When Care Goes Virtual: The Surprising Benefits of Video Visits

One thing Jillian Worth, MD, ABFP, can count on with teenage patients is their hesitancy to talk about serious subjects in the exam room. For teens coping with mood disorders, typical in-person appointments can feel artificial and discourage conversation. When the COVID-19 pandemic suddenly replaced office visits with video sessions, Dr. Worth noticed something remarkable: her young patients were opening up like never before.  

“What I’ve seen is kids on virtual visit in their bedrooms are more likely to talk about what they’re feeling, in the space where they have those feelings,” says Dr. Worth. “They’re willing to jump right into what they’re struggling with, instead of needing lots of warm-up.”

Another big benefit of video for young patients is flexible scheduling. Arranging an in-person appointment can delay care, when a quick video check-in has the power to turn things around for a teen. Adding a 15-minute virtual visit to the end of her day, says Dr. Worth, is much more doable than a regular visit, and takes care of the patient’s problem when it’s happening.

As a family medicine physician, Dr. Worth sees patients of all ages and backgrounds and surprisingly, video visits have proven beneficial across her diverse practice. Instead of having a patient seated in an exam room, video can offer a little window into their world, revealing the important objects, pictures and even people in their lives.    

“With longtime patients, at some point you stop asking social history questions, like who they live with,” says Dr. Worth. “But maybe you’ll see a grandkid running through the room on video and ask about them, and find out that family has moved in.”

Dr. Worth has discovered that asking her patients new questions that come up through video can lead to better patient care. Patients light up, she says, because they want to tell you more about who they are. They can also feel comfortable enough in their homes to admit problems they’ve never considered discussing in the office. If a patient reveals they feel unsafe in their relationship, for example, the care plan can include steps to address the situation.  

For elderly patients, occasional home visits can be a necessity, but before the pandemic they were usually limited to severely ill and homebound patients. Now that Dr. Worth sees most of her older patients on video, she looks out for them in new ways, such as noticing something in their environment that needs attention.

“I can have them pan around the room and see they have a loose area rug, or a dangerous step going down to their living room,” Dr. Worth says. “Maybe they use a walker and there’s a little dog running underfoot. Things I would never have known from an office visit.”

Then there are the patients who struggle more than others to even get to a provider’s office. Chronic conditions that involve regular appointments for care or medication management can be a challenge for those with debilitating illness, or for those who can’t get time off work. Visits using a patient’s smart phone can happen on a work break. People dealing with chronic pain can avoid a car trip and navigating a medical office building.

Another way virtual care boosts more equal access is the prevalence of smart phones across a diverse patient demographic. “It’s difficult for many working families to get themselves or their kids in for care, but most people have some version of a smart phone,” says Dr. Worth. “The flexibility and the capability of video on their device means they can hop on for a visit wherever they are.”

What’s clear is being able to see a patient when a visit might otherwise not have happened can change the course of illness and recovery. One elderly patient became bedridden and was considering hospice care. A family member held up her phone for a virtual visit with Dr. Worth from the patient’s bed.

“To see her in the office would have been impossible, but I was able to observe how it felt for her when she tried to move around,” says Dr. Worth. “I could see her pain and talk with her. Now we’ve got her in physical therapy at home and I see her sitting up in the living room.”  


Jillian Worth, MD, ABFP, is board-certified in Family Practice and currently practices at the Virginia Mason Bainbridge Island Medical Center. Dr. Worth specializes in family medicine, primary care, pediatrics, preventive medicine and transgender health.

Triumph Over Diverticulitis: Nancy’s Story

There’s not much that slows Nancy Fauls down. She was one of the first female skippers to race schooners in the Pacific Northwest and knows how to stay calm and keep everything moving forward. Then in January 2019, the Port Townsend resident experienced a lower abdominal pain that was overpowering. “I’d never felt anything like it before,” she remembers. “I could hardly breathe or move. I was doubled over.”

