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Home | Tag Archives: William Beaumont Army Medical Center

Tag Archives: William Beaumont Army Medical Center

WBAMC’s Addiction Medicine Intensive Outpatient Program Shifting Culture, Stigma at Fort Bliss

From tanks and fighter jets to grenades and cadence, the public’s perception of the military as an institution and the culture varies.

Perceptions within the ranks also extend to service members who fear reprisal if asking for help, a stigma the staff at Fort Bliss’ Addiction Medicine Intensive Outpatient Program (AMIOP) are working to end.

Since opening doors to Fort Bliss service members just over a year ago, over 150 service members have completed a six-week program at the AMIOP to sober up and break free from addiction. But, according to the experts, the AMIOP is only the beginning of recovery.

“Initially (service members) start at (Substance Use Disorder Clinic Care, or SUDCC) for most cases,” said Gisela Carter, program director, AMIOP / Partial Hospitalization Program (PHP). “A lot of times they get sent fairly quickly to us if they have higher needs.”

The AMIOP, the only one of its kind at Fort Bliss, offers intermediary rehabilitation for service members and provides a level 2.5 level of care based on the American Society of Addiction Medicine’s (ASAM) continuum of care which describes treatment as a continuum marked by four broad levels of service and an early intervention level. The lowest level of care, according to ASAM, is at level 0.5, early intervention, with the highest being at level 4, medically managed intensive inpatient services. The six-week-long program differs from SUDCC by approaching addiction with a full schedule of therapy modalities designed to keep patients engaged and practicing methods toward rehabilitation.

“We provide the tools during that six-week program and collaborate with patients (after completing the program) to see how they are using the tools,” said Maj. Marlene Arias-Reynoso, AMIOP medication provider/ SUDCC consultant and chief of 1st Brigade Combat Team, 1st Armored Division Embedded Behavioral Health. “The earliest they come and get help, the more effective the treatment will be. If they don’t come until a DUI later, there’s already things in place. Although the Soldier may want to recover, their career may likely be over.”

For one Soldier, a self-referral helped set up the Soldier to continue in the Army before the addiction took over.

“I had personal issues that escalated and I started going to Embedded Behavioral Health to get help then I was introduced to the program,” said the Soldier. “I was off-track very badly, everybody saw a change in me, even (senior leaders) before going through AMIOP.”

The Soldier, who wishes to remain anonymous, initiated his recovery at SUDCC and eventually found himself at the AMIOP for elevated care.

“For the first two weeks, like most people, I thought this was a bunch of BS. We’re going to come in here and sing Kumbaya, a lot of people are just going to say, ‘this is what you should do…’ but after we got past that particular phase, I had a few emotional days. They started to peel the layers off the onion to figure out what makes us turn to using substances,” said the Soldier. “It provided an open forum, where you can actually speak to others going through the same thing, because back in the unit you can’t speak to others freely. The group is where everybody opened up, in that forum, with a bunch of strangers and I put my business out there, but to this day we still have that group that we had.”

The Soldier’s perception of stigma surrounding Soldiers who ask for help is one the AMIOP staff is working to transform.

“There’s still a huge stigma about people who are recovering. There are still negative connotations with it,” said Carter. “Sometimes the value of the Soldier decreases and becomes negative because of the stigma, people refer to them as ‘bad for the unit’.”

In 2016, the Army Public Health Command’s Health of the Force report, a force-wide annual report discussing factors impacting Soldier readiness, lists five percent of active-duty Soldiers across the Army as being diagnosed with substance use disorder. The report consolidates the misuse and abuse of alcohol with prescription medication and other drugs.

“The longer you keep struggling with whatever substance, the worst the outcome is going to be. Habits are hard to break, so addicts may go back to (abusive) behaviors,” said Arias-Reynoso. “This is only six weeks, after that are the challenging times. The certificate (for completing the AMIOP program) is not the end, it’s the beginning.”

According to the Soldier, one activity at the AMIOP helped him realize the importance of scheduling and keeping him active to deter him from negative behaviors.

“I’m back to the (Soldier) who (other Soldiers) knew. I had stopped going to the gym, I loved being outdoors and I had gotten away from all of that because of depression, anxiety, and crazy thoughts going through my head,” said the Soldier. “I needed to eliminate the drinking, because at first I just wanted to minimize. But, (at the AMIOP) you have breathalyzers, urinalysis, AA meetings, which are eye-openers, just to see the long-term effects of what alcohol was doing.”

By starting treatment, the Soldier was also able to reconnect with a daughter who was beginning to notice the changes.

“I have no problem talking, but I wasn’t reaching out to my family as much (when the Soldier started drinking heavily). Once I opened up to family, it became easier to speak more about (addiction). Now our conversations are back to normal,” said the Soldier.

“When we have graduation in six weeks, I always tell (patients), this is genesis, this is the beginning, this is the initial start of the recovery,” said Carter. “There’s after-care at the SUDCC, in addition they come back to us on Fridays for several weeks to see how they are doing. It is like a recovery group for patients that have attended the AMIOP, and on the outside they continue that external support system like Alcoholic Anonymous or Narcotics Anonymous.”

According to AMIOP staff, continuity of treatment is essential in recovery and staying sober, with many programs designed to continue care three to six months after completing the program, to include family counseling.

“The program definitely gave us different tools to deal with the triggers, I don’t even go out to clubs anymore, I go do my activity and back to the house,” said the Soldier. “It’s helping me deal with everyday life and motivate me not to drink. As long as you have like-minded people and someone who has been through a similar experience, then you can relate. And that’s one of the best things about the program.”

Two cohorts of eight service members occupy the program year round, with each cohort’s participants starting at the same level of recovery.

“Recovery is not just something that happens, it’s a process and people have to continue to work on it,” said Carter. “Sometimes we have patients here until the day they walk out the gate (are out of the military), if a patient is willing to stay and work with us then we’re willing to admit them.”

“The tools that they learn here, even as civilians they can potentially apply them to their lives,” said Arias-Reynoso. “Being sober is not recovery. Have you changed your lifestyle? Not just stop your substance.”

Each September is Recovery Month, a Substance Abuse and Mental Health Services Administration-sponsored observance to increase awareness and understanding of mental and substance use disorders and celebrate those who recover. This year’s theme is: Join the Voices for Recovery: Invest in Health, Home, Purpose, and Community.

In efforts to increase awareness of addiction symptoms, the AMIOP recently provided training to primary care providers at Fort Bliss to help identify addictive behaviors, during regular exams to help service members before it becomes a habitual juggernaut.

“Anybody that actually needs help, no matter what your rank, don’t be afraid to stand up and say something,” said the Soldier. “Just speak up, don’t try to handle all issues by yourself. I always thought I was one of those people where it won’t happen to me and I had my stuff together but I didn’t… and it all came crumbling down.”

Today, the Soldier is back at his unit and working toward bettering himself while continuing counseling during recovery.

