With their new space, the physical therapy department at Waldo County General Hospital is beginning a Lymphedema Treatment Program. And that is making many people happy.
 
Ann Hooper, Imaging Department Manager, said she has been sending breast cancer patients with lymphedema to Brunswick for treatment. Recently, she had an 80-year-old patient who couldn’t travel that far but whose arm was so swollen it was purple. “I’m delighted we’re going to have treatment here,” she said, adding “that will help a lot of people.”
 
For Dianna Wing, who has lymphedema, being able to get treatments at Waldo County means she won’t have to take a four-hour round trip in order to have a 15- to 30-minute appointment. “I am so excited they are going to do it,” she said recently. “I’m really happy that I will get to stay in the community for treatment.”
 
Lymphedema refers to swelling that usually occurs in a leg or arm. It is caused by a blockage in an individual’s lymphatic system, which prevents a person’s lymph fluid from draining well. The fluid builds up, causing swelling. Lymphedema is most commonly caused by the removal of or damage to a person’s lymph nodes as a part of cancer treatment.
 
A small percentage of individuals are born with a rare, inherited condition, which causes problems with the development of the lymphatic system. The condition begins in infancy but often doesn’t show up for years.

 
Dianna was born with that condition but it didn’t show up until she was 13. It started in her left leg and later went into her right leg as well. “I haven’t seen my left ankle since I was 13,” said Dianna. Her parents took her to doctor after doctor to see what was wrong and time after time, she was told they didn’t really know what was wrong and she would have to “learn to live with it.”
 
That was difficult for a teenager and she was the subject of some teasing and ridicule. She rarely wears a dress because from the back, her leg goes straight up with no ankle present.
 
The condition is worse when the weather is hot and her skin would crack, which led to a cellulitis infection. She was given diuretics, which didn’t help. Her leg would get painful because it was so heavy; it was hard to get her shoes on because her feet would swell. In the late ‘80s, she was sent to a lymphedema program in Bangor, and her leg was wrapped with an ace bandage for two weeks but that didn’t help, either.
 
Then a few years ago, her then-husband saw a show on television about lymphedema and said, “I think that’s what you have.” Dianna immediately made an appointment with her doctor, who sent her to a vascular doctor, who in turn sent her to the lymphedema treatment program at a Portland hospital.
 
For Dianna, it was almost a miracle, even though she was told that by going 30 years without treatment a lot of the damage had already been done. Still, she was thrilled to hear the experts say they could help her manage her condition, rather then “You just have to toughen up and live with it.”
 
For the first two weeks, Dianna had to go to Portland every afternoon for treatment. At the end of each day, the therapists would wrap her leg and the next day, they would unwrap it and measure to see if the amount of fluid was being reduced.
 
After that two-week stint, Dianna was given compression stockings to wear during the day and compression garments to sleep in. During her last visit to Portland (she now goes every six months), she was excited when she was given smaller socks to wear.
 
While Dianna is thrilled that she will be able to get her treatments close to home, she is even more excited that people may become aware of lymphedema and know what they have. “It affects your daily life,” said Dianna. “It’s frustrating not to know what you have. I couldn’t be happier that people will have a resource so they can get treatment early to minimize the affects and will learn how to manage it.”
 
While Dianna was born with primary lymphedema, the more common type of lymphedema is secondary lymphedema. It most often develops from cancer treatments, including when lymph nodes are removed during breast cancer surgery or from radiation therapy to a lymph node region. The swelling can occur within days, months or years after surgery.
 
The most common symptoms of lymphedema are swelling, a heavy sensation in the arms or legs, skin tightness, decreased flexibility in the hand, wrist or ankle, difficulty fitting into clothing in a specific area, or a tight-fitting bracelet, watch or ring that wasn’t tight before.
 
There is no cure for lymphedema. The treatment focuses on reducing the swelling and controlling the pain.

Donna Hills, PT

 
Donna Hills, a physical therapist at the hospital, will oversee the Lymphedema Treatment Program at Waldo County General Hospital. She recently completed training and became certified at the Norton School in Chicago.
 
She learned how to use a special light massage technique to manually encourage the flow of the lymph fluid out of the affected area by stretching the tissue. Similarly, she will teach patients light exercises that they can use to encourage the movement of the fluid. In other cases, she will wrap the affected limb, also to encourage the fluid to flow back out of the limb and toward the trunk of the body to find an alternative route through the lymph vessels.
 
For new patients, she will work for five days in a row to drain the fluid and then bandage the area. After that, the patients will learn to do their own bandaging and to use a compression garment, which compresses the affected limb, again to reduce the swelling at first and later to prevent the limb from swelling in the future.
 
And as Dianna knows, it is good to catch the problem early.
 
Donna became interested in running the Lymphedema Treatment Program because of a young family member who two years ago had swelling in her leg, which turned out to be lymphedema. Fortunately, it was a fairly mild case and the family member is able to keep it under control through the use of compression garments and exercises.
 
Donna wants to be able to do the same for her patients.
 
If you have questions about lymphedema treatment or wish to make an appointment, with a referral from your physician, please contact the Rehab. Services Dept. at WCGH at 338-9316.