Nancy went to the local emergency room and then to her general practitioner who prescribed antibiotics to curb bacteria growth. The medication didn’t have much impact on her symptoms and she spent several days lying flat on her back. A month later she experienced the intense pain again and her doctor referred her to Virginia Mason. Because of the distance from Port Townsend to the hospital and the severity of her pain, she was transported by ambulance and ferry boat to Virginia Mason Seattle. Diagnostic blood tests and a CT scan indicated her pain was caused by diverticulitis.

Diverticulitis occurs when a diverticulum (a bulging sac that can form on the colon wall and push outward) becomes inflamed or infected. The condition is most common in people whose diets are lower in fiber and higher in processed carbohydrates.

“Diverticulitis used to commonly be seen in patients who are 50 to 70 years old, but now we’re seeing it in younger patients,” says Virginia Mason colorectal surgeon Vlad Simianu, MD, MPH. The culprits, he adds, are often obesity, smoking and a diet of highly processed and packaged foods.

Free of diverticulitis and enjoying life again.High fiber diets can prevent the colon diverticula from forming, he says, because the fiber results in smoother elimination without the damage that can occur with the pressure on the colon that is caused by constipation. And as Nancy experienced, damaged sections of the colon wall can become thinner and burst.

“Once the disease occurs, diet changes may help the symptoms but they are no longer the cure,” says Dr. Simianu. “The truth is once you have diverticula we don’t really know what drives them to become inflamed and infected, and therefore can’t be sure whether a specific medicine or lifestyle change will prevent a flare.”

Often the diseased portion of the colon must be surgically removed.

“These days the surgery is much easier on patients,” says Dr. Simianu. “It is minimally invasive, usually requiring three to five small cuts in the abdomen, as opposed to traditional surgery which involves one large incision. Patients heal faster and their stay in the hospital is reduced.”

In Nancy’s case, the nine inches of her colon with the disease were removed using robotic technology. She was back home three days following her surgery. She’s made some lifestyle adjustments, lost 50 pounds and is enjoying an active life in the beautiful town she calls home.


A version of this story originally appeared in the Virginia Mason Health System Annual Report

Bad Break, Good Outcome: Team Effort Restores Joint Function

“This is me leaving my apartment on my first day in Rome,” says Roberta Kelley, looking through her photo collection. “See how happy I was? And here I am having my first and only cup of espresso.”

Roberta’s dream vacation ended abruptly when after a long day of sightseeing, she stepped off a surprise curb and went down hard. Holding her tour map and phone, Roberta’s elbow took the brunt of the impact, crushing it. She remembers bystanders helping her into a cab and later, falling asleep in her rented apartment.

The next morning Roberta’s shock gave way to the realization her swollen arm was broken. A local hospital took an agonizing X-ray, and Roberta learned she’d need surgery to repair her ruined elbow. She could have the surgery done in Rome, the doctor told her.

“But I said no, I’m flying back to Seattle,” remembers Roberta. “I need to go to Virginia Mason where I get all my care and my doctors know me.” Roberta shares another connection with Virginia Mason, retiring in 2018 as a speech-language pathologist and orofacial myofunctional therapist (treating muscle disorders of the mouth and face).

Fitted with a temporary cast from her shoulder to her wrist, Roberta made the long trip home and then to Virginia Mason’s Emergency Department. She relaxed for the first time in days, with the team making her comfortable and gently guiding her through X-rays. That same morning Roberta met orthopedic surgeon Laura Stoll, MD.

Roberta in chair

Roberta Kelley

“Dr. Stoll showed me the images and explained her plan for surgery,” says Roberta. “She wanted me to know it was a bad break and there were no guarantees about what function I’d get back. I was so worried and nervous, but she said ‘I will take good care of you’ and gave me a hug. That made a world of difference.”

Roberta’s severe elbow fracture and dislocation required a prosthetic replacement of the radial head, the knob-like end of the radius bone that helps form the joint. The radial head sits in a pocket of the ulna bone, allowing the forearm to both flex and rotate. In addition to the prosthetic, Dr. Stoll rebuilt and repositioned Roberta’s elbow with a stabilizing system of plates and screws.