Multiple referral options exists for service members seeking treatment including self, physician and command referred. All patients are required to enroll in SUDCC prior to seeking higher levels of care.

Author: Marcy Sanchez William Beaumont Army Medical Center Public Affairs Office

El Paso-Based Reserve Unit Boosts Medical Readiness at Fort Bliss

Approximately 30 Soldiers with the 7248th Medical Support Unit (MSU), based out of El Paso, conducted an Annual Training event at William Beaumont Army Medical Center, providing additional healthcare support to Soldiers, retirees, families and other beneficiaries in the area.

The unit, which falls under the 7454th Medical Backfill Battalion out of San Antonio, is comprised of different medical professionals from patient administration specialists and combat medics to nurse practitioners and physician’s assistants.

“Our mission was to support the hospital in various departments,” said Maj. John Buen, a Certified Registered Nurse Anesthetist and officer in charge of the detachment. “We had Soldiers supporting (laboratory services, labor & delivery, and medical, surgical and behavioral health inpatient wards) for two weeks. The training helped supplement our own training to keep (reserve-component Soldiers) competent in their skills.”

The locally-based MSU provides medical support to Military Treatment Facilities throughout the Army through personnel backfills to sustain uninterrupted medical operations. Because the unit is mostly comprised of medical professionals, Soldiers are spread throughout WBAMC to provide premium training opportunities related to their Military Occupational Specialty (MOS) and provide a real-world experience.

“It was a good learning experience,” said Spc. Levi Raygoza, patient administration specialist, 7248th MSU. “I learned more (at WBAMC) than I did at (during initial MOS training).”

This is the first annual training Raygoza, an El Paso native, has been assigned for. A college student while out of uniform, Raygoza, who enlisted in the Army two years ago, said he believes the two-week exercise will prepare him for potential assignments in the future.

“(The staff) covered pretty much everything of what our job entails,” said Raygoza. “By the fourth day I was already on my own. With a little more training I would (feel comfortable) being activated.”

For several Soldiers, like Buen, the mission is an extension of their civilian occupations, providing added training for their civilian occupations and adding diverse work experience at WBAMC work areas.

“If we can provide manpower to help the hospital and promote (Soldier) skillsets at the same time,” said Buen, who also works as a civilian CRNA in the El Paso Community. “It’s a win-win for both institutions.”

The annual training event was held from July 8-20.

Col. Shawna Scully (left), deputy commander for medical services, William Beaumont Army Medical Center, and Sgt. Maj. Dina Pang, chief clinical noncommissioned officer, present reserve-component Soldiers with the 7248th Medical Support Unit commander’s coins for their service during an annual training event at WBAMC, July 20. |
Photo by Marcy Sanchez

Story: Marcy Sanchez – William Beaumont Army Medical Center Public Affairs Office

WBAMC ‘Mystery Shopper’ Aims to Gauge Patient Experience

William Beaumont Army Medical Center’s Patient Assistance Office recently kicked off a program to measure quality of outpatient encounters and provide immediate feedback to providers, clinics and other hospital staff.

The program, similar to retail-industry mystery shopper programs, entails patient advocates randomly questioning consenting patients who have recently completed a medical appointment at any of WBAMC’s primary care or specialty care clinics.

“The intent is to give patients the opportunity to give us (immediate) feedback of their experience, positive or negative,” said Thomas O’Dea, patient advocate, WBAMC. “From the beginning of their appointment to the end, we want to know what they thought.”

Patients have always had an opportunity to provide feedback concerning their experiences through traditional means such as Interactive Customer Evaluations (ICE) comments and the Military Health System’s recently launched Joint Outpatient Experience Survey (JOES). Outpatients can expect a JOES survey a few days after appointments and may return the survey via mail or electronically.

In addition to allowing patients to provide instant feedback, the mystery shopper program allows for WBAMC patient advocates to correct or address concerns on the spot.

“We want (patient’s) information, their name, phone number, so that if we do get a negative feedback we can address the situation and that’s where we want to go with it, we want to be able to reach back to (the patient),” said O’Dea. “It’s to add that personal factor to (patient’s experience), and the survey can provide us with a lot of good information, such as: are we doing the right thing, are we becoming complacent, that feedback is valuable overall for the organization as it carries over to JOES.”

The Military Health System’s patient satisfaction survey, JOES, assesses outpatient beneficiary experiences at Military Treatment Facilities (MTFs) allowing the MHS to compare results to the civilian benchmarks. Patient advocates plan to launch a similar mystery shopper program directed at inpatient experiences to supplement the TRICARE Inpatient Satisfaction Survey (TRISS), aimed at gauging inpatient experiences.

Providing high-satisfaction rated feedback on surveys like JOES and TRISS also impact medical operations directly through monetary incentives for increased medical resources such as staff and equipment as well as patient amenities such as recent mobile device charging stations available in select wait rooms.

For patients such as Sgt. Emmanuel Rivera, customer service is essential to meeting objectives.

“It’s not about doing the job faster but improving customer service,” said Rivera, a culinary specialist with 1st Battalion, 36th Infantry Regiment, 1st Stryker Brigade Combat Team, 1st Armored Division. “Good customer service helps keep customers.”

As an employee in the food service industry, guest relations are essential to daily operations for Rivera, who says he’d prefer to give instant feedback on his experience over waiting for a survey.

According to O’Dea, patients can provide feedback on any part of their WBAMC experience, from the first interaction while making an appointment to picking up any prescribed medications at pharmacies.

“It begins with first interaction with our facility which could be the appointment line, whether patients couldn’t get through (to schedule an appointment) or if there’s a certain number that is not working. We’ll alert those who can fix it,” said O’Dea. “It’s the whole experience, until they finish. We’re excited about it. We care about your experience and we care about our facility.”

Primary care clinics throughout the WBAMC footprint will also participate in mystery shopper surveys. For more information, contact WBAMC the Patient Assistance Office at 915-742-2692.

Author: Marcy Sanchez –  William Beaumont Army Medical Center Public Affairs Office 

WBAMC’s Child, Adolescent and Family Behavioral Health Service Hosts ‘Camp Wonder’

William Beaumont Army Medical Center’s Child, Adolescent and Family Behavioral Health Services welcomed 17 school-age children to a week-long camp designed to discuss experiences in a safe and supportive environment at Fort Bliss.

The summer camp, dubbed “Camp Wonder,” included four half-day sessions comprised of three counselor-led sessions targeting self-esteem, empowerment, depression, anxiety, behaviors, coping skills and social skills. Children completing kindergarten through fifth grades from Milam, Bliss and Colin L Powell Elementary Schools, were divided into age-appropriate groups to encourage interaction and uniform progression with peers.

“This is a great program for my son to participate in dealing with emotional and socioemotional feelings,” said Ebonie Sanchez, a military spouse at Fort Bliss and mother of three. “I thought it would be really good for him because he is young, so any aspect that can help him with his maturity level and growth, I’m all about it.”

