Vol.3 Issue 4 - The MetroHealth System

MetroHealth Dialogue
Volume 3 Issue 4
metrohealth.org/dialogue
Spine Center supports
referring physicians
MetroHealth’s gynecologic cancer team includes, from left to right, Peter G. Rose, MD, Director
of the Division of Gynecologic Oncology; Abdelwahab D. Shalodi, MD, Gynecologic Oncology;
Peter M. Laye, MD, Director, Radiation Oncology; Lisa Vibbert, RN; Timothy Phillip Kasprzak, MD,
Diagnostic Oncology Imaging; and Pamela Haba, RN, OCN.
MetroHealth offers highly focused
gynecologic cancer treatments
MetroHealth has one of the area's largest gynecologic cancer programs.
Resources for gynecologic cancer at MetroHealth include:
■ A cancer care team to provide coordinated care.
Specially trained oncology nurses
An outpatient social worker
Genetic counselors
A specialized gynecologic pathologist
A radiologist specifically trained in interpreting X-rays for cancer.
■ A state-of-the-art Colposcopy Clinic on MetroHealth’s main campus.
■ Specialized, cancer-specific imaging protocols for staging.
■ Access to all open Gynecologic Oncology Group sponsored clinical trials.
■ Computer technology which makes chemotherapy dosage extremely
accurate and easier to track.
■ Interventional radiology for insertion of IV ports, fine-needle biopsies and
minimally invasive treatments to cut off blood supply to tumors.
■ $5.4 million in new radiation oncology technology, including a new
dedicated high dose rate bracytherapy system and suite.
The most common gynecologic cancers treated at MetroHealth include
endometrial, ovarian and cervical cancer. “We see more advanced cervical
Continued on page 5
MetroHealth Spine Center physicians
consult with referring physicians
and help plan care for spine issues
including pain management,
physical medicine and rehabilitation,
interventional procedures, minimally
invasive surgery and advanced
surgical procedures.
Conservative treatment options:
❚ Rest
❚ Physical therapy
❚ Injections
❚ Anti-depressants
❚ Muscle relaxants
❚ Orthotics
❚ Steroids
❚ Radiofrequency rhizotomy
Physical therapy is the mainstay of
those options, said Daniel Malkamaki,
MD, who is a physical medicine &
rehabilitation (PM&R) specialist on
the Spine Center team. “We have to
get patients moving and you need
to help patients cope through that
movement,’’ oftentimes through
a combination of medication and
therapy.
Continued on page 4
Call the Physician
Referral Service:
216-957-3222
or 1-866-260-5376
PROUD SPONSOR OF THE COMEBACK

CASE STUDY: Hand surgery
The physician:
Kevin J. Malone, MD
Department of Orthopaedic Surgery
The patient:
A 55-year-old truck driver had his thumb crushed in the hitch of
a truck. He was a non-smoker with no significant past medical
history. The accident resulted in an incomplete thumb amputation
with extensive bone and tendon injury. Surgery was done for
revascularization and to try and repair the area. Only one artery was
repairable; no vein was repairable. Over the next several days, the
thumb appeared more ischemic and necrotic and the patient was
experiencing shortness of breath. The patient went to the OR for
revision amputation and primary closure.
The evaluation:
The short thumb would lead to significant functional limitations.
Options for this patient included toe-to-thumb transplantation,
a prosthetic thumb or thumb metacarpal lengthening. Toe-tothumb
transplantation surgery involves removing one toe with its
associated blood vessels, nerves and tendons and attaching it to the
hand where the thumb had previously been. This is a good option
when a significant portion of the native thumb has been lost. This
patient had preservation of his thumb metacarpal, which made
lengthening an option to improve the function and appearance of his
thumb without sacrificing other body parts.
The procedure:
Metacarpal lengthening was done over a course of 13 weeks. At
the initial surgery, a fracture was created in the metacarpal and a
special external fixation system was applied that could be adjusted
daily to lengthen the bone through the fracture site and allow the
fracture to heal. It is a slow process that requires the patient to
adjust the external fixation system several times a day to control
the lengthening. The body can accommodate lengthening of
approximately 1 mm per day, which will allow the soft tissues to
stretch and the fracture to heal. Our target was a 2 cm increase in
length. At the end of the lengthening process, the external fixation
system was left in place until the fracture healed. The process took
approximately three months. After the external fixation device was
removed, a second surgery was performed to deepen the web
space between the thumb and index finger, which also results in
indirect lengthening of the thumb and allows the patient to grasp
larger objects. At the end of this process, the patient was fitted
with a thumb tip prosthesis that was designed to match the skin
color. The prosthesis is not durable enough to be used for forceful
grasping and pinching, but produces a cosmetically appealing result.
