*Editor’s Note: There was an editing error in the print version of this article. We take full responsibility and apologize for the oversight.
Photo by Maria DeForrest
Lynsey Brandt, MD, was working as a pharmacist when a routine encounter with an older patient became etched into her memory. The woman’s hand shook as she wrote out a $400 check for her medication, and her vulnerability struck a chord with Brandt.
She wanted to do more to help this woman, to play a bigger role in her health than she could as a pharmacist. Brandt went to medical school to become a geriatrician and specialize in the care of older adults. It’s an area of critical need; there are about 49.2 million Americans aged 65 or older but only 3,590 full-time geriatricians—only one full-time specialist for about 14,000 seniors.
Brandt joined Christiana Care Health System in 2015 and now practices in the Swank Center for Memory Care and Geriatrics Consultation. Some of her patients have a specific health problem, while others are just looking to ensure they’re on track to live a long, active life.
Her patients often want to keep their independence and avoid living in a nursing home or other facility.
“That’s what people fear, No. 1, when they come to see me, whether they say it or not,” Brandt says. Much of her advice is common sense: exercise, eat right, get enough sleep, stay social. “The stuff your mom told you, you should do anyways,” she says.
Brandt also closely examines a patient’s medications and doesn’t miss an opportunity to end a prescription. Many times, problems are caused by medications meant to fix another problem. Someone may take a diuretic for swelling of the legs, for example, which can adversely affect bladder control.
Some medications can also lead to memory problems and falling risks.
But if Brandt can help her patient control their leg swelling through diet, compression stockings or other natural means, she can prevent the entire cascade of health effects.
Often, caregiving duties and tough decisions fall on older adults’ middle-aged kids, but Brandt unloads some of that burden. Such duties as telling a patient they shouldn’t drive doesn’t make her popular, but she thinks it’s important to break the ice.
“I always say that we can’t tackle this problem unless we talk about it openly,” she says.
Photo by Justin Heyes/Moonloop Photography
Because she spends about half her time delivering babies, Angela Caswell-Monack, DO, has seen firsthand the change in how American mothers are choosing to give birth.
In Delaware, about 1/3 of babies are delivered by Cesarean section, a figure that most medical experts agree is far too high. When they’re not medically necessary, C-sections can pose extra risks to the mother and the baby.
Caswell-Monack says her team at Beebe Healthcare advocates for vaginal delivery. In cases where labor takes a little longer than normal, they will let it proceed naturally without automatically turning to surgery.
Total C-sections at Beebe Healthcare’s Lewes hospital have fallen from 40 percent in fiscal year 2016 to 31.3 percent in the current fiscal year, through March.
Women are delivering later, too; the average age of first-time mothers is 26, five years older than it was in 1972.
“Many women are waiting longer because they’re still in school, are working on their career or haven’t found the right person,” Caswell-Monack explains. All the doctors at her Rehoboth Beach practice are women, and many of them had children when they were over 35.
These mothers are generally good candidates to give birth at Beebe, she says, even though the hospital doesn’t have a neonatal intensive care unit. Women older than 35 do face higher risks, but usually have normal deliveries.
“We offer the same screenings they could get anywhere else, and if there are any problems, we recommend patients go to the best place,” Caswell-Monack says. More experienced expectant mothers also have advantages.
“They tend to [ask] good questions, and they need good answers,” she says. “They don’t want to be brushed off. They want to be taken seriously.”
Caswell-Monack also performs procedures like hysterectomies (the removal of the uterus) and sees patients for office visits to discuss reproductive health.
“We also talk about other things that make them human, like intimacy and sexuality,” she says. Contraception discussions sometimes include sterilization, commonly referred to as “getting tubes tied.” But women have many more choices today, she adds, noting long-term but reversible procedures that can be performed in a single visit.
Photo by Justin Heyes/Moonloop Photography
“Door-to-balloon time” refers to the number of minutes between a patient hitting a hospital’s doors and a balloon being inserted to open their artery. Because each minute counts when heart muscle is dying, this measurement is used around the world to determine hospitals’ care of heart-attack victims.
It’s also the standard by which Arvind Gireesh, MD, measures his team at Nanticoke Health System. As interventional cardiologist, Gireesh is able to open blocked blood vessels without using open-heart surgery.
In 2004, the national standard for door-to-balloon times was 90 to 120 minutes. Gireesh’s team, along with others throughout the country, aim for 60.
They set a benchmark two years ago but have managed to come in below it for some time now.
These lower door-to-balloon times have been saving lives at Nanticoke Memorial Hospital, Gireesh says.
Last week, he treated a young man who entered the hospital in cardiac arrest. “Ten years ago, he may have died, but four days later, he walked out,” Gireesh says.
Emergencies test his team in a unique way, but about half the procedures they perform are elective, or planned. A person may have long-term chest pain—a sign of reduced blood flow to the heart—and without treatment, a potential heart attack in the making.
“The No. 1 thing that patients have to keep in mind is the recognition of symptoms,” Gireesh says. “It’s important to listen to your body. If you’re having chest discomfort, chest pressure … you have to make sure you seek a medical professional.”
Gireesh studied medicine because he looked up to his mother, a physician, and chose his specialty after his father had a heart attack. His says it’s his patients’ gratitude that keeps him motivated.
“It never gets old saving somebody’s life … the gratitude of a patient after something like that happens to them, it’s life-changing,” he says. “Having seen it professionally hundreds of times and having gone through it with my father, it just never gets old.”
Photo by Justin Heyes/Moonloop Photography
James Zaslavsky, DO, began his career in medicine as a physical therapist, helping patients heal from pain using movement instead of medicine or surgery.
But because physical therapy relies on the body to heal itself, more serious injuries may be beyond a therapist’s ken. So Zaslavsky decided to become a medical doctor to help these patients too.
He pursued a doctor of osteopathic medicine (DO) pathway because it emphasized a holistic approach to healing bones and muscles, including lifestyle changes, physical therapy and acupuncture.
“It more closely modeled my beliefs as a physical therapist, to treat the patient as a whole person,” he says. Another common alternative to surgery includes stem cells, which can divide into any type of cell, to stimulate the body to regenerate its own tissue.
It’s often the patients, Zaslavsky says, who see surgery as the one-time fix to their pain.
“We have many days when we’re talking people out of surgery,” he says.
He conducts about half his procedures at First State Surgery Center, which is owned by his practice, First State Orthopaedics. The other half are performed at the hospital and are typically for patients who are sicker and need more complicated procedures.
For those who aren’t likely to need hospital services, the surgical center provides a superior experience and has lower infection risks than a hospital, Zaslavsky explains.
If surgery is necessary, he turns to techniques that preserve the patient’s range of motion. Often, spine pain comes from the motion between vertebrae, and one way to relieve it is to fuse these small bones together.
While this approach is common, it comes with the risk of merely shifting the problem elsewhere in the spine. Recovery times can also be long because patients usually have movement restrictions after a fusion surgery.
Alternatively, replacing or repairing a disc can prevent long-term problems while helping the patient recover more quickly.
“It’s absolutely more challenging,” Zaslavsky says of these “motion-sparing” techniques. “But it’s very rewarding.”
He sees that payoff in one patient who returned to the helicopter pilot’s chair in two weeks and another who ran a marathon six weeks after surgery.
“In order to make those things happen for our patients, it’s worth going the extra mile,” he says