Combating A Crisis: Methodist Launches Narcotic-Free Surgery

Concern over the opioid epidemic prompted an IU Health Methodist team to do what it could to incite change. It is the first in the U.S. to publish a study showing the positive effects of cutting narcotics out of ureteroscopy.

In a groundbreaking move, surgeons at IU Health Methodist Hospital decided to stop prescribing oxycodone and hydrocodone for kidney stone procedures and, instead, gave patients an anti-inflammatory drug.

The mission: see how patients responded to narcotic-free surgery in hopes of combating the opioid crisis by inciting a move to fewer prescribed painkillers.

“It was a big leap to do this,” says Amy Krambeck, M.D., a urologist at Methodist who helped lead the study. “It was kind of going out on a limb.”

From February to May, 51 patients who underwent a ureteroscopy — the most common procedure to treat kidney stones in which a small scope is inserted into the bladder and ureter — were given the anti-inflammatory drug diclofenac, rather than narcotics.

The biggest concern, says Dr. Krambeck, was that the lack of painkillers would generate more phone calls for nurses and staff, more return trips to the emergency room and that the patients’ pain wouldn’t be controlled. Ureteroscopies can cause intense cramping and discomfort post surgery. 

But when patients in the study were compared to those treated during prior ureteroscopies when narcotics were used, there were fewer phone calls to staff and return trips to the ER actually decreased, she says.

Even more hopeful, patients who had undergone previous kidney stone procedures told Dr. Krambeck they preferred the non-narcotic version.  

“Anecdotally, they have said this was the best stone surgery they’ve had,” says Dr. Krambeck. “They felt like the narcotics just masked the pain. With this, we are treating the inflammation.”

During the study, nearly 1,400 fewer hydrocodone tablets were prescribed, says Tim Large, M.D., a urologist and endourology fellow at Methodist.

The results from the first-of-its-kind study in the United States were recently published in the “Journal of Endourology.”

The conclusion read: “Narcotic-free ureteroscopy is achievable, based on this study, with pre-operative counseling, a zero tolerance for providing narcotics, and support from ancillary and supporting staff. By managing patient expectations, along with their pain, and being honest about the unnecessary use of opioids in endoscopic surgery, there appears to be minimal need for narcotic prescriptions after uncomplicated ureteroscopy.”

“We are the first to put it out there,” says Dr. Large. “The first in the clinical ship.”

Dr. Krambeck performs as many as 300 ureteroscopies each year. She says doing them without narcotics is now her standard.

She hopes to begin cutting narcotics out of percutaneous stone removal procedures, as well.

“We are trying to get completely away from narcotics as much as possible,” she says. “I hope this will be adopted for other procedures. Narcotics have been overprescribed in the United States for a long time.”

— By Dana Benbow, Senior Journalist at IU Health.
   Reach Benbow via email dbenbow@iuhealth.org or on Twitter @danabenbow.

IU Health Medical Center Ranked Among Nation’s Top Hospitals For 21st Consecutive Year

U.S. News rates eight clinical programs, including cancer and cardiology, in top 50 in the nation

U.S. News & World Report has released its 2018-2019 ‘Best Hospitals’ rankings that name Indiana University Health Medical Center among the nation’s top hospitals for the 21st consecutive year. According to the U.S. News rankings, IU Health Medical Center is the No. 1 ranked hospital in Indiana and Indianapolis and the only nationally ranked adult hospital in the state.

“IU Health Medical Center is honored to be recognized as the top destination in Indiana, demonstrating our team’s strong commitment to delivering the best care to every patient we see,” said Jonathan Gottlieb, MD, executive vice president and chief medical executive of IU Health. “Patients, families and other healthcare professionals have many choices when seeking care. Respected rankings like these provide an important guide with the potential to inform these important decisions.”

To create the rankings U.S. News evaluated more than 4,500 medical centers nationwide in 25 specialties, procedures and conditions. Fewer than 4 percent of hospitals received national rankings in one or more clinical specialty programs. IU Health Medical Center stands among an elite group of only 35 hospitals to earn national rankings in eight or more clinical specialties.