Metacarpal lengthening was done using a special
external fixation system.
After the bone was lengthened, surgery was done
to deepen the web space between the thumb and
index finger.
The final result is seen on the hand at left.
The result:
The patient was able to return to work as a truck
driver. He was able to use his hand for all jobrelated
tasks and activities of daily living. This is a
good outcome for a traumatic thumb amputation.
2
For more information: metrohealth.org/dialogue

CMEs: Save the date
(Also see page 8)
The 2nd Annual Trauma Symposium,
a collaboration between The MetroHealth System
and Cleveland Clinic hospitals. Offering two days
of wide-ranging education and discussion geared
toward physicians, nurses, EMS/pre-hospital and
hospital medical professionals of all levels.
Friday and Saturday, Oct. 12-13
Intercontinental Hotel, 9801 Carnegie Ave.,
Cleveland, Ohio 44106.
Hand team members from left to right: Kevin Malone, MD; Blaine Todd
Bafus, MD; Harry A. Hoyen, MD; and Michael W. Keith, MD.
Hand care now available in Lyndhurst
MetroHealth orthopaedic surgeons Kevin Malone, MD, and Blaine
Todd Bafus, MD, are now seeing patients at offices located at
29001 Cedar Rd, Suite 519, (the corner of Cedar and Brainard
Roads) Lyndhurst. The MetroHealth office was established there
at the former offices of hand surgeon Stanley H. Nahigian MD,
who retired.
Dr. Malone joined MetroHealth’s Department of Orthopaedics in
2007 as a member of the hand and upper extremity reconstruction
team. He is an assistant professor at Case Western Reserve
University School of Medicine, Department of Orthopaedics.
Dr. Malone completed medical school in Cincinnati and residency
in orthopaedic surgery in Detroit. He then spent a year in Seattle
completing a fellowship in hand and microvascular surgery, with
a heavy emphasis on upper extremity trauma. His clinical and
research interests include traumatic and degenerative conditions
of the elbow, forearm, wrist and hand.
Dr. Bafus is a board-certified orthopaedic surgeon and performs
acute, reconstructive and rehabilitative treatment for injuries or
disorders of the fingers, hand, wrist, arm, elbow and shoulder.
Dr. Bafus is an Assistant Professor at Case Western Reserve
University School of Medicine, Department of Orthopaedics.
Dr. Bafus completed medical school in Portland, Oregon, and
residency at The University of Michigan Health System in
Ann Arbor. He was fellowship-trained at The Cleveland Clinic.
His clinical and research interests include orthopaedic outcomes,
carpal tunnel syndrome and hand fractures in the combat setting.
Both Drs. Bafus and Malone also see patients at MetroHealth
Medical Center.
For more information, visit
northernohiotraumasystem.org
CME, CEU, Con-Ed credit hours will be available
The 2nd Annual Newest Solutions for
Cardiac Problems Symposium, “An
Essential Update for Primary Care
Providers,’’ presented by the MetroHealth
Heart & Vascular Center.
Thursday, Oct. 18, Noon-5:30 p.m.
Embassy Suites Hotel - Rockside
5800 Rockside Woods Blvd., Independence, Ohio
For more information, contact Holly Bennett at
216-778-3925 or visit MetroHealth.org/heart.
CME credits will be available
12th Annual Perinatal Conference,
presented by the Perinatal Center of Northeast
Ohio at MetroHealth and the Cleveland Society of
Obstetricians & Gynecologists. Featured speakers
include Cynthia Gyamfi, MD, FACOG, Director,
High-Risk Perinatal Clinic, New York-Presbyterian
Hospital, Columbus University Medical Center,
and Mona Prasad, DO, MPH, Assistant Professor
of Obstetrics and Gynecology, Department of
Obstetrics and Gynecology, The Ohio State
University Wexner Medical Center.
Wednesday, Nov. 14, 8 a.m. to 5 p.m.
MetroHealth Medical Center
2500 MetroHealth Drive, Cleveland, Ohio 44109.
For more information, call 216-778-5498.
CME credits will be available.
3
Call the Physician Referral Service: 216-957-3222 or 1-866-260-5376

Spine Center supports referring physicians (from page 1)
Spine Center PM&R and pain management specialists work
together and keep referring physicians informed as patients
progress through stages of physical therapy.