“Because elbows are mechanically complex, they are tricky to repair and surgical outcomes can be unpredictable,” says Dr. Stoll. “Roberta’s dedication to recovery and her positive attitude were so important. Achieving a good outcome really becomes a team effort.”

“Team Roberta” included Dr. Stoll working side-by-side with an occupational therapist in joint visits, going over X-rays and creating a rehabilitation plan. Roberta began a rigorous therapy regimen, which included daily home exercises. Roberta set her smart phone to remind her when to do them. At first she felt discouraged, not able to bend her arm enough to wash her face, put on make-up or even earrings. But her occupational therapist stayed positive and encouraging, even as she challenged Roberta with those very tasks each week to help condition her new elbow.

“My range of motion is excellent now, but it came with a lot of effort and exercise,” says Roberta. “I told Dr. Stoll she did fabulous surgery. She said ‘yes, but you did all the hard work.’”


A version of this story originally appeared in the Virginia Mason 2019 Annual Report.

New Friends for Life After Paired Donor Kidney Exchange

For a few years, Steve Harper had thought about donating a kidney. “I thought it would be a good thing to do,” Steve explains. “And sometimes thinking about doing something makes you feel like a better person and for a time, that was good enough.”

Then one night, Steve, the chief engineer of an ocean-going tugboat, was midway through the night watch in the engine room when he happened to listen to a podcast about Nobel Prize-winning economist Al Roth. Roth won the Nobel Prize in 2012 for his work creating markets for items that have no cash value. Items like kidneys. He was instrumental in creating the mathematical algorithms that resulted in the creation of the National Kidney Registry.

In the late night quiet on the tug, 46-year-old Steve started thinking. He had already achieved his lifelong goal to earn a pilot license, and had been wondering what his next goal should be. Maybe this time, he thought, the goal could be something that wasn’t so self-directed. It also might benefit someone else. It could even save someone’s life. “And that is when it occurred to me what my next goal would be, my next great adventure,” Steve says. “I would donate a kidney.”

“It took almost two years to get my work schedule set up to so I could make this happen,” Steve recalls. “Then there were six months of needle sticking, ultrasounds, MRIs, paperwork, psychological interviews and doctor visits. I got injected, inspected, and finally, selected.” 

Steve became one of four people in a paired donor kidney exchange that took place at Virginia Mason. “A beautiful, courageous, and generous woman named Wendy Johnson pledged her kidney to a stranger so her friend, DC Crist, would be moved to the top of the list,” Steve remembers.

Kidney foursome

Friends for life (left to right): Douglas “DC” Crist, Steve Tucker, Debbie Nayakik and Wendy Johnson

Wendy was not a match for DC, but Steve was. It was decided that Wendy’s kidney would go to her match, Debbie Nayakik, who lives in Utqiagvik, Alaska, the northernmost town in the United States. Before the transplant, both of Debbie’s kidneys were functioning at eight percent. “I prayed each day and night that God would pull me through each day so I was healthy enough to receive a kidney,” Debbie remembers. “Then one evening I got the call that there was a kidney for me.

“I didn’t realize what I was really getting myself into. The doctor told me I couldn’t eat raw whale muktak [outer skin and blubber], which I love. Then it finally soaked in my brain that I needed to do this and I obeyed the rules,” Debbie says. “I was blessed with a healthy kidney, thanks to Wendy. My life has been prolonged so I can see my two grandchildren grow up.”

DC Crist, the second recipient of the paired kidney donation, suffered from polycystic kidney disease. Clusters of cysts had developed in his kidneys and had become enlarged, diminishing kidney function over time. He and Wendy are both interested in civic causes on Bainbridge Island and their paths crossed often. When Wendy learned DC needed a kidney she felt compelled to investigate the donation process and eventually decided to donate.