For 2018-19, IU Health Medical Center achieved national rankings in the following eight clinical specialty areas for adults (ranking out of top 50 hospitals):

  • Cancer—46th
  • Cardiology & Heart Surgery—46th
  • Diabetes & Endocrinology ­—30th  
  • Gastroenterology—22nd
  • Geriatrics—28th
  • Nephrology—23rd  
  • Neurology & Neurosurgery—27th
  • Pulmonology—39th

Additionally, IU Health Medical Center is rated high performing in four of nine adult procedures or conditions included in the U.S. News & World Report Best Hospitals ratings. Those include COPD, colon cancer surgery, heart failure and knee replacement.

The annual rankings, now in their 29th year, are designed to assist patients and their doctors in making informed decisions about where to receive care for challenging health conditions or for common elective procedures.

The full list of U.S. News Best Hospitals rankings is available at health.usnews.com/best-hospitals. This year’s rankings, produced by U.S. News with North Carolina-based research organization RTI International will also be published in the U.S. News “Best Hospitals 2019” guidebook. 

Methodist Masters: They’re Training Doctors Of The World

The International Scholars Training Program launched at Methodist Hospital to educate physicians on heart failure, but quickly expanded to other areas of expertise. “If you build it,” says Dr. I-Wen Wang, “they will come.”  

It started as a niche, a very specific niche – teaching physicians and surgeons from China the advanced management of heart failure patients using left ventricular assist devices (LVADs).

IU Health Methodist Hospital welcomed that first group of scholars in January of 2014 — cardiologists, cardiac surgeons and an ICU nurse manager.

“China is in a unique position in that they have a large, growing heart failure population like the U.S.,” says I-Wen Wang, M.D., a Methodist cardiovascular surgeon specializing in thoracic and transplant surgery. “But they do not have LVAD.”

China is a country with 1.4 billion people, roughly four times the population of the U.S. – yet they perform just 350 heart transplants a year, less than a third of heart transplants in the U.S., says Dr. Wang.

“Our goal, initially, was to provide a way for us to help educate them on the management of LVAD with a goal of preparing major hospitals to become clinical trial sites,” says Dr. Wang. 

But that goal soon expanded.

Since that first group came to Methodist in 2014, the IU Health International Scholars Program has trained 58 scholars, as of the end of 2017.

It is on target to train 20 more this year.

The program’s reach has grown to other countries – and other specialties. Scholars are being trained in orthopedics, interventional radiology, gastrointestinal, pediatric oncology, neurology, emergency medicine, ICU, nursing and more. 

They are flying with LifeLine for organ procurement. They are shadowing physicians at other IU Health locations — Riley Hospital for Children, IU Health Saxony Hospital and others.  

“It has really diversified from just this very narrow niche we started,” says Dr. Wang.

And it’s grown organically. Word of mouth. Reputation. IU Health has a great program.

“It’s the field of dreams,” says Dr. Wang. “If you build it, they will come.”

While being trained, the scholars spend anywhere from one month up to a year for training, says Amy Hoene, director of cardiovascular services at Methodist, who oversees the program she helped launch with Dr. Wang.  

They come to observe in all areas, operating room, clinic, rounding, ICU, animal labs and more. 

The people being trained at IU Health go back and quickly rise inside their hospitals, getting promoted and being recognized for their knowledge, expertise and great work.

“It certainly establishes our brand,” says Dr. Wang. “They go back and that translates to, ‘Maybe we should send other people.’ We’ve been able to create the IU Health brand there that wasn’t there before.” 

***

Inside Methodist, a group of scholars sit talking with Hoene and Dr. Wang about this program that brought them to the United States.

Amy Liu is a cardiac anesthesiologist who has been doing research at the Krannert Institute of Cardiology.

Yang Yang is a cardiac surgeon training at Methodist and doing research. He is also married to Liu; the two came as a team.

“I’ve learned best concepts from my mentors,” Dr. Yang says. “I’ve done several pig experiments. I’m very interested in that. I can’t do that in our hospitals. It is so exciting.”

Yan just graduated from medical school and is applying to be a resident in cardiac surgery in the U.S. He is here to visit for two months doing observation. 

“I am reaching out for opportunity to observe more, get clinic experience,” he says. “To see how you guys practice here, how you treat patients, how you communicate with the patients.”

Wi Yang came to train at Methodist in interventional neuroradiology. “I’ve learned a lot,” he says.

But more is gained beyond the medical expertise, says Hoene.