“Even with lumbar stenosis, gains are realized with manual
physical therapy intervention,’’ Dr. Malkamaki noted during a
recent CME about a multi-disciplinary approach to spine care.
Michael Steinmetz, MD, Medical Director of the Spine Center, told
CME attendees that surgery is indicated for patients when there is:
❚ Failure of conservative therapy, which typically can
be decided at about 8 weeks
❚ Intractable pain not responding to medicine
❚ Progressive weakness
“Most patients improve without even needing to be seen by
a surgeon,’’ said Dr. Steinmetz. “However, when they do not
improve, surgery can be needed.”
The goal of surgical treatment is pain relief through several
pathways:
❚ Decompressing static neural compression
❚ Stabilizing the spine if pain is due to instability
or causing dynamic neural compression
❚ Improving alignment if deformity is present
“More often than not, surgery involves multiple strategies to try
to address the problems the specific patient is facing,” said Dr.
Steinmetz.
Early referral to Spine Center specialists can impact patient
outcome. Some reasons to consider early referral include:
❚ Lateral degenerative changes and discs producing
radiculopathies (compression of nerve roots)
❚ Degenerative changes along the posterior margins of
the vertebral bodies and the posterior longitudinal
ligament resulting in compression of the cord and
a myelopathy (central discs can contribute to this)
❚ Intractable pain with progressive weakness
❚ Lhermitte’s sign - electric shock sensation down the back
and into the upper extremities
MetroHealth’s specialized Spine Center treats patients when the
current treatment is not helping or when symptoms are worsening.
It is designed to take the guesswork out of where and when to
refer the patient and to which specialist. The center’s goal is to get
the patient to the right specialist and then back to their primary
provider when feeling better.
New imaging center
offers quick scheduling,
interpretations for
referring physicians
The state-of-the-art imaging center at
MetroHealth West 150th Health & Surgery
Center offers referring physicians:
❚ Imaging interpretations within
24 hours (sometimes less)
of testing completion.
❚ Extensive subspecialty interpretation
of images.
❚ A wide-bore MRI which is hospitable
to patients up to 550 lbs., as well as
those patients who can’t lie down
in a flat position.
❚ Full handling of insurance authorization
for imaging tests with immediate
scheduling upon receipt of insurance
authorization, generally within three
days and sometimes sooner.
In addition to the MRI, the center offers:
❚ 16 slice CT Scanner
❚ Ultrasound
❚ Diagnostic X-Ray
The health center, at 4330 W. 150th St. in
Cleveland, is less than a minute from I-71,
offering convenience for patients coming
from many areas in Cuyahoga County.
Visit metrohealth.org/imaging
for more information.
4 For more information: metrohealth.org/dialogue

Pediatric surgeons available 24-7
Pediatric surgeons are available at MetroHealth
around the clock, seven days a week for surgeries
and consults. The surgeons are available as part of
an agreement MetroHealth has with Akron Children’s
Hospital to provide MetroHealth patients with
specialists.
Four surgeons are part of the pediatric team working
at MetroHealth, sharing one-week rotations. “We
are always available by phone for consults and we
are always within an hour or less of being here,’’ said
Robert Parry, MD, Chief Attending Pediatric Surgeon,
who has been seeing patients at MetroHealth for
seven years.
Pediatric surgical procedures at MetroHealth Medical
Center in August and April of this year were at the
highest volumes in the past 24 months. And about
60 percent of cases which the surgeons see are
emergent. “While we are seeing more patients than
predicted, we have room to see more,’’ he said.
Robert Parry, MD
Todd Ponsky, MD
Gynecologic cancer treatments
(CONTINUED from front page)
cancer than other area hospitals because
many of our patients don’t have health
coverage and don’t come for regular
screening,’’ said Abdelwahab D. Shalodi,
MD, a gynecologist oncologist with more
than 31 years of experience treating
cancers.
MetroHealth’s gynecologic cancer medical
specialists meet regularly to review cases
and treatment plans.
The radiation oncology upgrades streamline
treatment, said Peter M. Laye, MD, Director,
Radiation Oncology. “The most current
radiation therapy technology allows us to
shape the radiation field around the tumor
and avoid surrounding normal tissue. We
can administer a high dose to the tumor
without damaging healthy tissue.’’
Dr. Parry noted that MetroHealth’s high-quality NICU
and PICU are critical partners for the surgical team.
Physicians: For a consult with a pediatric surgeon
Monday through Friday, 8 a.m. - 4:30 p.m.
call 216-207-1255.
