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Windsong Whispers Newsletter Winter 2016

EVIDENCE SUPPORTS ROLE OF CALCIUM SCORING EXAM

According to the Centers for Disease Control and Prevention, heart disease is the leading cause of death in the United States for both men and women, accounting for nearly 25 percent of all deaths each year. The additional burden placed on the US healthcare system amounts to nearly $110 billion in healthcare services, medication and lost productivity.

According to research out of Johns Hopkins in 2014, the presence of calcium deposits in arteries of the heart is a powerful predictor of cardiovascular disease risk. Coronary calcium scores are a marker of biologic aging according to lead investigator, Cathy Handy, MD, MPH, an internal medicine resident at Johns Hopkins School of Medicine. The cardiac CT for calcium scoring is a non-invasive screening tool. It uses high speed CT to scan the heart and measure the total load of calcified (hardened) plaque in the coronary arteries to detect the presence of coronary artery disease at an early age. The presence and degree of calcification visible on CT scans of the arteries of the heart determine the calcium score of the individual.

The Johns Hopkins study demonstrated that individuals with small but detectable deposits of calcium buildup had twice the cardiovascular risk of people with plaque-free arteries. The fi ndings also suggest that calcium buildup also predicts elevated risk for cancer, lung disease, hip fractures and chronic kidney disease.

The Cardiac CT is recommended for men over 45 and women over 55 with the following risk factors:

  • Family or personal history of heart disease
  • Past or present cigarette smoking
  • High cholesterol
  • Diabetes
  • High blood pressure

HELP FOR CHRONIC PELVIC PAIN

Causes of chronic pelvic pain are varied, but are often associated with pelvic varicose veins also known as pelvic congestion syndrome (PCS) when other etiologies are not found such as uterine/ovarian abnormalities. Signs of PCS may include irritable bladder, varicose veins on vulva, buttocks or thigh and leg swelling / varicose veins.

PCS is similar to varicose veins in the legs. Both result when the valves in the vein become weakened and do not close properly allowing blood to fl ow backwards and pool in the vein causing pressure and bulging veins. Since this worsens with sitting/standing (due to backup from gravity), symptoms often worsen throughout the day.

Common signs:

  • Leg/pelvic/buttock pain, aching or cramping
  • Pelvic discomfort and fullness throughout the month
  • Pelvic bloating
  • Pain/aching with and/or after intercourse
  • Pelvic/abdominal tenderness

Symptoms may be worse:

  • After standing for long periods of time
  • Following intercourse
  • During menstrual periods
  • During/following pregnancy

PCS is most common in 30 – 50 year old women. Other factors that may increase risk include a history of varicose veins, two or more pregnancies, polycystic ovaries and hormonal dysfunction.

Dr. Dana Dunleavy, director of Windsong’s Interventional Radiology team, can evaluate for pelvic congestion syndrome using a specialized ultrasound. Treatment for PCS at Windsong involves an outpatient minimally invasive procedure carried out under local anesthesia with intravenous sedation, to assure patient comfort. A small catheter is placed into the vein to perform a diagnostic venogram. Blood supply to the pelvic varices is then blocked by the use of surgical plugs and/or embolic agents. The blood is then rerouted from the damaged veins, into healthy veins. After the procedure, patients can return home or to work immediately.

If you have patients that could benefit from a consultation, please have them contact the Interventional Radiology appointment line at (716) 929-9484.


NEW VARICOSE VEIN TREATMENT OFFERED AT WINDSONG

On December 15, 2015 Windsong’s Interventional Radiology clinic became the very first facility in the greater Western New York area to perform the VenaSeal™  closure system procedure for venous reflux / varicose veins. There is currently only one other area in New York State that has utilized this cutting edge technology. This procedure is performed by Dr. Dunleavy, who is board certified with fellowship training in Interventional Radiology from Johns Hopkins Hospital.  He also holds a Certificate of Added Qualification in Vascular / Interventional Radiology.

The VenaSeal™ treatment is a new minimally invasive procedure which uses an advanced medical adhesive to close the diseased vein in patients with symptomatic venous reflux disease.

Venous reflux disease occurs when valves in the veins of the lower leg no longer function properly. This allows blood to flow backward, or reflux, resulting in enlarged or varicose veins as well as other symptoms such as swelling and heaviness.

“Varicose veins may be a sign of a more serious condition known as chronic venous insufficiency, which in severe cases can result in lifestylelimiting lower leg pain, swelling, skin damage and ulcerations,” said Dr. Dana Dunleavy, Director of Interventional Radiology at Windsong.

Windsong’s commitment to state of the art technology reaches far beyond breast imaging with the addition of the VenaSeal™ procedure. Clinical trials have shown that this closure system often has minimal to no bruising and allows patients to return to normal activities quickly. Unique to the VenaSeal™ treatment is that only one needle stick is needed, eliminating the need for the additional injections of local anesthetic around the treated vein – unlike endovenous laser ablation or radiofrequency ablation.

As a new FDA approved procedure, the VenaSeal™ does not currently have a procedure code and is not currently covered by medical insurance, and is therefore only available as a self pay option. Other treatment techniques which do have a procedure code and are covered by insurance are also offered at Windsong’s vein practice.

To schedule a consultation, please contact Windsong’s Interventional Radiology clinic at (716) 929-9484.


MAMMOGRAPHY GUIDELINES

Windsong Screening Mammography Recommendations

Breast cancer is the most prevalent type of cancer (excluding skin cancer) and accounts for more than 40,000 of all cancer-related deaths in American women (2nd only to lung cancer). One of every 8 women will be diagnosed with breast cancer in their lifetime.