“[Steve’s] kidney was essentially looking for a home. Thankfully that was me.”
— DC Crist

“Without Wendy donating her kidney on my behalf, I wouldn’t have had anything to trade for Steve’s kidney,” DC says. “I would have been just one of thousands of Americans on the waiting list. Because Wendy’s kidney was donated on my behalf for Debbie and Steve’s kidney was donated altruistically [without expectation], his kidney was essentially looking for a home. Thankfully that was me.”

The transplant team at Virginia Mason has performed more than 1,000 living donor transplants and is well up to the challenge of a paired kidney exchange. Transplant surgeons Nick Cowan, MD, and Jared Brandenberger, MD, operated, first on DC and Steve, then a week later on Wendy and Debbie.

“I felt a thousand times better immediately,” DC recalls.

Because the transplants occurred locally, as opposed to implanting a kidney that had been transported from another facility, the four participants had the unique opportunity to meet each other face to face. “We set up a meeting with DC two days after the surgery,” Steve recalls. “The meeting was great. He looked terrific. His creatinine level was lower than mine. We found that we had a lot in common. We are both sailors, we both play guitar and we both have amazing life partners.”

All four paired exchange partners eventually met. “I traded a kidney for three new friends.” Steve adds, “Good trade.”

Steve has a heartfelt message for the care team that performed the transplants: “There is no way for me to express my respect and admiration for the incredibly smart, dedicated, well-trained people who make miracles like this possible. Thank you, from the bottom of my heart, for studying so much harder in college than I ever did. You are the true heroes of this story.”

Finding Light on the Ride: A Comeback Story

The tricky thing about hitting bottom is knowing when you’ve done it. Making his way to his usual bus stop, Jon Perry slipped on an icy sidewalk and grabbed for a garbage can to break his fall. That might have worked, except Jon weighed about 280 pounds and the force snapped his upper arm in five places. It hadn’t helped that he’d been drinking.

The day Jon was about to be wheeled into surgery on his arm he confessed to recent heavy drinking, and the surgery was cancelled. It had all the elements of hitting bottom: his arm would heal painfully and never be the same. But a year later, Jon was in the hospital again. Battling alcohol addiction and weighing 400 pounds, Jon was told if his kidneys didn’t start working in a few hours they could fail permanently. Here, finally, was bottom.

Jon Perry

Jon Perry, who once rode for Benaroya Research Institute’s bicycle team.

Jon’s kidneys did start working that night, but something had changed. “I had faced my mortality and here was another chance,” says Jon. “Something made me want to seize the opportunity.”

Maybe what kicked in that night was Jon’s muscle memory for facing challenges. He’d been a two-time Ironman triathlon finisher and competitive bike racer; one season riding to a state championship. That’s when the drinking slowly started. The more he drank the better he got at hiding it. But he couldn’t hide the toll it took on his spirit, swamping it in alcohol. Beyond exhausted, Jon fired his coach, kept drinking and his weight ballooned.

Jon’s choice to get better that night in the hospital might have flown away, but he had the benefit of community. Jon’s south Seattle loft is in a building designated for artists, who all applied and moved in at the same time. Jon gave his TV away and recommitted to his music, playing bass guitar and drums, and adding a passion he’d put aside: singing.

“It’s inspiring to be in this community, one I helped build,” says Jon. “It was a huge part of my recovery.”

Getting back to work and doing what he loved, Jon’s recovery leapt forward. Working long hours on his feet as a cook helped the pounds fall off, as did giving up alcohol – not so much as a drop, Jon says. Soon he could ride his bike to work; he kept feeling better and continued to lose weight.

Jim, Jon’s stepfather, witnessed Jon’s incredible transformation and was moved to help. It would be the last gift to his stepson: Jim had terminal lung cancer.

“We sat on the edge of his hospital bed and he said, ‘I want to do this for you, when you’re ready,’” remembers Jon. Jim was offering to pay for a big surgery – a body contouring procedure that would tighten the loose skin around Jon’s abdomen, the result of his significant weight loss. “He said it was to finish off what I had accomplished,” says Jon. “He believed in me.”