“These relationships develop between the scholars and those at IU Health,” she says. “These unplanned friendships develop that end up lasting.”

— By Dana Benbow, Senior Journalist at IU Health.

   Reach Benbow via email dbenbow@iuhealth.org or on Twitter @danabenbow

One-Year Post Transplant And He Feels 10 Years Younger

Family friends Jeff Stephen and Jenny DeBoo share something more than friendship. Last year, DeBoo donated her kidney to Stephen.

A year ago, Jason DeBoo and his two teenage daughters paced the halls of IU Health University Hospital – awaiting word that all was well. Their wife and mother, Jenny DeBoo was in surgery with Dr. John Powelson, donating a kidney to her friend Jeff Stephen.

Jason and his daughters – Kaylee, and Kenzy, wore bright green t-shirts supporting Jenny’s decision. The girls’ shirts read: “I knew mom when she had two kidneys. I knew Jeff when he had junk kidneys.” Jason’s shirt read: “I have her heart but Jeff has her kidney.”

Jenny DeBoo met Stephen three years ago when her daughter and Jeff’s niece played softball together. It was at the softball field where Jenny learned of Jeff’s diagnosis – polycystic kidney disease (PKD). The inherited disease causes clusters of cysts to form in the kidneys. Stephen was diagnosed in 1997. The disease progressed and in November of 2015 he began hemodialysis.

“I was so interested in the fact that living donation was a thing and I was excited to learn more about it,” said DeBoo. “I was like many, many others and just wasn’t educated on it.” Over time, the DeBoo family spent more time with Jeff, his wife, J’la and their son Jett.

“We became closer and they became members of our ‘camping crew.’ Through camping and every day life they became part of our family,” said Stephen. And as his disease progressed, Stephen began having heart issues. He needed a new kidney. Different family and community members were tested but there was no match. There are than 100,000 people in the United States are awaiting a kidney transplant. There are more people awaiting a kidney than there are donors.

“I decided I wanted to try, not knowing my blood type or anything, except that I felt completely healthy,” said DeBoo, from New Paris, Ohio. “I discussed it with my husband and two daughters and put serious thought, prayer, and discussion into it. My family was 100% supportive and I was hooked and determined to donate to our sweet friend, Jeff,” said DeBoo who worked with IU Health transplant coordinator Kelly Coffey.

“The first time I spoke to Kelly she was so patient, kind, positive and made sure I knew she was 100% on my side and an advocate for my well-being and health,” said DeBoo. The life expectancy of a patient receiving a kidney transplant more than doubles. A living kidney donor helps reduce the time a patient is on the transplant wait list; a living kidney is typically healthier than one transplanted from a deceased donor.

“Patients receiving a kidney from a living donor have a better one-year kidney survival than those receiving a kidney from a deceased donor,” said Dr. Powelson.  Any healthy adult 18 or older who is mentally and socially capable can be a living kidney donor. They may give directly to someone they know or through non-directed donation. DeBoo was a perfect match for Stephen.

As DeBoo’s family waited for her surgery, Stephen’s family waited for updates on his transplant. On June 14, 2017, Stephen received one of DeBoo’s kidneys in a surgery performed by Dr. William Goggins.

“The whole transplant staff was amazing. The doctors were just incredible and caring,” said Stephen. “I’m pretty sure the transplant nurses are angels straight from heaven. We could never thank them enough.”

A year after the transplant as DeBoo and Stephen posed for pictures with transplant coordinator Coffey, they wore their own green t-shirts. DeBoo’s read: “Jason has my heart but Jeff has my kidney.” Stephen’s read: “Jason may have her heart by I have her kidney.”

Stephen had another message too: “I feel 10 years younger. I couldn’t be more grateful to my friend.”

And DeBoo’s message: “Before this experience, I wasn’t even a donor on my license. Living donation has changed my life in so many positive ways. I always tell my friends, family and even strangers that ask how I’m doing, that if I had 10 kidneys I’d give them all away and I don’t have a single regret from making this life-changing choice. Seeing Jeff so happy, healthy, being able to just chug a bottle of water, or even coach his 5-year-old son’s t-ball team makes my heart so happy.”

— By T.J. Banes, Associate Senior Journalist at IU Health.
   Reach Banes via email at
 T.J. Banes or on Twitter @tjbanes.