In collaboration with Army Community Services, the camp also engaged parents with workshops addressing behavioral reward systems, medication management, family strengthening, and special education services available at Fort Bliss schools. During the camp, children were introduced to a reward system, earning small prizes for accomplishing daily goals. Parents were encouraged to continue the reward system at home, utilizing leisure activities such as video games and cell phone usage as rewards.

“Since he first found out he was going to the camp he asked question after question,” said Sanchez. “After coming home that first day he was ecstatic, he had so much fun he showed me a reward system they implemented and that gave him motivation to do more positive things to gain rewards.”

“Because school behavioral health is embedded within schools, during the summer they don’t have any children (assigned to programs) so they host camps and groups,” said Lashonda Bogan, outreach coordinator, Child, Adolescent and Family Behavioral Health Services, Department of Behavioral Health, WBAMC. “(The workshops) incorporate parenting classes into what the kids are learning, so (parents could continue to engage at home).”

According to Bogan, the short groups and camps offered during the summer allow eligible children to participate in programs before committing to services during the school year. Programs are aimed at increasing understanding and awareness of special-needs children to better prepare military families for challenges such as deployment of service-members, adding to unit readiness.

The program introduced Sanchez’ six-year-old son, DeAaron, to social settings outside of school while also addressing feelings, bullying and respecting others and themselves.

“It might be their first time being around other kids they could identify with,” said Bogan. “Knowing everyone in the camp (is unique), made campers more comfortable being themselves.”

“(DeAaron) has (Attention-deficit/hyperactivity disorder) so sometimes sitting down and calming down to get all the instructions (at school) is difficult for him,” said Sanchez. “He is learning about being courteous and those life skills parents want them to have to be successful.”

The camp wrapped up with a closed performance for parents featuring children singing as a choir about bullying and respect and swimming at the Fort Bliss Aquatics Training Center.

When asked what he enjoyed about the camp, DeAaron answered “the song,” while also adding he had fun during the camp.

“I’ve seen changes,” said Ebonie Sanchez. “I’m very involved in every aspect of his life, as much as I can be. (Camp coordinators) did have a mandatory meeting for the parents where bullying and coping with certain emotions were discussed, which I felt was a really great aspect of the camp.”

For the soon-to-be first grader, DeAaron says he’ll take what he learned and apply it to school, a goal Sanchez yearns.

“I feel like this was a positive camp that allowed children to work in an environment they felt was fun but also gained the skills of cooperating with others, showing respect and learning about bullying,” said Sanchez. “I look forward to him continuing using the skills he learned here and help him be successful in the next grade level.”

“All of us have our own things that make us different, but we shouldn’t treat anyone differently,” said Bogan.

The summer camp was held June 18 through 22.

Author:  Marcy Sanchez  – William Beaumont Army Medical Center Public Affairs Office

WBAMC Doctor Transplants Ear “Grown” on Soldier’s Forearm

Plastic surgeons at William Beaumont Army Medical Center successfully transplanted a new ear on a Soldier who lost her left ear due to a single-vehicle accident.

The total ear reconstruction, the first of its kind in the Army, involved harvesting cartilage from the Soldier’s ribs to carve a new ear out of the cartilage, which was then placed under the skin of the forearm to allow the ear to grow.

“The whole goal is by the time she’s done with all this, it looks good, it’s sensate, and in five years if somebody doesn’t know her they won’t notice,” said Lt. Col. Owen Johnson III, chief, Plastic and Reconstructive Surgery, WBAMC. “As a young active-duty Soldier, they deserve the best reconstruction they can get.”

The revolutionary surgery has been over a year in the making for Clarksdale, Mississippi native, Pvt. Shamika Burrage, a supply clerk with 1st Battalion, 35th Armored Regiment, 2nd Brigade Combat Team, 1st Armored Division.

In 2016, while returning to Fort Bliss, Texas, after visiting family in Mississippi, a tire blowout changed Burrage’s life in an instant.

“I was coming back from leave and we were around Odessa, Texas,” said Burrage, who was travelling with her cousin. “We were driving and my front tire blew, which sent the car off road and I hit the brake. I remember looking at my cousin who was in the passenger seat, I looked back at the road as I hit the brakes. I just remember the first flip and that was it.”

The vehicle skidded for 700 feet before flipping several times and ejecting the Soldier. Burrage’s cousin, who was eight-months pregnant at the time, managed to only suffer minor injuries while Burrage herself suffered head injuries, compression fractures in the spine, road rash and the total loss of her left ear.

“I was on the ground, I just looked up and (her cousin) was right there. Then I remember people walking up to us, asking if we were okay and then I blacked out,” said Burrage, whose next memory was waking up in a hospital.

She was later told by doctors if she would not have received medical attention for 30 more minutes, she would have bled to death. After several months of rehabilitation, Burrage began to seek counseling due to emotions caused by the accident and its effects on her appearance.

“I didn’t feel comfortable with the way I looked so the provider referred me to plastic surgery,” said Burrage.

“She was 19 and healthy and had her whole life ahead of her,” said Johnson. “Why should she have to deal with having an artificial ear for the rest of her life?”

When explained her options for reconstruction, Burrage was shocked and initially resistant to go through with the total ear reconstruction.

“I didn’t want to do (the reconstruction) but gave it some thought and came to the conclusion that it could be a good thing. I was going to go with the prosthetic, to avoid more scarring but I wanted a real ear,” said Burrage, who is now 21. “I was just scared at first but wanted to see what he could do.”

In order to avoid any more visible scarring, Johnson selected prelaminated forearm free flap, which involved placing the autologous cartilage into the patient’s forearm to allow for neovascularization, or the formation of new blood vessels. This technique will allow Burrage to have feeling in her ear once the rehabilitation process is complete.

“(The ear) will have fresh arteries fresh veins and even a fresh nerve so she’ll be able to feel it,” said Johnson.

In addition to the transplant, epidermis from the forearm, while attached to the ear, will cover up scar tissue in the area immediately around Burrage’s left jawline.

“I didn’t lose any hearing and (Johnson) opened the canal back up,” said Burrage, whose left ear canal had closed up due to the severity of the trauma.
“The whole field of plastic surgery has its roots in battlefield trauma,” said Johnson. “Every major advance in plastic surgery has happened with war. This was trauma related.”

With only two more surgeries left, Burrage states she is feeling more optimistic and excited to finish the reconstruction.

“It’s been a long process for everything, but I’m back,” said Burrage.

Author: Marcy Sanchez – WBAMC/US Army

New Simulator Preps WBAMC Staff for OB Emergencies

A new simulation system at William Beaumont Army Medical Center’s Labor & Delivery Department aims to improve patient care and safety through advanced training simulations.

