an emergency and we will do it here.' "

Thakkar, former emergency room physician at Lawrence Hospital, said he was not nervous. "In an emergency you just do what you have to do," he said. "It's what you learned for."

Thakkar and Raman laid the woman across several seats, while the flight crew ran for a medical kit. Phil Jones and Susan MacDonald, a Danvers couple who were seated one row in front of the woman, grabbed a blanket and held it up, making a curtain for the makeshift delivery room.

"We were the official blanket-holders," Jones said.

Flight attendants handed Thakkar and Raman rubber gloves, a clamp, and scissors, and they delivered the baby in about 30 minutes. She was healthy, with bright eyes and dark hair.

"She looked perfect," Thakkar said. "She opened her eyes and was very happy."

The doctors cleaned the girl and handed her to the mother, who was exhausted but overjoyed. "Thank you very much," she told the doctors, Thakkar recalled. "We love you."

When the flight crew announced that a baby had been born on board, the passengers erupted in applause. "Everybody was worried, and they announced that the baby was born, and everybody clapped and then the doctors came back and everybody clapped for the doctors," said Ashish Nanda, a passenger from Newton who was on his way back from visiting family in India. "We all felt great."

Stephanie Marques, a passenger from Harwichport, said it was the most exciting flight she had ever been on. "Everyone did a great job," she said. "It was really moving."

Customs officials deemed Sasha a Canadian citizen, because she was born over Canadian airspace. The flight landed about 45 minutes after the birth.

The mother's identity was not clear. Nor were her reasons for traveling to Boston at such a late stage of pregnancy. Passengers said she was traveling with a toddler. She told the doctors her name was Susan, but Northwest Airlines, MGH, and Massport declined to release her full name, citing privacy considerations.

Paul Thibeau, a Northwest spokesman, said no rules prohibit women from flying while pregnant. Flight crews can deny a passenger entry on a plane if they are concerned about her safety, but generally leave it to a woman and her doctor to decide when it is safe for her to fly, he said. Thibeau said he was not aware of anyone stopping the woman from boarding Flight 59.

Hours later, Raman was still at Logan, his flight home to Minneapolis delayed because of the snow. But he didn't mind. He passed the time clicking through photos of the baby on his digital camera.

"It's always a joy to see a newborn baby," Raman said. "And I was glad I was able to help."

Michael Levenson can be reached at mlevenson@globe.com.

LAWRENCE - Pentucket Medical is invited the public to celebrate the opening of its magnificent new RiverWalk offices on Saturday June 14th from 11 a.m. to 3 p.m. Festivities included tours, speeches, a cookout and ribbon cutting. The Pentucket Medical staff was on hand to conduct tours of the entire facility. Pentucket Medical – RiverWalk replaces the office suite formerly located at Turnpike Street in North Andover.

“We wanted this occasion to be a true family event,” says Executive Director John Sarro. “We gave tours, Sue Tucker was there along with other leaders to help us cut the ribbon, and we had hot dogs, hamburgers, and refreshments.”

State Senator Susan Tucker presided over the noontime ribbon cutting ceremony that included the region’s political, community and business leaders.

Located at RiverWalk, the former Lawrence mill complex just off Route 495 in Lawrence, the new facility has been drawing rave reviews from staffers and patients alike since opening its doors on May 24th. According to Sarro, “Every aspect of the new 30,000 square foot building has been planned for the comfort and security of patients, from the relaxing waiting areas and vibrant color scheme, down to the cabinet design in the exam rooms. We wanted to create a unique environment; a great place to receive care and a great place to provide it."

Pentucket Medical is thrilled to announce that we have relocated our North Andover offices to RiverWalk, the multi-million dollar office complex being developed by Sal Lupoli at 500 Merrimack Street in Lawrence. Our 35,000-square-foot, custom-built facility at RiverWalk is a showcase of patient-centered amenities, comfort and convenience (including a fast elevator), located just two minutes from Route 495 at Exit 44.

Please come to our Open House Saturday, June 14th from 11:00am to 3:00pm, which will feature tours of the new facility, refreshments, and a ribbon-cutting ceremony!

DIRECTIONS

From the South via Rt 495:
• Merge right onto ramp marked Exit 44-45. (Ramp merges onto the lower deck of bridge)
• Cross river bearing right into Exit 44
• Follow loop, following signs to Exit 44 (Merrimack Street.)
• Recross river to Exit 44. Bear right, down the ramp to Merrimack St.
• Turn right onto Merrimack St. and take an immediate right into the RiverWalk complex and follow signs to Pentucket Medical

From the North Via Rt 495:
• Exit Route 495 at Exit 44
• Cross river and bear right onto Exit 44
• Turn right at bottom of ramp
• Turn right into RiverWalk complex
• Follow signs to our building

From North Andover:
• Take Main Street north through downtown
• Turn left on Sutton Street and pass under Route 495.
• Turn right after highway into the RiverWalk complex and follow the signs to Pentucket Medical

Anyone who has ever had a biopsy performed can relate to the anxiety of waiting for results.  However, those who have had procedures at Merrimack Valley Endoscopy Center benefit from a rapid turnaround of results that some believe represents the future of excellent medical service. 