Healthcare In The Comfort Of Home Sweet Home

Not all patients receive infusion treatments in the hospital. Some choose to administer the treatments from the comfort of their home.

She wanted to see her grandbaby born and she didn’t want to be in a hospital or hospice. She wanted to be home and available to take part in welcoming her grandchild into the world. This grandmother chose home infusion.

A young mom wanted to care for her baby who needed infusions to help with digestive complications. She chose to give the infant treatments at home.

“There really isn’t a specific age of our patients. They range from infants to the elderly,” said Benjamin Meyer, IU Health pharmacy coordinator for Home Health Care. Every day, compounds are mixed, inspected, packed and shipped to patient’s homes throughout Indiana. A visiting nurse assists with the general instruction on starting the infusions and follows up as needed. A call center is readily available to answer patient questions; Meyer is part of that team.

Questions may range from, “I’m thinking of taking another medication. Can I still take my infusion?” to “I’m feeling extra tired after infusion. Is that normal?”

“Pharmacists have been one of the most trusted professions. Part of that means me trusting my patients to take care of themselves at home – that they can safely infuse their medications,” said Meyer, a graduate of Butler University’s College of Pharmacy. He has been with IU Health for 14 years. “This provides a personalized plan of care for patients. We treat them as individuals; not numbers.”

Patients who opt to administer infusions at home are treated at IU Health for a variety of conditions including malnutrition, pain management, immune deficiencies, cystic fibrosis, Crohn’s disease, rheumatoid arthritis, and complicated infections.

“Their primary goal is to get better and some conditions tend to heal better at home,” said Meyer.

One patient diagnosed with an immune deficiency started infusion treatments at IU Health Simon Cancer Center. Days of work were missed to spend time at the hospital. Some days meant negotiating inclement winter weather – driving, parking, and walking – when the patient didn’t have the energy to leave home.

After eight months, the patient’s hematologist/oncologist ordered home care.

Writing about the home infusions, the patient said: “What a wonderful way to get care. It’s convenient, and there is some flexibility on what day I do it. Believe me, it’s so much better to be at home.  It’s faster and I don’t have to worry about being exposed to other patients. It’s also easier mentally.”

The evening of the patient’s treatments are spent on a couch, curled up with a favorite blanket and often falling asleep watching a movie with a spouse nearby.

“We have some patients call frequently for assistance and others who just take off and it becomes a way of life,” said Meyer, adding the transfusions are generally administered intravenously through the chest or arm. “These are patients who are vested in their own health care and want to be in the comfort of their own home, with their family and the lifestyle they are accustomed to. It makes it more convenient, especially if you are dealing with long-term treatment or care.”

— By T.J. Banes, Associate Senior Journalist at IU Health.
   Reach Banes via email at
T.J. Banes or on Twitter @tjbanes.

‘Sister Cucumber’ Is A Transplant Staple

When her co-workers describe Morgan Martin, they say she’s a “transplant staple.” She’s been with IU Health for seven years – always working in transplant.

She spent six years in transplant ICU at IU Health University Hospital – much of that time as a charge nurse – before becoming a nurse practitioner last year.

“From a very early age I’ve always had a keen curiosity in science and how the body works. I can remember asking for microscopes, anatomy/physiology books, figurines, and a real stethoscope for birthdays and Christmases,” said Martin.  “My Grandma JoAnn always wanted to be a nurse but was the youngest of 11 children and was never able to follow her dream.”

In some ways, Martin feels like she’s fulfilling her grandma’s dream. She loves her role of combining a passion for science and working with people.

Martin grew up in Silver Lake, in northern Kosciusko County in what she describes as a family with lots of ties to caregiving. Her father, Morris Jones is a volunteer firefighter, one cousin is a nurse, and another is a nurse practitioner. Her mother is Cindy Jones. Martin has been married for five years to Dan and they have a two-year-old daughter Taytum. 

“She’s the love of my life,” said Martin about her daughter.  She also enjoys family camping trips and attending baseball games especially the Chicago Cubs.

Martin’s known for sharing her fresh garden produce with co-workers – one who calls her “Sister Cucumber.” More than anything, her coworkers know Martin for her devotion to patient care.