The state-of-the-art simulator provides WBAMC staff up to various cutting-edge training scenarios which are documented and transmitted to allow for instant feedback on the exercise, increase communication during emergencies, and improve interdisciplinary and clinical performance.

“We have been doing monthly simulation training for years. However, the (new simulation system) is a more advance simulator that will provide feedback to the team regarding their performance” said Maj. Laquincyia Key, clinical nurse specialist, Maternal-Child Health Services (MCHS), WBAMC. ”

The new simulator follows standardized guidelines from the American College of Obstetricians & Gynecologists, which not only provides health care staff with instant feedback from the exercise according to their performance, but also collects and transmits the data to the Defense Health Agency to advance and standardize training platforms. According to Key, the new simulator also meets required DHS’s biennial training mandates.

“The (previous simulation system) needed updating and wasn’t able to collect training data and track clinical outcomes,” said Key. “The (new simulation system) has pre-programmed scenarios with Internet curricula available.

Because most patients at WBAMC’s L&D are low risk, the simulator helps train and prepare staff for emergency cases. Scenarios such as postpartum hemorrhage, umbilical cord prolapse, shoulder dystocia, eclampsia, breech vaginal delivery and operative vaginal delivery are feasible with the simulator to provide staff opportunities to improve obstetric emergency skills.

“Communication and organizational culture are the root causes of most cases of perinatal death and injury,” said Key. “Simulation-based training allows the team to practice high-risk, low-volume obstetric emergencies in preparation for when these events actually occur. They are able to identify areas of improvement and evaluate their team’s performance with non-judgmental debriefing.”

Scenarios also supports WBAMC Simulation Center’s continuing mission to produce measureable outcomes from scenario-based training.

Added features include a medical manikin capable of birthing an infant manikin which allows staff to conduct neonatal resuscitation training. Over 100 newborns are delivered each month at WBAMC.

Author: Marcy Sanchez – U.S. Army/WBAMC

WBAMC’s Sim Center Receives Prestigious Recognition

William Beaumont Army Medical Center’s Central Simulation Committee Medical Simulation Center recently gained provisional accreditation from the Society for Simulation in Healthcare, an international organization promoting improvements in simulation technology, educational methods, and patient safety.

The Simulation Center at WBAMC supports Continuing Medical Education and Graduate Medical Education (CME/GME) to increase patient safety and practitioner competence. The center provides healthcare professionals with lifelike scenarios aimed at developing and shaping teamwork, communications and critical thinking skills to enhance outcomes.

“(Full accreditation means) we’ll have an opportunity to bring different funding and programs into the organization and have broader opportunities,” said Lt. Col. Olga Betancourt, deputy chief, Education Division, WBAMC. “In turn, these increased opportunities will affect patient care because residents will be able to practice more and conduct different research improving Army Medicine.”

Although the simulation program at WBAMC is vastly focused on supporting the GME mission at WBAMC, CME is also profiting from the Sim Center’s various programs designed to educate and refine nursing skills and training requirements, as well as honing the skills of Soldiers preparing for deployment. After documenting outcomes for two continuous years, the center will be eligible to reapply for full accreditation from the organization.

Col. Erik Rude, commander, William Beaumont Army Medical Center, and Command Sgt. Maj. Janelle Ray, command sergeant major, WBAMC, are presented a plaque representing WBAMC’s Central Simulation Committee Medical Simulation Center’s recent provisional accreditation from the Society for Simulation in Healthcare, an international medical simulation accrediting organization, at WBAMC, Jan. 26. (Photo Credit: Marcy Sanchez)

In preparing for the accreditation, staff members developed curriculum to evaluate detailed processes for each scenario presented to GME residents.

“Everything we do here is to assist in (GME residents’) training development and to provide medical simulation for their respective programs,” said Thomas Soto, Simulationist, WBAMC. “So when residents actually conduct a procedure for the first time, it isn’t on a patient. It’s training hands on with high-fidelity Manikins.”

According to Betancourt, a native of Philadelphia, one of the first steps toward accreditation was formulating a multidisciplinary strategic plan to welcome creativity and collaboration thus developing the center’s programs to benefit training.

“It’s not just about doing the training but providing the curriculum that backs that training up such as what are the objectives, who’s the target audience, and developing scenarios for different training events,” said Soto, the simulation center’s only dedicated simulationist. “Simulation isn’t just providing a simulation the technician wants to show. This is targeted to residents and providers that are going to (or already) working on real patients and going out in to the community and performing these skills. It’s very specific and really detailed.”

Simulation programs at the center range from endoscopic surgery to neonatal care, benefiting all new healthcare professionals training at WBAMC from general surgery residents to the Army’s junior enlisted medics.

“There’s a lot of programs that are currently using the simulation program,” said Betancourt, who also supervises operations in the simulation center. “One of the rooms we created within the sim center is a patient room, a lot of the students will actually come into the room and actually work with a (simulated) patient in the room.”

Future plans include expanding the center’s capabilities to include laparoscopic surgery, spinal fusions, and robot-assisted surgery simulations.

In addition to current capabilities, the center is also an approved Fundamentals of Endoscopic Surgery site, meaning residents may be evaluated on their fundamental knowledge, clinical judgement and technical skills at the center required in endoscopy, a requirement for most surgery residents in WBAMC’s GME programs.

“We have the equipment and the site for designation which they need before graduating,” said Soto, a native of Aransas Pass, Texas. “We’re saving the Army money, getting residents trained and what they need to be credentialed.”

Future developments with full accreditation will also provide the necessary training physicians may require, eliminating the need to travel to other medical centers or hospitals to conduct training.

Simulation center staff credits WBAMC’s chief of education, Col. Susana Argueta, with initiating the accrediting process and collaborating with WBAMC leaders to develop program curriculums. Full accreditation across all Army Medicine simulation centers is also a goal to improve overall Army readiness.

Author: Marcy Sanchez – WBAMC /US Army

William Beaumont AMC welcomes new Command Sergeant Major

William Beaumont Army Medical Center held an assumption of responsibility ceremony during which Command Sgt. Maj. Janell Ray assumed responsibility as WBAMC’s command sergeant major.

Ray, a native of Fort Hood, Texas, previously served as command sergeant major of U.S. Army Medical Department Activity (MEDDAC) and Ireland Army Health Clinic at Fort Knox, Kentucky.

“Welcome to a great command sergeant major,” said Col. Erik Rude, commander, WBAMC. “As soon as the (command sergeant major list) came out, my phone blew up. Not enough people could call me to tell me about how great (Ray) is.”

A unit’s command sergeant major is the top enlisted advisor to the commander and an advocate for enlisted Soldiers.

During the ceremony Rude performed the traditional passing of the unit colors to Ray, a symbolism of assumption of responsibility and authority of the incoming command sergeant major.