Why all the fuss over mammograms?

As you might know, the USPSTF and more recently, the American Cancer Society, have made recommendations contrary to the American College of Radiology (ACR), the American College of Obstetrics and Gynecology (ACOG), the Society of Breast Imaging (SBI), the National Comprehensive Cancer Network (NCCN), and the American Medical Association (AMA). In accordance with the long standing guidelines adopted by the American College of Radiology, Society for Breast Imaging, ACOG, Windsong strongly recommends women begin ANNUAL screening mammograms at age 40. Women with a family history of breast cancer should consult their physician about when to start mammography and if additional imaging is needed.

It should be noted that the new American Cancer Society breast screening guidelines and previous data used by the United States Preventive Services Task Force to create their recommendations, acknowledge that starting annual screening at age 40 saves the most lives.


MEDENT USER TIPS

If you utilize Medent, you should check the fax number in your system to ensure it is going to our dedicated fax line at (716) 631-4051. If you are using other fax numbers, we cannot assure that the faxes are being picked up on a regular basis. We have also noticed that some Medent scripts are coming over with an old Lancaster address. Please note that the new address should be 4893 Transit Road, Depew, NY 14043. You may need to make the change in your EMR to avoid patient confusion.


WINDSONG COMPREHENSIVE BREAST CARE WELCOMES NEW BREAST CARE COORDINATOR

Kay Dekker, RN, BSN, recently joined the Windsong Comprehensive Breast Care program as the Breast Care Coordinator. As Kay stated, “I was drawn to this position based upon two distinct factors – the excellent reputation of Windsong and my personal experience with losing a loved one to breast cancer.” Kay added that prior to her first interview she did her due diligence and heard numerous accolades relative to the quality of services provided at Windsong, as well as the expertise and professionalism of surgeons, Dr. Peyser and Dr. O’Donnell. Kay added, “Many I spoke with indicated that if they had a loved one with breast cancer they would seek services at Windsong Comprehensive Breast Care. There was no question that I wanted to be a part of a program that really makes a difference in the lives of patients.

Kay recently spent the day with one of the breast surgeons and was extremely impressed with the personal care and education provided to patients and their family members. “Each and every patient was treated with the utmost respect and individualized care,” said Kay. She feels that there are miracles happening on a daily basis within the Breast Care program.

Kay has been fortunate in her career to work in a variety of settings including developmental disabilities, assisted living, homecare, palliative care and hospice, in both the for profit and not for profit worlds. She firmly believes that each setting afforded her the opportunity to grow personally and professionally. Kay’s areas of expertise are healthcare operations, business development, marketing, compliance, contract negotiations, customer satisfaction, staff development and training. She admits that her greatest joy is helping others and sharing what she has been fortunate to learn over the years.

Kay has been married to her best friend and partner in crime, Andy for 32 years. She has two beautiful daughters and two wonderful son-in-laws and a fantastic 4 year old grandson. Kay is a bit of a dare devil, having sky dived, and parasailed. She has also done her share of white water rafting, zip lining, jet skiing, and has even done a ride along in a race car. Please don’t hesitate to reach out to Kay if you have questions related to a newly diagnosed breast cancer patient.
She can be reached at (716) 631-2500, ext. 2208


WINDSONG PACS ZERO DOWNLOAD APPLICATION

Go to the PACS Login here on the site, enter your Username and Password to access PACS. Here you can search for your patient’s exam images and associated report. For optimum query results, use the following format: LAST NAME, (SPACE) FIRST NAME and click the Blue arrow next to the search text box:

The Filter should be set to (All) and View set to All Exams.

The Buttons of interest at the top of the page assist you in viewing the Report, viewing the exam, and the ability to identify if any prior exams were performed at our facility.

There is also the Skill Builder which has some good tips and tutorials on maneuvering through the site, and may be helpful in answering any questions you may have.
If you do not have a log in, please contact Janiene at (716) 6312500 ext. 2249


LOW DOSE LUNG CANCER SCREENING

Most have heard that an annual low-dose chest computed tomography (CT) for lung cancer is an eligible screening benefit for any patient with insurance that meets the screening requirements, however some confusion lies around who is eligible.

Who is eligible for an annual low dose lung cancer screening CT?

Patients between 55-80 years old (55-77, if Medicare) who are current or former smokers with at least a 30 pack-year history of cigarette smoking who have smoked within the last 15 years are eligible. Once referred to Windsong, patients will be evaluated for screening and enrolled in a comprehensive program to help reduce the risk of lung cancer. The program will include smoking cessation and reminders for recommended follow up appointments.

What do you do with patients that are not eligible because of age but meet all other criteria?

Although the criteria for screening is fairly stringent, there are times when patients that are younger may receive the screening with clinical support from their physician. On those occasions when the physician feels it may be beneficial for the patient to have the exam, the recommendation would be to have the physician attempt to get authorization for the screening based upon clinical information, regardless of age. There are times when the insurers will make an exception and we feel it is best to advocate on behalf of your patients. If the authorization is denied, the patient could pay the out of pocket cost for a chest CT without contrast, about $225.

Coding Blues and IHA Patients

Please keep in mind that IHA does not recognize the S8032 code which should be submitted for Blue Cross Blue Shield patients. IHA asks that physicians code the low dose lung screening as a chest CT without contrast (71250) with a screening diagnostic code.

To make an appointment or to refer a patient, call Windsong at (716) 631-2500. For more information about the program, please contact Windsong’s Lung Patient Navigator, Tracey Supples at (716) 631-2500 ext. 2183

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