Last spring when the speech pathology department at Waldo County General Hospital (WCGH) received Training Program Accreditation from the American Telemedicine Association, the director, Michael Towey, called telepractice “a game changer.” Telepractice is the delivery of speech therapy to adults and children via computers.
 
He was right.
 
Consider:
 
• During the month of October, some 22 speech pathologists from 15 states attended telepractice training programs sponsored by the speech department at the hospital. There were another 60 at speech therapy technology training, also held at Waldo County.
 
• The department recently completed teaching the first graduate level training course in speech telepractice in the country at the University of Maine.
 
• The department has been training clinical staff at Ohio State University and partnering with them to get telepractice going at the largest university in the United States.
 
• Speech pathologist Nathan Curtis recently had an article published on technology in speech therapy in the ASHA Leader online edition, a national publication that goes to all members of the American Speech Language Hearing Association.
 
While the WCGH speech pathology department was the fourth institution in the United States to receive the Training Program Accreditation, there is a big difference between the other three institutions and WCGH’s speech pathology department. WCGH is the only one that allows the therapists to work from their offices with patients in their homes on their own computers with a $29 webcam. The other three involve a patient going to a nearby clinic to work with a provider in a far-away large medical center.
 
“Other telemedicine services are not usually web-based, they use expensive specialized equipment only available in hospitals or clinics. That’s why an internet based approach using available computers in peoples’ homes is a game changer,” Towey said.
 
He speculated at the time that other speech therapists would be interested in obtaining the accredited training program (a 300-page digitalized curriculum) used by his department. And he also felt that the accreditation would lead to a number of new opportunities for his staff.
 
He was right.

Speech pathologist Nathan Curtis helps a participant in the two-day accredited training program for Speech Telepractice held at Waldo County General Hospital in October.

 
Dr. Wayne Secord, who is internationally known and author of multiple tests and books on speech therapy, is a Senior Research Scientist in Speech-Language Pathology at Ohio State University. He said recently, “The training we received (at WCGH) has started us in a new direction. We’re going to remake our treatment rooms to be digitally capable, and alter how we do things here. The workshop in Belfast was practical as well as empowering. We’re definitely going to partner with WCGH and apply for some unique research and training grants together.”
 
Then he added, “I think WCGH is truly on the cutting edge. But they do it so well that it comes very naturally to them now. We’re just in the beginning stages by comparison. Their cutting edge thinking and creative ways of assessing and delivering services has helped our program greatly. We’re just in start-up really, but they have given us a new mentality which we will most assuredly build upon in the future.”
 
As for whether telepractice is the wave of the future, Dr. Secord said, “It is a digital world today. That’s good and bad, but there is simply an incredible digital wave of change and transformation, so we really have no choice if we’re going to lead change, but to get on that wave and ride it for all it can do and explore all of its possibilities. There are some who will try to cheapen services and deliver an inferior product given how this service only takes you, the other person, and a digital connector. But the WCGH staff are really out in front of it all.”
 
“It is amazing how their leadership is working to transform how we do things here at this great university. We are highly regarded in this field, and WCGH is actually having a huge impact on how we think and act,” he concluded.
 
Judy P. Walker, Ph.D., CCC-SLP, of the Department of Communication and Disorders at the University of Maine in Orono, said, “The WCGH speech therapy staff taught the first telepractice training course this summer in my department. The students and faculty were very pleased with this course, learning the tools to embark upon telepractice. The information has been instrumental in developing a graduate student telepractice training program which we are in the process of launching.”
 
“Professionals in my field consider Waldo County General Hospital to be leaders in speech telepractice. Thanks to Mike (Towey), Nathan (Curtis), Jenn (Whitcomb) and Amy (Reid) for sharing all their knowledge and being so supportive of our program at the University of Maine,” Dr. Walker concluded.
 
Her thanks were echoed by Dr. Secord who said, “We are in the transforming stage, but I think we’re on the edge of greatness, and much of it is due to the gang at WCGH.”
 
Nathan Curtis’s article, “APP-titude: App-Enabled Telepractice,” was published in the Oct. 9, 2012 online edition of the ASHA Leader, available on the web at http://www.asha.org/qr/100912d. In the article, he discussed how five years ago, WCGH began using a telepractice-based speech and language program with preschoolers and school-age students in underserved areas of the state. He talks about some of the interactive websites he uses, which allow the young students to interact with games, similar to the hands-on material they get during conventional therapy.

Nearly 150 council members attended the annual Community Advisory Council meeting on Nov. 19.

Waldo County General Hospital held its annual Community Advisory Council meeting on Monday, Nov. 19, at the University of Maine Hutchinson Center.

The nearly 150 council members in attendance heard Dr. Vance Brown, the Chief Medical Officer at MaineHealth since 2008, talk about Accountable Care and what it means for the future. 

Dr. Vance Brown, the Chief Medical Officer at MaineHealth, talked about Accountable Care and what it means for the future.