“I’m truly humbled and honored to serve as the command sergeant major for the Soldiers, civilians and families of WBAMC,” said Ray. “Over the past 25 years I’ve been fortunate enough to serve with some great outstanding leaders and soldiers. I’m forever grateful and appreciative for their mentorship and guidance because it’s them who prepared me to take on the responsibility of what I perceive as the most challenging but rewarding job in my entire career at this point.”

According to Rude, while Ray’s peers discussed her strengths and knowledge with medical operations, both in and out of Military Treatment Facilities, their biggest emphasis was her love and caring for Soldiers.

“The success of this organization lies with each and every one of you doing your part as a member of an outstanding winning team,” said Ray. “Continue striving to be better tomorrow than you are today, so we can take our organization to the next level.”

Since July, 18 2017, WBAMC’s top enlisted position was filled by interim Command Sgt. Maj. Michael Fetzer, previously serving as command sergeant major, Troop Command, WBAMC.

“(Fetzer is) outstanding,” said Ray. “I’ve always appreciated his candid leadership and guidance. Because of his leadership, WBAMC is better today.”

WBAMC is dedicated to increasing Army Readiness through patient-friendly access to high-quality healthcare.

“We’ll continue to guide this extraordinary organization into the future of Army Medicine,” said Ray.

The ceremony was held at the Fort Bliss and Old Ironsides Museum, on Fort Bliss, December 19, 2017.

Author & Photographer: Marcy Sanchez – WBAMC/US Army

Commission on Cancer Highlights WBAMC Cancer Guidelines, Treatment

In 2016, Sherita Kelly, despite being in the best shape of her life, was diagnosed with stage three breast cancer, an advanced stage of breast cancer extending beyond the immediate tumor region but not yet invading other organs.

After her 40th birthday, Kelly, a military spouse and native of Columbus, Georgia, was recommended and requested a mammogram through her Primary Care Manager (PCM) even though she regularly performed self-exams and never detected abnormalities. The American Cancer Society recommends annual mammograms for women ages 40-44.

Once her mammogram was completed and she was informed of the diagnosis, Kelly didn’t know what to do next.

“I had multiple tumors but I never felt them,” said Kelly. “I didn’t know where to go or who to see.”

William Beaumont Army Medical Center has operated a cancer program fully approved by the American College of Surgeons, Commission on Cancer since 1954. Recent reports from the Commission on Cancer highlight WBAMC’s adherence to standardized guidelines on cancer screening and treatments.

“We can treat most cancer patients, except those requiring inpatient chemotherapy which we can’t (logistically) support,” said Dr. Warren Alexander, staff physician, Hematology/ Oncology Clinic. “As part of the Commission on Cancer, we do make a concerted effort to participate in screenings, not just for malignancies but for other (issues) to make the quality of life of our patients a little bit better.”

Over the past few years, WBAMC’s cancer treatment has been above the national average for administration and reporting radiation and chemotherapy after diagnosis, according to the Commission on Cancer, a program dedicated to improving survival and quality of life for cancer patients through standard-setting, prevention, research and education.

“We have evidenced-based information that proves we are consistently above other Commission on Cancer sites when you pull all the data,” said Alexander, a San Francisco native. “Quarterly reports look at data and administration of radiation (therapy) after breast cancer therapy as well as mastectomy, we’re almost across the board 100 percent.”

According to Alexander, other measures also includes recommended treatments following the Commission on Cancer’s standardized guidelines, of which WBAMC is reported at 100 percent compliance.

“Even as guidelines change, we adapt,” said Alexander, who was recently recognized as one of the top specialty-care doctors in the Army. “(WBAMC) is above the national average in surgical outcomes. When you adhere to the guidelines you have a tendency to have good outcomes.”

Because of WBAMC’s proactive approach to recommended screenings, which incorporates everyone in a patient’s line of care, Kelly’s persistent PCM’s recommendations for a mammogram led to detecting Kelly’s cancer before it metastasized to stage four breast cancer, considered to be incurable.

“I was diagnosed in July, had a right mastectomy in September and started chemotherapy on Oct. 6,” said Kelly. “From the very first time I walked into the office, the physician explained everything. (Treatment) was difficult but the staff here made it easier, compared to how it could have been.”

After 28 treatments of radiation therapy, Kelly’s cancer went into remission.

Because of her experience during her battle, Kelly, already a registered nurse specializing in emergency medicine, is hoping to pursuit an education to also specialize in oncology. With the assistance of outside organizations, Kelly began initiated and began volunteering in the hospital’s Survivorship Group, a group aimed at comforting and educating other patients diagnosed with cancers.

“Once you’re diagnosed, your life completely changes. It’s always in the back of your head, how do I live without constantly thinking about whether it’s going to come back again,” said Kelly.

In addition to a full-team approach, WBAMC’s access to care and the military’s comprehensive health care which covers retirees and family members, also played a vital role in Kelly’s treatments.

“Having a team effort is important to be able to push patients from one clinic to another to include primary care,” said Alexander. “If you need a colonoscopy, mammogram… you can get one versus in the private sector where there may be a cost that may prohibit you from doing so. (WBAMC screenings) are free, (patients) just have to get it.”

Through adherence to guidelines and proactive screenings, WBAMC’s cancer program continuously contributes to Army readiness through patient-friendly access to high-quality healthcare.

Author: Marcy Sanchez – WBAMC

WBAMC Doctors Perform First TAVR in El Paso

Earlier this year, William Beaumont Army Medical Center doctors performed the first Transcatheter Aortic-Valve Replacement (TAVR) in El Paso at WBAMC.

The procedure is a minimally-invasive alternative to open-heart surgery for patients with severe Aortic Stenosis (AS), a condition involving the narrowing of the heart’s aortic valve which minimizes or blocks blood delivered to the aorta resulting in limited blood flow throughout the body.

The TAVR procedure is revolutionary not only as an alternative to traditional means of treating AS but also as a solution for patients who may not have had an option two years ago.

“It (is) a feasible way to save patients who are not good candidates for surgery,” said Maj. Ryan McDonough, interventional cardiologist and chief of cardiology, WBAMC. “There are patients who are not good surgical candidates but are excellent candidates for a percutaneous approach due to comorbidities, illnesses and previous surgeries.”

Because blood flow is limited in patients with AS, it makes the heart work harder to pump blood through the body, resulting in symptoms such as chest pain, fatigue and difficulty breathing.

Similar to a stent placed in an artery, patients are implanted with self-expanding valves via a catheter usually entering the body through the femoral artery in the groin. The minimally-invasive procedure results in reduced operating and recovery time when compared to traditional open-heart surgery procedures which usually demand for a sternotomy (opening of the sternum) to treat AS.

According to McDonough, as new as the procedure is to medicine, there are two Food and Drug Administration-approved devices available to patients for the procedure: self-expanding and balloon-expanded valves. While both have similar functions, the WBAMC patients were implanted with the self-expanding to minimize risks.