The approach is captured by a sign over the desk of Dr. Tom Fazio, which reads, simply “No More Sleepless Nights.” 

“I didn’t coin the phrase,” says Dr. Fazio, who said he heard it being used at Massachusetts General Hospital as a reference to an effort to “speed up the flow of information back to the patient”. 

“The classic pattern at the teaching hospitals,” he says, “has been for a biopsy to plod through a sequence of processes and people, so that information can often take weeks to emerge.  Meanwhile the poor patient is a nervous wreck, awaiting the results. Hence the reference to sleepless nights.”

At Merrimack Valley Endoscopy Center, there are no such delays.  In fact, according to Susan Curran, manager of the Center, “for most procedures, the primary care physician has the results before their patient leaves the building.” 

In cases in which a biopsy or other procedure is performed, she says, “the results are back to us, usually within 48 hours. “

“The wonderful thing about this place,” she adds, “is that if we find a mass in the colon or esophagus, the patient can have a CATscan the same day and leave with an appointment to see a surgeon.” 

More generally, Dr. Fazio sees lessening the uncertainty a patient experiences by shrinking the interval between test and delivering the result as a goal that can be shared by the entire Pentucket Medical organization. 

“Nearly all of us have known how tough it is to wait for a result,” he says.  “To the extent that we can get back more quickly with outcomes to our patients, we are serving them better and setting ourselves apart as a practice.  It’s just the right thing to do.”

HAVERHILL – The Cardiac Stress Laboratory at Pentucket Medical has been awarded a three-year term of accreditation by the American College of Radiology (ACR.) 

“We thought it was very important to have our vascular lab accredited by the ACR to demonstrate our commitment to quality diagnostic services,” said Dr. Seth Bilazarian, a member of Pentucket Medical’s cardiology group. “This formal review process confirms that our staff and equipment functions at the highest level. We are very proud of this accomplishment and confident that we can serve the Merrimack Valley community for many years to come.”

The Cardiac Stress Laboratory, located within the 4th floor Pentucket cardiology offices at One Park Way in Haverhill, conducts Exercise and Nuclear Stress Testing, Echocardiography, Holter Monitoring and Loop Recording, as well as CT Angiography. 

Accreditation by the ACR acknowledges achievement of high practice standards are a peer-review evaluation by board-certified physicians and medical physicists who are experts in the field.  Assessment includes evaluation of both personnel and the adequacy of facility equipment. 

Dr. Seth Bilazarian and Dr. Sunny Srivastiava are co-hosting a cardiology program on Haverhill Community TV (public access channel 22) called Matters of the Heart. Upcoming shows include a program about Peripheral Arterial Disease on Tuesday April 15th at 8:30 pm, and another on Atrial Fibrillation that will air Wednesday April 23rd at 8:00 pm. For more information please see HCTV's online program schedule at http://haverhillcommunitytv.org/program_sched.html.

Many of you have probably already heard results of a study that will be published in the next few weeks in the New England Journal of Medicine. This study raised concerns about the use of Avandia, one of many medications that is used to treat patients with diabetes. The information has been in newspaper articles, on medical web sites and in the TV news.

This study was a meta-analysis or review of many published studies in which Avandia was used to treat diabetic patients. In this analysis, Avandia was associated with an increased risk of heart attacks and an increased risk of death from cardiovascular disease. This information has clearly brought about legitimate concern on the part of patients and medical care providers.

Our response at Pentucket Medical was to have an urgent meeting of primary care providers, endocrinologists and cardiovascular specialists to formulate points of advice for our patients. We have also contacted world-renowned specialists in this area.

Listed below are the chief points of information we would like to relay to our patients.

1. The information or data is not particularly strong regarding problems with Avandia. The studies that we reviewed in the meta-analysis were never intended to sort out the questions of whether Avandia caused any cardiac problems.
2. There were a very small number of cardiovascular events in these clinical trials. This weakens the findings because the small numbers leave too much room for error.
3. There are ongoing clinical trials that will provide us with much more detailed and stronger information about this medication.

What should you do if you are taking Avandia?

1. Please do not make any changes in your medications without consulting with your physician.
2. Please make arrangements to meet with the provider that helps manage your diabetes to discuss which medications are best for you.