Most common pediatric surgical
procedures at MetroHealth:
Inguinal hernia repair
Umbilical hernia repair
Circumcision
Laparoscopic appendectomy
Abscess incision and drainage
Laparoscopic gastrostomy
Exploratory laparotomy
Foreign body removal
Nissen fundoplication
Mass excision
Esophageal dilatation
Laparoscopic cholecystectomy
Perirectal abscess incision and drainage
Cyst excision
Lysis of adhesions
Oliver Soldes, MD
Mark McCollum, MD
Dr. Laye noted that the technology allows
administering treatment at a rate more
than 40 percent faster than conventional
machines. “This means patients can
complete their treatment faster and spend
more time with their family.’’
“It’s a great team,’’ said radiologist Timothy
Kasprzak, MD, who is trained to detect
subtle changes in tumors. “We can tailor our
evaluations to accurately stage gynecologic
cancers. For instance, high resolution
magnetic resonance imaging (MRI) of the
cervix can help determine if a patient is a
candidate for surgery. For ovarian cancer,
our radiology specialist can evaluate for
spread to soft tissues in the abdomen.’’
“Our dedicated gynecologic oncology
nurses follow our patients with physicians
from day one,” said Pamela Haba, RN, OCN,
“educating them extensively about the
diseases and treatments and side effects.
We work with a wonderful palliative care
team who help patients fight the diseases
and continue with life and treatment.’’
5 Call the Physician Referral Service: 216-957-3222 or 1-866-260-5376

Rehabilitation Institute of Ohio moves to new facility
The MetroHealth Rehabilitation Institute of Ohio is a nationally
recognized leader in providing high-quality comprehensive
rehabilitative services for patients recovering from traumatic
brain injury, spinal cord injury, stroke, traumatic injuries of the
neuromusculoskeletal system, amputations, joint replacements
and other disabling conditions.
Facts about the MetroHealth
Rehabilitation Institute of Ohio
We have been designated on multiple occasions by
the National Institute on Disability and Rehabilitation
Research as a Model System program for spinal
cord injury. This designation assures patients of
receiving the most advanced therapies and having
opportunities to participate
in groundbreaking research.
We attract more than $13 million in funded
clinical research from federal, state and private
agencies, and have built one of the most
comprehensive residency and fellowship training
programs in the nation.
We are partnered with the internationally
acclaimed Cleveland Functional Electrical
Stimulation Center, in collaboration with Case
Western Reserve University and the Cleveland Louis
Stokes Veterans Administration Medical Center.
Patients benefit from the use of new technologies
and innovative engineering to restore movement in
paralyzed limbs.
The inpatient rehabilitation institue is moving to a fully updated,
modern facility located at MetroHealth Old Brooklyn Health
Center in Cleveland’s historic Old Brooklyn neighborhood. This
attractive building provides a quiet and pleasant environment
and has been completely remodeled to address the specific
needs of rehabilitation patients. Features include large, private
patient rooms, dedicated family gathering areas, expanded
therapy gyms and bright, wide corridors. Located only 2 miles
south of MetroHealth Medical Center, the Old Brooklyn Health
Center is at 4229 Pearl Road (between Memphis Avenue and
State Road). It has a convenient, safe, well-lit and enclosed
parking garage, with a connecting climate-controlled bridge.
This substantial investment in the MetroHealth Rehabilitation
Institute of Ohio will help ensure that patients continue to
receive the highest quality rehabilitation services to achieve
the best possible recovery and successful re-entry to the
community at their highest possible functional level.
Find out what sets the MetroHealth Rehabilitation Institute
of Ohio apart as a model for rehabilitation excellence.
Contact Dawn Laws, PM&R Director of Clinical Operations,
at 216-778-3776 with questions or to schedule a tour.