Several months after Jim passed away, Jon underwent a circumferential lower body lift at Virginia Mason – an extensive surgery to lift and reshape the front and back areas of the torso, removing excess tissue. Plastic and reconstructive surgeon James Schlenker, MD, says Jon’s strong motivation to be active again made him an ideal candidate for an operation with life-changing potential.

“Often people who lose a lot of weight don’t anticipate the impact of having loose skin, and there are many types of procedures available,” says Dr. Schlenker. “The lower body lift is a less common and more involved operation than abdominoplasty, but results can be dramatic for the right patient. The surgery had great benefits for Jon, helping him continue doing everything he enjoyed.”

Jon was buoyed by Dr. Schlenker’s enthusiasm for the surgery’s possibilities, and for his gentleness and knowledge. Recovery took all the weeks prescribed, but for Jon it’s been nothing short of transformative. These days you’ll still find him on a bicycle – at a leaner 175 pounds, reminiscent of his bicycle club days. And who knows? His next race may be just around the bend.

“It’s been a monumental time for me,” says Jon. “Life is rich. I have so many things and I’m incredibly grateful. I like to say there is light where we’re traveling.”

 

Worth the Distance: Advanced Cancer Treatment Helps Alaska Man After Just One Infusion

**By Hagen F. Kennecke, MD, MHA, FRCPC

The day after Christmas in 2016 brought unwelcome news for Wasilla, AK resident Josh McCool.

McCool, then 26, was diagnosed with a rare tumor of his adrenal gland, called a pheochromocytoma (fee-o-kroe-moe-sy-TOE-muh). But after surgery to remove the tumor, a type that can cause serious complications but is rarely cancerous, McCool’s symptoms returned and got much worse.

“My resting heart rate was very elevated,” remembers McCool. “I was super weak, unable to play with my kids, and spending 16 to 18 hours a day in bed. On top of that, I lost more than 100 pounds over six months. I would be out of breath just walking from our couch to the kitchen.”

A Rare Cancer 

McCool’s pheochromocytoma was a type of malignant tumor known as a neuroendocrine tumor, or NET. There are many types of NETs, some which make abnormally high amounts of hormones that cause many different symptoms. After traveling to the Seattle Cancer Care Alliance and undergoing extensive evaluation, McCool was referred to the Neuroendocrine Tumor program at Virginia Mason Medical Center.

That’s when I first met McCool, who had become very weak and sometimes needed a wheelchair. He was in significant pain and his cancer was secreting adrenaline, which was causing even more symptoms. To help target his treatment we used a specialized PET-CT scan, called NETSPOT®, which identifies hormone receptors on cancer cells.

With the cell receptors identified, McCool became a candidate for an advanced treatment known as Peptide Receptor Radionuclide Therapy (PRRT) with a treatment called Lutathera®. In PRRT, a cell-targeting protein, or peptide, is combined with a small amount of radioactive material. When injected in the blood stream, this new substance, called a radiopeptide, binds to NET cells, delivering a high dose of targeted radiation.

Josh Before and After Treatment

Immediate Results

Amazingly, just one week after his first treatment, McCool noticed his symptoms were improving. A better appetite was followed by markedly more energy, increased activity and a significant decrease in his back pain. The targeted nature of PRRT — binding to a protein only on the cancer cells — greatly minimized side effects.

A total of four treatments were needed, once every two months. Since PRRT is not available in Alaska, McCool arranged travel to Virginia Mason. After only his second infusion, McCool was completely off pain medications, had gained weight and was able to play with his two young sons.

A New Beginning

Josh-McCool_Shannon-and-sonsDespite all the challenges of therapy, McCool feels very lucky. “Getting the green light to move ahead with the treatment was like winning the lottery,” says McCool. “It has definitely been a character building experience and one I couldn’t have gotten through without the amazing support system of family and friends that I’ve been blessed with all along the way.”

McCool finished his treatment this month and is planning a trip to Disneyland with his family next year.

All of us on the Neuroendocrine Tumor Program team who took care of Josh McCool take great inspiration from the remarkable improvement in his health. While PRRT is not a cure, the treatment has the potential for adding years to an active and fulfilling life.