“The valve is stented on a self-expanding metal that reacts to heat. When exposed to heat it expands to a predesigned form and the catheter slowly comes off the valve and expands,” said McDonough, a native of Port Jefferson, New York. “You don’t have to balloon expand or pace (regulate the heartbeat by means of an artificial pacemaker), (the valve) is recapturable and repositionable. The valve deploys to 80 percent first, allowing us to assess whether it’s position and functionality is correct before fully deploying.”

The self-expanding valve also conforms and seals to non-circular aortic valve annulus (passages) and may be safer to use than other TAVR devices due to decreased potential to rupture tissue, decreasing mortality risk.

For 75-year-old Daniel Mooneyhan, the second patient to be implanted with the valve in El Paso, the valve provided relief after suffering with AS for two years.

“I was walking one day and I had to stop and hold on to a tree at a park. I was having a lot of heaviness, a little chest pain here and there,” said Mooneyhan, a 75-year-old retired Army first sergeant.

After a series of tests and exams, Mooneyhan was informed that his aortic valve was failing. Due to previous ailments along with reluctance to open-heart surgery, Mooneyhan didn’t prove to be a good surgical candidate for a bioprosthetic valve, which must be sewn into place during open-heart surgery, occasionally taking hours to complete.

“I didn’t want to be cut open. If I had to be cut open just forget it,” said Mooneyhan.

While this was a first at WBAMC, it wasn’t new to Mooneyhan, who had been researching treatment options for his condition.

“I watched hundreds of videos (regarding the procedure) and talked to the specialists,” said Mooneyhan. “They (perform the procedure) in Tucson, Albuquerque, Lubbock, Dallas, Indianapolis, San Antonio, so why can’t we do this here in El Paso?”

After McDonough spent three years supporting and training for the use of the TAVR device, the device was approved for treatment at WBAMC.

“It’s awesome,” said McDonough, who along with an interdisciplinary team of surgical professionals performed both treatments. “I felt very comfortable with our team doing this procedure and it’s very much a collaborated team approach. It’s not the technical part of deploying the valve, it’s the process.”

On Nov. 15, Mooneyhan received a call to be admitted for treatment at WBAMC the following day. Less than a week later, Mooneyhan was back home, feeling relieved.

“I’m sleeping better, I’m getting a full breath, I’m feeling good and have no scars or anything,” said Mooneyhan, just 10 days past the TAVR procedure. “There’s people here in this city, in this county who probably need this procedure, I think this is the future.”

“Once the valve is in and it’s functional, their heart is fixed,” said McDonough. “The only reason we keep the patient is to make sure they don’t develop conduction abnormalities (electrical impulses which cause the heart to beat), a potential need for a pacemaker and to monitor the access site.”

While WBAMC has already scheduled another pair of TAVR procedures, the success and benefit of the treatment made an emotional impact on Mooneyhan.

“There’s people out there who need this, who are dying,” said Mooneyhan. “To those guys that are retired and any veteran who needs this, they need to come (to WBAMC). These doctors are awesome, they’re good doctors.”

Author –  Marcy Sanchez – WBAMC / U.S. Army

William Beaumont Army Medical Center’s CNSs Recognized, Defined

In the United States there are approximately 72,000 Clinical Nurse Specialists (CNS) and approximately 2.7 million nurses. That’s one CNS to every 37.5 nurses.

What is a CNS you may ask?

Clinical Nurse Specialists are Advanced Practice Registered Nurses (APRNs) who not only provide patient care but specialize in mentoring, educating and progressing clinical practices in specific patient populations. Sept. 1 – 7 marks the annual National CNS Recognition Week.

“They’re not the same as other (APRNs),” said Col. Gayla Wilson, chief nursing officer, William Beaumont Army Medical Center. “They focus on their clinical areas. They’re spectacular in what they do. One of the key roles, as educators, is bringing the latest and greatest evidence-based practices to the fight.”

Clinical Nurse Specialists are one of four APRNs which include nurse anesthetists, nurse midwives and nurse practitioners. While CNSs in a civilian capacity are capable of diagnosing and prescribing medication, Army CNSs focus on progressing Army Medicine as a whole and employing best-practice in their respective specialties.

“I think the biggest difference (for Army CNSs) is shifting focus from single patient care to advancing the care of all patients,” said Lt. Col. Patrick Marlow, CNS, Emergency Department, WBAMC. “While others work full time with patient care, (being a CNS) gives us the education and time to implement programs and efforts (to advance their clinical areas).”

Recently, Marlow, a Milwaukee native, was instrumental in implementing an Emergency Department program which decreased wait times for beneficiaries while increasing primary care engagement with active-duty service members. Although CNSs do take an active role in patient care, their greatest impact is improving overall proficiency and efficiency of their units.

“(CNSs) create strong foundations for the staff,” said Wilson. “I don’t have to depend on the (officer in charge of a unit) to carve time out of their day to make sure all of their staff understand the latest practices.”

“We are considered expert clinicians at the bedside but one of our more significant roles is to help guide and mentor newer nurses,” said Maj. Maria Pescatore, CNS and officer in charge, Medical-Surgical Unit, WBAMC. “CNSs help improve new nurses’ skills and critical thinking while increasing their capabilities and development, breaking them out of a novice role to an advanced one.”

While CNSs continuously research for best practices in their fields, their expertise goes beyond clinical practices as they play a role in improving safety measures in their units as well. Wilson also points out this year’s CNS Week theme “Leading Changes to Healthier Living,” is embodied by WBAMC CNSs in their vigilant staff education including raising awareness of proper patient lifting techniques, increasing communication among staff and building resilience.

“My favorite part (about being a CNS) is being with the new nurses and mentoring and guiding them through their nursing practice,” said Pescatore, a native of Binghamton, New York. “The best part is to watch them grow; it reinvigorates why we do what we do.”

One unique challenge WBAMC CNSs face is preparing to transition to the Fort Bliss Replacement Hospital, which is slated to open in 2019, by providing input regarding development of clinical areas to maximize best practices by healthcare professionals. Additionally, Wilson states CNSs are active in mitigating costs by researching and endorsing more efficient equipment and supplies.

“(CNSs) improve efficiency, competency and throughput capabilities by going with the best product and educating staff on utilization of the best product,” said Wilson. “(CNSs) are definitely moving us in the right direction and moving us as a team.”

There are currently six CNS roles at WBAMC covering the hospital’s Critical Care Unit, Medical and Surgical Units, Perioperative Nursing Services, Maternal Child Health Services and Emergency Services. As WBAMC transitions from Level III Trauma Center designation to Level II, their roles are crucial as subject-matter experts to train and educate nursing staff on efficient practices to prepare for more comprehensive or definitive care.

Because of the continuous advancements CNSs provide to clinical practices, their actions sometimes require an interdisciplinary approach to formulate changes which improves overall patient care at WBAMC.