“The number one question I get asked is ‘why did I choose to continue my career in transplant after I became a nurse practitioner,’” said Martin.  “Transplant is amazing medicine. It truly changes people’s lives. These surgeries aren’t for the faint of heart, but it’s so astonishing to watch people transform into much healthier versions of themselves.  I really enjoy the mix between medical and surgical nursing/medicine with complexities that match no other.  It’s grueling and intense and feels like home to me.”

One of her favorite stories is about a patient who was gravely ill. His family wanted him to make it to his daughter’s June wedding.

“We did it and it was so rewarding,” said Martin. “He got to go to his daughter’s wedding. It took a lot of care and rehab but I realized then, that’s why I love working in transplant.”

More about Martin:

  • What makes her a good caregiver: “Everyday I left the house for school growing up my mom always used to say, ‘have a good day and be kind to everyone.’  I’ve really taken those instructions to heart.  I think the ability to relate to others, help them have a better day, be present in the moment, and treating others as you would want to be treated helps me to be a good nurse practitioner.”
  • About her mentors: “I’ve had some pretty great mentors throughout my nursing and nurse practitioner career at IU Health.  Someone from every department has influenced my practice in one way or another.  From our surgeons, to x-ray techs, PT/OT, housekeeping, to nurses new and experienced, I strive to care for others like my colleagues and team members do.”
  • Something that would surprise people to learn about her: “As a huge Disney fan, I’ve been known to burst out into some pretty great Disney tunes during patient care.  Now that I’m able to round on the transplant kids over at Riley, I feel that my singing is a little bit more appreciated and accepted with them versus the adults.  It’s pretty popular with my 2-year-old at bath time as well.

— By T.J. Banes, Associate Senior Journalist at IU Health.
   Reach Banes via email at
 T.J. Banes or on Twitter @tjbanes.

38-Year-Old Lung Transplant Recipient: ‘Each Breath Is A Gift’

It all started with a tickle in his throat, a nagging cough and then a downhill spiral that left him weighing 102 pounds. Without a double lung transplant, he wouldn’t make it. Five months later, Nicholas Brown is back in the weight room with a new set of lungs, using each breath to its fullest.

The tickle in his throat was irritating. It crept up every now and then and caused Nicholas Brown to cough.

Then that little annoyance started coming around more often. A tickle that was more intense, like a scratch. A cough that lasted for days.

Brown was a healthy, 37-year-old guy. He lifted weights and ran. He was active.

That irksome cough? Whatever. It would pass.

It always did.

***

The night was a cold one, the kind of deep cold where the air seems too frigid to even breathe.

It caused Brown to launch into a coughing fit that wouldn’t end. Uncontrollable coughing. He was out with friends when one of them, a woman named Liz, got stern with Brown.

She insisted he go see a doctor about the cough. She pushed hard.

“Even though I was trying to be stubborn and say, ‘Ah, it’s nothing. It will go away,’ everyone else is noticing,” says Brown. “They are noticing, this is just not right.”

Days later, Brown made an appointment to see a doctor. He would get some medicine, Brown thought.

And that cough would be history.

***

One doctor blamed the cough on acid reflux. When the medicine for that didn’t work, Brown was sent to an allergist.

But he wasn’t allergic to anything — except black mold and cockroaches. Brown was sent for a CT scan.

“The doctor comes out and it was the look the vet gives you when it’s time to put the dog down,” Brown says.

She told him he had idiopathic pulmonary fibrosis.

“I jokingly said, ‘Oh, can you write me a prescription to get me out of work?’” Brown says. “She said, ‘Yes, I can.’”

That’s when it hit him. This must be serious. But he’d never even heard of idiopathic pulmonary fibrosis.

Come to find out, that cough was caused by scarring of his lungs. IPF is a disease with no known cause. Over time, the scarring gets worse, making it hard to take a deep breath. The lungs cannot take in enough oxygen.

And it causes a cough. That awful cough.

***

Once at IU Health, doctors started preparing Brown for the possibility of a lung transplant. A very likely possibility. 

“I just wanted to hang on to the lungs I had,” Brown says.  

He was finally at a job he loved. After two college degrees, one in telecommunications and the other in business, Brown had just become a journeyman tool and die maker. He was doing high precision grinding in the aerospace field.

But doctors told him, that job was no longer allowed. And even though Brown didn’t want to give up his own lungs, he would soon find out he didn’t have a choice.

And there likely wasn’t much time.