Hagen F. Kennecke, MD, MHA, FRCPC
Hagen F. Kennecke, MD, MHA, FRCPC, has advanced training in oncology and specializes in neuroendocrine tumors and colorectal cancers. He is director of the Cancer Institute at Virginia Mason. Dr. Kennecke practices at Virginia Mason Hospital and Seattle Medical Center.

New Treatment Slows Tumor Growth, Improves Quality of Life

The epitome of frustration is, when your symptoms have taken control of your life and medical professionals can’t find a way to make them stop. For more than five years, that was Gig Harbor resident Ellen Dunn’s life.

She suffered with ongoing cramping, diarrhea and dry flushing of her skin. She was first diagnosed with Irritable Bowel Syndrome, but that was incorrect. “No matter what was

Ellen Dunn

Ellen Dunn underwent therapy at Virginia Mason for carcinoid tumors, an uncommon cancer that affects the intestines, pancreas, lungs and other parts of the body.

prescribed, my symptoms just kept getting worse. It was ruining my life,” Ellen remembers. “I told my internist it’s got to be something else. She recommended I take a blood test for carcinoid syndrome, and that’s what it was.”

Finally, Ellen had an answer. Malignant carcinoid tumors tend to grow slowly. But when they increase in size, they cause pain and can produce hormones that cause diarrhea, flushing and disrupt the body’s endocrine system. Standard chemotherapy and radiation aren’t effective on these types of tumors.

Fortunately for Ellen, she learned she had carcinoid tumors at the same time a treatment to control the growth of neuroendocrine or carcinoid tumors (NET) was going through a clinical trial. Led by Hagen Kennecke, MD, medical oncologist and medical director of the Floyd & Delores Jones Cancer Institute at Virginia Mason. Ellen was selected to be the first patient in the Pacific Northwest to receive this treatment.

Called peptide receptor radionuclide therapy (PRRT), the treatment involves an injection of a small protein peptide into the patient’s bloodstream. The peptide finds the cancer tumors and binds to them, while also protecting the surrounding tissues. PRRT has been shown to significantly slow the growth of tumors. It is also beneficial to patients with advanced neuroendocrine tumors who are not candidates for surgery and whose symptoms are not responding to other medical treatment.

In December, Dr. Kennecke and radiologist Marie Lee, MD, administered the first treatment to Ellen. She receives PRRT treatments every two months in an outpatient setting The treatment lasts only a few hours and has minimal side effect. Ellen had her third PRRT treatment in April.

“Until now, there has been no effective therapy to shrink small bowel and lung neuroendocrine tumors when surgery is not an option,” says Dr. Kennecke. “While this procedure does not cure cancer, it significantly extends the lives of those living with the disease and improves their quality of life. We are proud to be on the forefront of this promising, highly targeted therapy which can be used for the treatment of other cancers in the future.”

More than 3,000 patients with advanced carcinoid tumors live in Washington state. This new treatment helps the majority of these cancer patients and controls the tumors for three years on average. The treatment may be repeated as needed.

“I’m so thankful that I was accepted into the program,” Ellen says. “I feel very fortunate.” In early April 2018, Virginia Mason became the first medical center in the Pacific Northwest to administer PRRT as part of routine care, offering a viable new treatment to many patients. In the near future, Virginia Mason will be offering clinical trials of a very similar therapy to treat patients with prostate cancer.


A version of this article also appears in the Virginia Mason Health System 2017 Annual Report.  

Pelvic Organ Prolapse: How a Restorative Treatment Helped Mother and Daughter

Kathy Silva describes the 12-acre farm where she grew up and where her mother, Rosemary Cockrill, still lives. Life in scenic Port Angeles, Wash. could be low key if you let it. But Rosemary, 86, kicks it up a notch, making time to go to concerts, see a play or a movie, or take a class at the senior center.

“She’s never going to get old,” says Kathy, who lives about 20 miles from her mom, in the town of Joyce, and works for the local school district.