Over the course of this year’s CNS week WBAMC CNSs educated beneficiaries and fellow staff members as to how the role they have in the hospital impacts patient care and readiness for service members.

Author: Marcy Sanchez – WBAMC

WBAMC First Texas-based DoD Hospital Recognized for Vaccination Efforts

William Beaumont Army Medical Center was recognized as the first Military Treatment Facility (MTF) in the state of Texas to be qualified for the Immunization Action Coalition’s (IAC) Hepatitis B Birth Dose Honor Roll.

According to the IAC’s website, WBAMC is also the first Army Medical Center to be recognized and the second DoD MTF to qualify. From June 2016 through June 2017, 96 percent of infants born at WBAMC were vaccinated with the hepatitis B vaccine following birth.

“We’re promoting excellence to our infants and military families,” said Maj. Laquincyia Key, clinical nurse specialist, Maternal-Child Health Services (MCHS), WBAMC. “We ensure they are educated before they leave our hospital by providing them the most up-to-date information so they can make an informed decision regarding the Hepatitis B vaccination.”

The IAC launched its Hepatitis B Honor Roll initiative in 2013 to recognizing hospitals and birthing centers for attaining high rates of hepatitis B vaccines at birth.

Mary Anderson (center), regional medical director, Department of State Health Services, presents a recognition letter to Col. Erik Rude, commander, William Beaumont Army Medical Center, and Maternal-Child Health Services staff in recognition of the hospital’s efforts. Photo Credit: Marcy Sanchez

One of the main efforts leading to WBAMC’s successful hepatitis B vaccination program is due to the MTF’s whole-team approach to educating patients on the benefits and risks of vaccination.

The chances of an infant acquiring hepatitis B, through transmissions such as sexually-transmitted diseases and sharing syringes, are low so some parents delay vaccinations, said Key, a native of Jeanerette, Louisiana. The WBAMC MCHS staff takes it upon themselves to educate parents so they understand the risks involved.

“If the nurse is told ‘no,’ it’s elevated to the pediatrician. The pediatrician then counsels the patient and makes sure that the patient understands the risks of not receiving the vaccine after birth,” said Key, who spearheaded the efforts toward recognition. “It is common practice but they have the option to not vaccinate or wait for a follow up appointment.”

According to the Centers for Disease Control and Prevention, hepatitis B is caused by a virus that attacks the liver which can cause lifelong infection, cirrhosis of the liver, liver cancer, liver failure and even death. Furthermore, the World Health Organization (WHO) claims hepatitis B resulted in 887,000 deaths in 2015 with an estimated 257 million people living with the virus.

Because the risk of chronic infection is higher for infants and children, WHO recommends all infants receive the hepatitis B vaccine as early as possible after birth, preferably within 24 hours, followed by a two or three-dose schedule.

In addition to educating patients, MCHS staff also began to educate within their ranks to equip staff with the knowledge necessary to inform patients and improve communication within the unit.

“We’ve always educated, now we’re just streamlining the education process and having everybody saying the same thing, everybody is getting the same information,” said Key.

Prevention of a perinatal transmission, when a mother is infected with the hepatitis B Virus (HBV), requires the administration of the hepatitis B vaccine and immune globulin to the infant within a 12-hour window after birth. To reduce the probability of perinatal transmission, the Maternal-Child staff ensures the mother’s original hepatitis B test results are present at time of delivery to prevent possible human error and ensure infants are treated properly.

William Beaumont Army Medical Center averages 150 births per month and provides high-quality, evidence-based newborn care with around-the-clock pediatricians. The hospital is in the process of receiving baby-friendly recognition as part of the World Health Organization and United Nations Children’s Fund Baby-Friendly Hospital Initiative, while aiming to provide immediate skin-to-skin contact after delivery.

The facility was honored on Thursday, August 10, 2017

Author: Marcy Sanchez – William Beaumont Army Medical Center

William Beaumont AMC First Medical Center in Continental US to Earn Army SOH Star

William Beaumont Army Medical Center was recently recognized as an Army Safety and Occupational Health Star site, becoming the first Army Medical Center in the Continental United States to receive the title.

In 2012, U.S. Army Medical Command adopted the Occupational Safety and Health Administration’s Voluntary Protection Program, a program promoting effective worksite-based safety and health, into its own Army Safety Management System (ASMS).

Shortly after, WBAMC rolled out ASMS to empower employees to take charge of safety in their area by self-identifying hazards; allowing staff to become a part of the hazard analysis process.

Organizations achieving the ASMS Star are recognized for the development, implementation and continuous improvement in the prevention and control of occupational safety and health hazards.

Leaders at William Beaumont Army Medical Center unveil the Army Safety and Occupational Health Star site flag, recognizing WBAMC as the first Army Medical Center in the Continental United States to be labeled as a “Star Site” at WBAMC | Photo courtesy U.S. Army/Roberto Johnson

Because of the organization’s size, achieving a culture of safety was no easy task, said Henry Ford, safety manager, WBAMC. In order to engage more than 4,000 employees at 52 geographically-separated facilities, the WBAMC’s safety plan included implementing Additional Duty Safety Officers (ADSOs) as representatives for the safety office and to streamline safety concerns within the organization.

WBAMC’s safety philosophy also integrated every staff member into the role of safety officer. Not only did employees become responsible for safety in their workspaces, they underwent training to understand how to recognize, identify and react to unsafe work environments.

Strides toward star recognition also involved improved accessibility to filing safety concerns through the inclusion of a “safety button” on each computer desktop in the hospital while increasing transparency of previous safety reports in order to encourage best practices in resolving reoccurring conflicts.

Other steps included mandatory leader walkthroughs, on-the-spot recognitions for safety excellence and creating friendly safety competitions within WBAMC.

The Rusty Star Award (literally a rusty star on rebar Ford mounted to a two-by-four) is one way the safety office has encouraged safety best practices, said Ford. The award is presented to the most active department submitting safety discrepancies or concerns through the MTF’s safety portal.

Proactive safety measures leading to the recognition also included updating Job Hazard Analysis (JHAs) to determine risks associated with individual occupations.

Not all occupations pose the same safety risks to the employee, said Ford. WBAMC has supply technicians who operate heavy machinery which face different risks than Medical Support Assistants who assist patients.

Author: Marcy Sanchez – William Beaumont Army Medical Center

WBAMC Nurse’s Persistence Prevents Deadly Outcome

Only six months on the job and a nurse with William Beaumont Army Medical Center’s Orthopaedic Clinic is being recognized for her tireless attention to detail, possibly saving a patient’s life earlier this year.

Megan Jackson, a licensed vocational nurse and native of Oxnard, California, was recognized for her efforts in treating a patient who was suffering from a Pulmonary Embolism (PE), a life-threatening blockage to one of the pulmonary arteries in the lungs caused by blood clots.

The patient had recently undergone knee surgery, but had recovered well. Following a short stay at the hospital the patient was discharged but a few days after began feeling delusional.