“It’s hard to put into words because you start looking at survival rates,” says Brown, “how long they say the average person lives after transplant.”

By April of this year, Brown was inside IU Health Methodist Hospital weighing 102 pounds (instead of his usual 170), struggling to survive.  

“They told me they had to list me (for transplant) or send me home for hospice,” Brown says. “I was almost gone.”

On March 5, lungs became available that were a match for Brown. He went to sleep the next morning for his transplant surgery and woke up two days later.

“For me it was instant,” he says. “I woke up and I knew I was breathing.”

It was a remarkable feeling that most take for granted. 

“I can’t even describe it,” he says. “Have someone hold your head under water for five minutes and then let you breathe.”

***

It’s impossible, Brown says, to thank the people and the place that saved your life.

His surgeon and the nurses. The pulmonary rehab staff and the Center of Life for Thoracic Transplant. The physical therapists and David Roe, M.D., medical director of pulmonary critical care and lung transplant at IU Health. 

IU Health boasted the 12th largest lung transplant program in the country by volume in 2017, performing 65 transplants. That’s up from 50 just five years ago. 

What a wonderful place to be cared for, Brown says. And recently, while at the gym working out, he looked in the mirror.

“Good grief, I look so much different than I did a couple months ago.  I was a walking skeleton,” he says. “I look human again.” 

Brown snapped a selfie at the gym and posted it with a thank you to the IU Health transplant team.

“Just thinking about all that they did for me,” he says. “I’m where I am today and it’s all because of them.”

Brown comes to Methodist twice a week for rehab. He is up to 132 pounds. This past weekend, he went to GenCon. He’s looking forward to plenty of wonderful, healthy years ahead.

And he has started a blog about his journey called Borrowed Breaths.

The tagline Brown created says it all: “Each breath is a gift. So use it to the fullest.”

— By Dana Benbow, Senior Journalist at IU Health.

   Reach Benbow via email dbenbow@iuhealth.org or on Twitter @danabenbow.

93-Year-Old Patient Gets To Meet Her Beloved Virtual Nurse

Marie Kenley has congestive heart failure and is a patient in IU Health’s Virtual Complex Care program. Each day, she uses technology to send her blood pressure, weight, heart rate and oxygen saturation back to a team of nurses who monitor the data – and are there for anything Kenley might need.

Technology is Margaret Marie Kenley’s gig. She is an avid “Facebooker,” keeping up with the goings on of her friends and family spread throughout the country – including six grandkids and 14 great grandkids.

When she wants to crochet something different, Kenley turns to her tablet. There was the time she found a picture of cactus gardens and recreated the tiny plants out of yarn.

And each morning when it’s time for Kenley to have her mini medical checkup? She turns to technology again.

She sits on her bed and places the blood pressure cuff on her arm – 115/65, the machine reads. She steps on the scale. She checks her heart rate and oxygen saturation with a pulse oximeter.

It’s all recorded, as part of IU Health’s Virtual Complex Care program, through home health telemonitoring. A small router then transfers Kenley’s data back in real time to a team of virtual nurses.

If there is anything unusual, or out of the normal paramenters, a nurse will contact Kenley, who has congestive heart failure. If Kenley needs a nurse at any time, she can call and they will talk her through chest tightness or dizziness.

Last week, Kenley got to meet one of her favorite virtual nurses, Jodi Ralston, who came to her home for a special visit.

“To me, they are another member of the family,” says Kenley, 93, whose husband of 72 years died two years ago. 

She smiles and gives Ralston a hug. “I’m so glad I finally got to meet you.”

***

Ralston is a telehealth nurse, overseeing IU Health’s team of virtual nurses, three RNs and two LPNs. It’s Ralston and her team’s job to monitor the data that is coming in from those patients’ homes.

After Kenley checks her readings each day, the machine asks her some questions and gives her a reminder.

Have you been having any chest pain? Do you need your clinician to contact you today? Please remember to take your medication as prescribed by your physician and maintain a proper diet.

Kenley answers by pushing a yes or no button on the machine. 

Before the telehealth monitoring, Kenley, who has a pacemaker, would make trips to her doctor or the emergency room. She says the telemonitoring has cut those visits by 50 percent.

“You feel comfortable talking to them and they don’t only ask you how you feel but they go into detail,” says Kenley, who worked 25 years at Hawthorne Community Center, 13 as director.