Kathy.Rosemary

Kathy Silva (right) and her mother, Rosemary Cockrill

But Rosemary’s life wasn’t always so active. For years, she suffered the symptoms of pelvic organ prolapse, when weakened pelvic floor muscles and ligaments allow organs such as the bladder, uterus or rectum to drop, sometimes protruding out of the vagina. Pelvic organ prolapse develops over time, often long after childbirth has stretched connective tissues. When the bladder is the affected organ, a feeling of heaviness or pressure, compounded by the frequent need to urinate and the fear of accidents, can keep women from getting out and doing the things they enjoy.

“My mom asked me to please look at Virginia Mason’s website to find a urologist who could help,” says Kathy. “I chose Dr. Una Lee, who specializes in pelvic organ prolapse, and all the information we needed about her was right there.”

Dr. Lee confirmed Rosemary would benefit from surgical intervention. A minimally invasive approach using small abdominal incisions to repair the prolapse, and a supportive sling placed to support Rosemary’s bladder and urethra would relieve the constant pressure and incontinence. There was just one problem. “My mom doesn’t like anything to do with hospitals and she wasn’t excited about any of it,” remembers Kathy.

It was her mom’s evaluation at Virginia Mason that got Kathy thinking about her own discomfort. She wasn’t having any urinary problems, but she’d been feeling like she was sitting on something, and was constantly adjusting her position to get comfortable. A visit to Dr. Lee confirmed Kathy was also suffering from pelvic organ prolapse, which she learned can be hereditary. If her mom wasn’t ready yet, maybe Kathy could blaze the trail.

Dr. Lee completed Kathy’s prolapse repair in one operation through the vagina. The success of her daughter’s surgery eventually moved Rosemary toward a decision. She would have the surgery.

“Mom goes anywhere she wants now,” says Kathy. “My son got married in Vegas, and Mom insisted on going. She flew on the plane and enjoyed the whole trip without worrying about the bathroom. I know the surgery is what helped her make that trip.”

At the two-year mark after Kathy’s surgery, a check-in with Dr. Lee confirmed there was still a problem with prolapsed tissue near the rectum. Kathy’s previous repair to support her bladder remained in place, but she needed a second surgery in another area to fix what’s known as a rectocele, or posterior vaginal prolapse. Kathy credits both procedures for making her good as new, “and that’s not bad for 66,” she says. She has an enduring gratitude for Dr. Lee and the care teams who have encouraged and supported her over the years at Virginia Mason.

“No one tells you when you get older what’s not normal, and women may not be confident talking about it,” says Kathy. “Dr. Lee is easy to talk to, and she really wants to know her patients.”

Rosemary wholeheartedly agrees with her daughter, and then some. “Dr. Lee and this surgery have given me my life back,” she says.


This story also appears in the Virginia Mason Health System 2017 Annual Report.  

 

Living with Fatty Liver Disease: Karen’s Story

She has dealt with non-alcoholic fatty liver disease almost as long as she has been in her 42-year nursing career. For 62-year-old Cle Elum resident, Karen Anne Anderson, RN, that means she has practiced what she preaches – being her own best health advocate – for more than four decades in her battle against non-alcoholic steatohepatitis (NASH).

NASH is the most extreme form of non-alcoholic fatty liver disease (NAFLD), which occurs when fat is deposited in the liver due to causes other than excessive alcohol use.

Karen was in her 20s when she initially noticed that something was wrong. Nausea and elevated liver enzymes led to gallbladder surgery in Puyallup. When her symptoms persisted, she was referred to Asma Siddique, MD, a member of the Liver Center of Excellence team at Virginia Mason.

Fatty liver lady

Karen Anderson with her daughter, Shiloh and husband, Chuck.

Upon assuming her care 10 years ago, Dr. Siddique ordered computed tomography (CT) scans and a liver biopsy. When the results were in, Karen was diagnosed with NASH-related cirrhosis (inflammation and scarring of the liver).