6 For more information: metrohealth.org/dialogue

New medical staff members at MetroHealth
Mohammad Mobayed, MD
MetroHealth Cancer Care Center,
hematology and oncology
Special interests: Gastrointestinal malignancies, breast cancer, lymphomas
Medical school: Damascus University School of Medicine
Residency, Fellowship: Wayne State University/Detroit Medical Center
Board certifications: American Board of Internal Medicine/Hematology,
American Board of Internal Medicine/Medical Oncology
Maria Isabel Herran, MD, FAAP
Director, MetroHealth Pediatric and Adolescent Hispanic Clinic
Special interests: Healthcare needs specific to the Hispanic population, well child and teen care;
school and sports physicals
Medical school: University of Puerto Rico School of Medicine, Rio Piedras, Puerto Rico
Residency: University Children’s Hospitals, Puerto Rico Medical Center
Fellowships: Northeast Ohio Medical University, Rootstown, Ohio; Mt. Sinai Hospital, Cleveland, Ohio
Board certification: American Board of Pediatrics
Blaine Todd Bafus, MD
Orthopaedic surgery, Hand and Upper Extremity Center
Special interests: Acute, reconstructive and rehabilitative treatment for injuries or
disorders of the fingers, hand, wrist, arm, elbow and shoulder; peripheral nerve injury;
enhancing care of the wounded veteran and veteran related issues
Medical school: Oregon Health & Science University, Portland, Oregon
Residency: University of Michigan Health System, Ann Arbor, Michigan
Fellowship: Cleveland Clinic Foundation, Cleveland, Ohio
Board certification: American Board of Orthopaedic Surgery
William L. Camp Jr., MD, MPH
Dermatology
Special interests: Skin cancer management, cutaneous infectious disease, psoriasis,
allergic contact dermatitis, cosmetic procedures
Medical school: University of Alabama School of Medicine, Birmingham, Alabama
Residencies: Internal Medicine, University of Alabama School of Medicine, Birmingham, Alabama; dermatology,
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, and University of Alabama School of Medicine.
Fellowship: NIH/NRSA Training Fellowship in Investigative Dermatology, University of Alabama, Birmingham
Board certification: American Board of Internal Medicine
Carvell Quang Tran Nguyen, MD, PhD
Urologist, urologic oncology
Special interests: Urologic cancer research, cancer biology
Medical school: University of Southern California Keck School of Medicine
Residency: The Cleveland Clinic, Cleveland, Ohio
Fellowship: The Cleveland Clinic, Cleveland, Ohio
Michael R. Zetz, DDS
Oral and maxillofacial surgery
Medical school: The Ohio State University College of Medicine & Public Health, Columbus, Ohio
Residency: Medical University of South Carolina, Charleston, South Carolina
Certification: American Board of Oral & Maxillofacial Surgery
7 Call the Physician Referral Service: 216-957-3222 or 1-866-260-5376

MetroHealth clinical trial aims
at resistant hypertension
Do you have a patient with hypertension that
is resistant to medical therapy? MetroHealth
is enrolling patients in a clinical trial that offers
the possibility of a surgical procedure to treat
hypertension.
Renal denervation involves threading a
catheter into the renal artery and using
radiofrequency energy to disrupt nerve
communications to and from the kidneys.
Patients go home the day following the
procedure. Data to date suggest that
the procedure may be very effective for
hypertension and is associated with very low
rates of complications.
2500 MetroHealth Drive
Cleveland, Ohio 44109
PRSRT STD
US Postage
PAID
Cleveland, OH
Permit No. 633
For more information, call 216-778-7110
or go to metrohealth.org/dialogue.
Your personal
health care assistant
Connect with
MetroHealthCLE on
Cardiovascular symposium for primary care physicians
A practical look at the most common cardiovascular conditions
will be offered to primary care physicians, nurse practioners
and nurses in an upcoming event presented by members of
MetroHealth’s Heart & Vascular Center.
“Important advances have occurred in the field of cardiovascular
medicine, especially in the area of vascular medicine. This event
will provide current guidelines about these advances from a
nationally known expert as well as a break-out session for case
presentations,’’ said course director Catherine C. Fallick, MD,
FACC, a heart failure specialist at MetroHealth.
“Sessions will give physicians personal access to clinical experts
to answer any questions they may have,‘’ said Dr. Fallick.
“The luncheon session featuring researcher Isabelle Deschenes,
PhD, will provide updates on the revolutionary science of
personalized medicine,’’ said Dr. Fallick.
William R. Lewis, MD, MetroHealth Chief of Clinical Cardiology,
will address the role of cardiac screening in the sports physical and
the risk of sudden cardiac death in athletes.
The 2nd Annual Newest Solutions
for Cardiac Problems Symposium,
“An Essential Update for Primary
Care Providers,’’ presented by the
MetroHealth Heart & Vascular Center.
Thursday, Oct. 18, Noon-5:30 p.m.
Where: Embassy Suites Hotel -
Rockside, 5800 Rockside Woods Blvd.,
Independence, Ohio
For more information, contact Holly
Bennett at 216-778-3925 or visit
MetroHealth.org/heart. CME credits
will be available
8
Call the Physician Referral Service: 216-957-3222 or 1-866-260-5376