“The patient came in saying he did not feel well,” said Jackson. “He was a little out of it, sweating a lot, had a fever and chills.”

Jackson’s first steps were to check the patient’s vital signs.
“All vitals were fine except for O2 (blood oxygen levels),” said Jackson. “He was a young gentleman and doesn’t smoke so it was very alarming.”

Normal oxygen levels range from 95 to 100 percent, the patient’s levels were fluctuating between 79 and 92 percent, which raised red flags for Jackson.

While below-normal blood oxygen levels may be a sign of hypoxemia, one of the underlying problems in hypoxemia cases is related to circulation. Jackson immediately called for a doctor who ordered an ultrasound and CT scan for the patient. While the ultrasound didn’t show anything of concern, the CT scan images revealed the PE.

“(Following surgeries) we watch out for deep vein thrombosis (DVT),” said Carmen Salcedo, head nurse, Orthopaedic Clinic. “DVTs can lead to a PE.”

According to the Centers for Disease Control and Prevention, while the number of Americans affected by PE is unknown, it is estimated 60,000-100,000 Americans die from PE each year. Approximately 25 percent of those figures are sudden deaths where the cause of death, a PE, is first discovered.

Because of the post-operation risks associated with surgeries, the Orthopaedic Clinic has an open-door policy for post-operation patients feeling any kind of excruciating calf or lower extremity pain, both of which are early signs of DVT. One mistake post-operation patients may make is remaining sedentary for long periods of time following surgery, a common cause for DVTs and other blood clots.

“We want (post-surgery patients) to move, they need to keep the blood flowing,” said Salcedo. “We try to remind patients that pain is a good sign as long as they’re not suffering.”

Thanks to Jackson’s instincts, the patient was treated and recovered fully. Jackson credits her training and tenacity in helping the patient in what could have been a fatal oversight.

“When I was at nursing school I didn’t think it was for me until I had an actual patient,” said Jackson, a mother of two. “I just knew (what to do) and went by my gut feeling. If I think about it I start to second guess myself.”

Jackson’s knack for caring is evidenced by her reluctance to discharge a patient if they still have concerns.

“If someone says they don’t’ feel well, (Jackson) will hold them in the room all day, if she has to, in order to get them seen,” said Salcedo, also Jackson’s supervisor. “In the (PE) case that’s exactly what she did, she held on to the patient until a doctor came to see him. Nurses with her (tenure as a nurse) may have dismissed it, (LVNs) may not have thought critically like that. For a lot of nurses it can take them years to get to that point.”

Jackson, who has been an LVN for just over a year, has also broadened her experience beyond the Orthopaedic Clinic. Jackson’s participation in WBAMC’s nursing float pool has provided her with experiences in other wards throughout the hospital.

“I worked every chance I was able to,” said Jackson.

“(Jackson) knows what each (Orthopaedic Clinic provider) likes and it’s helpful for her to go up to the floors and assist,” said Salcedo. “(Jackson) has earned a reputation in the hospital and any (hospital ward) would be happy to take her.”

Author: Marcy Sanchez – WBAMC

WBAMC Neurosurgeon Helps Soldiers Return to Duty

William Beaumont Army Medical Center’s Neurology Clinic is taking a different approach to beneficiaries suffering from neck pain.

Neurosurgeons at the clinic are combating cervical disc disease, a common condition among the military population, by performing cervical disc arthroplasty (CDA), or disc replacement surgery, on beneficiaries who may be experiencing the painful effects of the wear-and-tear condition.

“I believe in the procedure because it promotes faster recovery, and reduces the chance of degenerating the disc above and below,” said Dr. Pedro Caram Sr., senior neurosurgeon, WBAMC.

The joint replacement surgery involves replacing damaged cervical disc(s) with prosthetic disc(s). The treatment may provide relief for patients by decompressing or relieving pressure on the spinal cord or nerves and restoring stability and alignment.

Other symptoms from a degenerative disc may include increased pain in shoulders, arms and in some cases may even lead to migraines.

Dr. Pedro Caram Sr. (left), senior neurosurgeon, Neurology Clinic, William Beaumont Army medical Center, performs a multilevel hybrid cervical disc arthroplasty on a patient suffering from multilevel cervical disease during a surgery at WBAMC. (Photo Credit: Marcy Sanchez)

“I’ve treated people with what they thought were migraines but really their necks were causing the problem,” said Caram, a native of Houston. “(Staff) examines patients very carefully in the clinic. I don’t let them get away without an exam and look to find out what they’ve done from a conservative (management) standpoint, find out if they’ve had any trauma and go over medications.”

The initial examination also includes a look over pain history, spasms and a test of strength, the results of which alarms most patients.

“(Caram) proved I was a lot weaker strength-wise on my first visit,” said 1st Sgt. Joseph Phillips, C Company first sergeant, 1st Battalion, 6th Infantry Regiment, 2nd Brigade Combat Team, 1st Armored Division. “The pain limited my ability to do pushups, sit-ups, wear body armor for long durations, it would hurt.”

When he began noticing a consistent pain in his neck and shoulders, Phillips, a native of Prince Frederic, Maryland, began seeking medical attention and was eventually referred to the Neurology Clinic. Phillips was also suffering from tingling of the hands, numbness of the arms and the aforementioned loss of strength.

“It was pretty consistent, everyday all day like a five or six (on a pain scale of one to 10),” said Phillips.

After a visit with Caram, Phillips, an 18-year Calvary Scout veteran, was recommended for surgery.

Caram favors CDA over the traditional treatments which may lead to delayed recovery.

A prosthetic cervical disc is shown (Photo Credit: Marcy Sanchez)

In 2007, the Food and Drug Administration approved CDA as an option for treating cervical disease. In 2009, Caram spearheaded the procedure at WBAMC and has since performed dozens of surgeries.

According to an article Caram and colleagues published in the Journal of Surgical Orthopaedic Advances, in a study of 34 single-level CDA patients, 30 returned to duty with an average 8.5 weeks of recovery time. In a multilevel cervical disc disease study with a hybrid approach to treating the disease, meaning CDA and cervical spinal fusion applied, out of 30 patients, 24 were able to return to active duty with an average 15.6 weeks of recovery.

For Phillips, a 37-year-old father of two, results were immediate following his multilevel hybrid cervical disc arthroplasty.

“I had no more issues, no more tingling and my strength came back immediately,” said Phillips.

Prior to the surgery, Phillips would struggle to throw a ball and play with his two daughters, said Phillips. Six weeks into his post-operation recovery, Phillips is able to participate in more physical activities at home than before.

“It proves that us older guys should have got fixed a lot sooner, we should have paid a little more attention to our bodies over the last 18 years,” said Phillips.

“(Phillips) will be fit for duty. That’s what our goal is: to make them fit for duty,” said Caram.

Author: Marcy Sanchez – WBAMC / DVIDS

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