“Dr. Siddique’s comprehensive care has included ordering bloodwork and imaging, about every three to six months. She has also helped facilitate my participation in two clinical trials,” Karen remembers. “My other care includes periodic liver biopsies and help with lifestyle changes related to nutrition and exercise.”

When Karen is asked if she has advice for someone who might be at risk for NASH, she says, “I would tell them what I tell all patients – be proactive with your health, eat right, exercise regularly and listen to your body. If you are experiencing fatigue, nausea or discomfort in the lower, right area of your chest – where the liver is located – be sure to speak with your primary care provider about it.”

According to Dr. Siddique, people of Asian and Hispanic descent are at higher risk for the disease for reasons that are not clearly understood, but likely to include a combination of genetic, environmental and other factors.

It is difficult but possible to improve and even reverse NASH with lifestyle modifications such as diet, exercise, limiting alcohol use and treating risk factors like diabetes and cholesterol. If NASH is undiagnosed or untreated, the disease can progress to cirrhosis, which increases the risk of liver failure and liver cancer.

NASH is currently the second most common reason people require a liver transplant. “That is why it’s so important to not ignore non-alcoholic fatty liver disease,” advises Dr. Siddique. “Thankfully, clinical research in the next four to five years will likely result in FDA approval of a drug combination to treat the disease.”


A version of this story also appears in the Virginia Mason Health System 2017 Annual Report. 

Integrated Behavioral Health: Taking Care of the Body and Mind

A Virginia Mason patient for 32 years, Tom Cyr visited his primary care physician with some familiar complaints. He had back pain, a side effect from a hard physical career, and his damaged knee – a decades-long condition requiring multiple surgeries – threatened to derail daily life. Tom’s doctor addressed those problems but was equally concerned about signs he wasn’t coping.

Annual Report - Primary Care“I was down,” remembers Tom. “Bad things had happened in my personal life. My doctor felt it even more than I knew it.”

Tom got an appointment that day with Megan Bott, LICSW, outpatient and Emergency Department social work supervisor, through a program integrating behavioral health care with primary care. Under the previous system, a patient might get in touch with social services by phone, and that’s where most interactions took place. Integrated services mean patients like Tom can see a social worker right away, for assessment and short-term counseling if needed.

Megan and Tom decided to meet regularly to start some basic cognitive behavioral therapy. Megan describes it as practical, skill-based therapy focused on identifying disabling thought patterns, reviewing what’s worked in the past and trying new approaches for problem-solving. Patients may have up to eight visits with the social worker, and be referred for continued mental health care when more support is needed. Megan and her two social work colleagues – covering Virginia Mason’s downtown Seattle and Kirkland locations – also provide crisis counseling, assistance to seniors, caregiver support, resources for people with special needs, and referrals for those dealing with abuse or addiction.

“For a primary care provider who realizes their patient is in distress, we offer a ready resource to support a variety of issues, often just in time,” says Megan. “After a diagnostic evaluation, we work closely with the physician, sharing observations and coordinating treatment to meet more of the patient’s needs.”

Forced into early retirement due to health problems, Tom was already struggling when the death of one family member and serious injury to another left him feeling hopeless and adrift. In sessions with Megan, Tom revealed an interest in volunteering, but didn’t know where to start. Megan told him about volunteer opportunities at Virginia Mason and offered to help with the paperwork. Soon Tom had a volunteer badge and a new-found expertise preparing large mailings for the medical center.

“The volunteer work was my savior through the holiday months last year,” remembers Tom. “Megan helped me with a lot of things I couldn’t cope with at the time. I probably would’ve been in my doctor’s office every other week and that wouldn’t have solved the problem.”

After Tom’s counseling sessions with Megan, a referral to psychiatry was planned but not needed. Tom says they both figured he’d graduated. Still a dedicated volunteer, Tom’s looking forward to his upcoming partial knee replacement that should have him walking pain-free. “But Megan made it clear her door’s still wide open,” says Tom.


A version of this story originally appeared in the 2016 Virginia Mason Health System Annual Report.