If she has a dizzy spell, the nurses will advise her to sit down. When she’s feeling better, they will tell her to drink a glass of water, she says.

“You have a feeling of being a human and not just something on paper,” says Kenley.

The telehealth team also looks for things out of the ordinary, beyond the medical testing results.

“We know her trends. She is very consistent at testing,” says Ralston. “If we, all of a sudden, would not receive her readings that prompts us to call her.”

If they don’t reach Kenley, they will call her emergency contact. The team also makes calls to patients’ doctors and, if needed, will send out an ambulance.

“We do all of those extra steps just to make sure,” Ralston says.

Kenley’s daughter, Diane Arnold, says she likes, too, that all of her mother’s doctors receive the data, as well. Kenley’s results are sent to all of them – so her heart doctor and primary care physician are on the same page.

More than anything, though, the monitoring gives Arnold and her two sisters peace of mind.

“We really have that comfort,” says Arnold. “To know there are eyes and ears watching her, it gives us a lot of comfort.” 

That is exactly what the program is meant to do, says Peter Kamwendo, program manager for IU Health’s Virtual Complex Care.

“This technology allows us to come into the home daily,” he says.

It also allows the medical team to catch things early, reducing healthcare costs and doctor’s visits.

“And in the end,” Kamwendo says, “this keeps patients healthier, which is always the goal.”

— By Dana Benbow, Senior Journalist at IU Health.

   Reach Benbow via email dbenbow@iuhealth.org or on Twitter @danabenbow.

Physician Has Performed More Than 1,000 Bariatric Surgeries

Dr. Don Selzer, chief, division of general surgery IU Health Physicians, IU Health North recently completed more than 1,000 bariatric surgeries. He talks about the weight-loss procedure and what he’s learned during his practice.

He has met more than 1,000 patients going through bariatric surgery, but Dr. Don Selzer remembers his first patient as well as his most recent.

“The most memorable experience in all my years of surgical practice was the first patient I operated on for bariatric surgery. He weighed 600 pounds had not been able to wear shoes for more than two years because he had so much swelling. I remember him walking into his appointment one year after surgery and he was wearing shoes. To see that impact was so worth it,” said Dr. Selzer, who completed his surgical residency at IU School of Medicine.

In his role with IU Health, Dr. Selzer has excelled in a practice that focuses on the causes, prevention and treatment of obesity. His training specifically focuses on medically supervised weight loss and management of obesity as a chronic condition.

What has changed during the course of his career spanning more than 1,000 bariatric surgical procedures?

“I think the one thing we’ve learned is when to operate and when not to operate. Specifically with bariatric surgery there is a time in some patient’s lives that they aren’t ready for changes in their lives,” said Dr. Selzer. Patients considering surgery may spend up to six months in nutritional, psychological and exercise counseling. Every patient must commit to completing specific steps to prepare for surgery.

“What I’ve learned is a human’s relationship to food and society’s relationship to food make it a psychological issue and if you lose sight of that, you may not have the best support following surgery,” said Dr. Selzer.

In a recent one-year follow up, one of Dr. Selzer’s patients Anthony Martin, 65, talked about how different his life is since surgery. He started the process at 370 pounds and now weighs 199 pounds.

“I have a whole lot more energy. I’ve been busy working around my home, rebuilding a deck and other projects. Before surgery, I had trouble even walking,” said Martin, a resident of Fairland.

For Dr. Selzer’s patients, bariatric surgery is the last resort. Most have tried multiple diets and weight-loss programs with limited success.   

“Generally speaking, if it sounds too good to be true – like a magic pill – it probably is too good to be true. Choosing bariatric surgery is the toughest way to lose weight but it’s also one of the most successful options that leads to maintained weight loss,” said Dr. Selzer.

What does it mean to have helped more than 1,000 patients reach that milestone?

“Every year at around this time, I sign a book or card for a graduating fellow or resident and I’m always reminded of the reality about surgery and medicine in general. Whenever you think you’ve mastered the process you will be humbled. It just means that I’ve attempted 1,000 times at perfection,” said Dr. Selzer. He recites one of his favorite quotes by Vince Lombardi Jr.: “Gentleman, we will chase perfection and we will chase it relentlessly, knowing all the while we can never attain it. But along the way, we will catch excellence.”