After talking about his uncles, Phil and Brad Brown, who were veterinarians in the area and known as “characters,” Brown said it’s time to get serious about increasing the value of health care that is provided. He said per capita healthcare spending in the United States is far greater than in any other industrialized country and yet we compare poorly on many indicators of health, especially adult obesity.Brown said studies of Medicare costs across the country have shown “an unbelievable amount of variance in how care is provided.” For example, the annual cost of care for a Medicare patient in Portland is around $6,000 while it is $12,500 in Dallas.

Brown broke healthcare system down into three levels:

   •   effective care: services which are of proven value, such as the use of  beta-blockers for a heart attack patient;

    •  supply sensitive care: services which seem to be based on capacity, such as an increased use of specialists when they are readily available; and

   •  preference sensitive care: services such as knee replacements, lumbar back surgery and hysterectomy for benign uterine conditions, which vary greatly from hospital to hospital, and have alternative treatments available.

Brown said there is “a huge need for change” and the healthcare system needs “to deliver value versus doing a service and getting paid for it.”

MaineHealth and Waldo County General Hospital are part of a program to see how Accountable Care Organizations (ACO) can be successful. Brown said the success of an ACO depends on four fundamental changes in how care is delivered. They are:

   •  comprehensive primary care: investing in primary care to build one-stop comprehensive services through the primary care doctors;

   •  more support for patients: having nurses and other trained professionals spend more time with patients to help them understand their healthcare needs and to access services;

   •  better information technology:  providing a “Shared Health Record,” so patients who have more than one doctor can have those doctors see   their full history and communicate with each other; and

   •  new quality improvement programs: having physicians and nurses work together to achieve specific quality goals, which will measure their success.

Brown used as an example a story from The Atlantic of how accountable care could work in the future. An 82-year-old widow who lives in Anaheim, Calif., got on her scale one morning, as she does every morning, and she had gained three pounds. A half  hour later, as she’s eating her breakfast, her doctor’s office calls, her scale is wired to a monitor in the office, and they noted her three-pound weight gain. The woman has congestive heart failure, and a weight gain like this could indicate a buildup of fluid in her lungs.

She saw her doctor that day. He adjusted her medications and she was monitored closely for a few days. This avoided potentially serious health complications and a stay in the hospital, and the care the doctor provided cost far less than what could have been.

Brown concluded by saying, while we’re not paid to provide care like this today, over time accountable care will change that. Accountable care has the potential to address the needs of people like that woman much more effectively than our current way of delivering healthcare. 

Executive Director Mark Biscone surprised Dr. Ralph and Mary Snyder with flowers to recognize their 50 years of service on the Community Advisory Council (formerly known as the Board of Incorporators).

Also at the annual meeting,

Peter Haddock, third from right, was given a cake by the Board of Directors for having served on that body for 30 years

    •  Lee Woodward, president of the Board of Directors of the hospital, said this has been a championship year with the hospital being honored as one of the 100 Greatest Community Hospitals in the country, He said Mark Biscone, executive director of the hospital, is clearly the most valuable player, but there are also tremendous position players, who make the team even better; and

After eight years on the Board of Directors and serving as its treasurer, Frank Morong is stepping down and was recognized for his service.

   •  35 individuals were elected to the Community Advisory Council. They are Brian Beaulieu, David and Judy Beebe, Philip Carthage, Syrena Gatewood, Carol Good, Kevin Johnson, Traci Kirkpatrick, Carol Knight, Amy Marnecheck, Ryan Otis, Sharon Romanow, Eric Sanders, J.B. Turner, and Christine and Dennis Urick, all of Belfast; Dora and Roscoe Pinkham of Belmont; David Felton of Brooks; Skip Bates, Rebecca Greene, and Douglas Hise of Camden; Iris Hooper of Frankfort; Kathleen and William Maseychik of Jackson; Andrew O’Brien and Virginia Yarnell of Lincolnville; Thomas Flacke, Norman Schultz, and Rebecca and William Vachon of Morrill; Sarah Tomalty of Northport; Eric Belley of Rockport; Elizabeth Bowen of Swanville; and Charles Pray of Waldo.

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Husson University Nursing Professor Jeanne-Ann Ouellette, left, presents Erin Bellaire, with the Clinical Education Award from Husson University. Looking on at right is Teri Young-Hise, Director of Nursing at Waldo County General Hospital, who along with Bellaire is a Husson University graduate.

Erin Bellaire, RN, recently received the Clinical Education Award from Husson University. The award recognizes someone who has gone above and beyond to assist students in their clinical learning.

On Nov. 26, Ruth Charne, who has diabetes herself and understands the challenges diabetics face, presented a free program entitled, “Take Control and Live Well with Diabetes.” She discussed some of the ways to control blood sugar, which may help reduce the risk of diabetes-related complications.

Oct. 27 in celebration of National Breast Cancer Awareness month, 22 women who could not afford a screening mammogram received on free at the hospital. Then in November to celebrate Diabetes Awareness Month, Waldo County General Hospital provided 50 free cholesterol and glucose screenings.

Inez Tower of Swanville, right, is the winner of this large gift basket of  beauty products that the imaging department at Waldo County General Hospital raffled off for Breast Cancer Awareness Month. The products in the basket were donated by The Upper Cut in Belfast. At left is Ann Hooper, the manager of the imaging department.