More about Dr. Selzer:

  • He is married to Cindy Selzer, a pharmacist. They have two sons, Samuel, 11, and William, 8.
  • His initial exposure to a career in medicine was from his mother, a retired internal medicine physician. “I was told by my physique (he stands at 6’3”) I should go into orthopedic surgery, but I was enticed by general surgery,” said Selzer.
  • Originally from Wisconsin Dr. Selzer is a fan of both the Badgers and the Hoosiers. He also enjoys spending time outside on the baseball field with his son, a pitcher, running, trying new restaurants, and watching historical documentaries. 

— By T.J. Banes, Associate Senior Journalist at IU Health.
   Reach Banes via email at
T.J. Banes or on Twitter @tjbanes.

Oncology Patient: New Gene Therapy Offers New Hope

Diagnosed with large B Cell lymphoma, Lori “Jill” Trinkle is preparing for a groundbreaking gene therapy and will be receiving the revolutionary CAR-T treatment at IU Health – the only site in Indiana to administer the treatment.

She knows she’s a pioneer – one of the first to receive a revolutionary new cancer treatment. But Lori “Jill” Trinkle looks at it as a way to acknowledge the progression of a medical and scientific field that is out to slay the giant called “cancer.”

Diagnosed February 16, 2017 with high grade, aggressive large B cell lymphoma – Non-Hodgkin Lymphoma (NHL), Trinkle, of Michigan, was originally treated with chemotherapy. After six founds – administered during a 21-day hospital stay – a PET scan showed that her chest was clear. She completed the treatment on June 30, 2017 and four months later the lymphoma was back. Tinkle went through two more rounds of chemotherapy in preparation for a stem cell transplant. A year after her diagnosis, she was admitted to IU Health Simon Cancer Center for three weeks for the stem cell transplant. Anther PET scan came back clear.

But in May the cancer returned in her right lung. On June 13 she began 20 treatments of radiation to attack the mass in her chest.

Those two treatments – with relapses – were the pathways that lead Trinkle, 59 to a gene therapy that has only recently been approved by the FDA. IU Health is the only state-approved site to use the treatment known as CAR-T.

During a recent check-up Trinkle met with Dr. Michael Robertson, who specializes in hematology/oncology to talk about that next step in her treatment – CAR-T. Specifically, the groundbreaking gene therapy uses custom-made cells to attack a patient’s own specific cancer. As part of the Indiana University’s Grand Challenge Precision Health Initiative, CAR-T cell therapy allows doctors to isolate T-lymphocyte cells – the body’s cells that fight infections and are active in immune response. According to Dr. Mervin C. Yoder, M.D., a leader in IU’s Precision Health Initiative, the T cells are then engineered to express a chimeric antigen receptor (CAR) that targets a protein on a patient’s cancer cells, attaches to them and eventually kills them.

As Doctor Robertson evaluates Trinkle during her recent check up, he asks about her breathing, if she has fever, lumps or bumps. She tells him about a rash that could be from radiation and some back pain, she believes is caused by a degenerative disc. Otherwise, she says she feels great and is ready for the next phase of her treatment plan.

“I think we’re on track,” said Dr. Robertson. “The reason she’s one of the first for the CAR-T treatment and the reason she is a good candidate is because standard chemotherapy hasn’t done the job to control the lymphoma. We’re hoping the immune system can do what the chemo couldn’t do.” He tells Trinkle to expect to be fatigue – symptoms similar to when she went through her stem cell transplant. She will remain in the hospital for about three weeks. In addition to Dr. Robertson, Trinkle has been in the care of medical oncologist Dr. Karuna Koneru, medical radiation oncologist, Dr. Fred Wu, both of Bloomington, IUH Southern Indiana Physicians.

“It could be scary but I’m comfortable with my doctors and the process,” said Trinkle, who has an older brother, younger brother and two younger sisters. She has one daughter and they enjoy exploring Michigan together. “I’ve stayed positive through it all. My faith is strong. I’ve met fantastic people in the hospitals – both Bloomington and Indianapolis – very capable and caring. I look forward to having my energy back and doing the things I love – yoga, volunteering, walking and fostering animals.”

— By T.J. Banes, Associate Senior Journalist at IU Health.
   Reach Banes via email at
 T.J. Banes or on Twitter @tjbanes.