1. The George Washington University Hospital
health
www.gwhospital.com
news
Summer 2006
Outpatient
Surgery From
Head to Toe
• No Need to Shoulder
Rotator Cuff Pain
• Foot Surgery
That’s a Step Ahead
• Relief for
Endometriosis
or Fibroids
Arthroscopic
Knee Surgery
Torn
Rotator
Cuff
Hernia
Bunions
Eye
Surgery
Fibroids

2. The George Washington University Hospital Summer 2006
Introducing The GW Surgery Center:
Outpatient Surgery From Head to Toe
A
dvanced medical technology and surgical
techniques now make it possible to treat many
conditions, such as hernias, cataracts and torn
rotator cuffs, on an outpatient basis. Patients often go
home an hour or so after leaving the operating room.
At The GW Surgery Center, we know patients
want their surgical experiences to be as efficient,
convenient and stress-free as possible. Staff members
at the center are dedicated to meeting these needs.
Opened in Spring 2006, The GW Surgery Center
is located just a few blocks from The George
Washington University Hospital. It offers patients
the following advantages:
• Personalized care — Procedures are
planned in advance, so surgeons and
staff are able to give patients one-on-
one attention.
• Minimal waiting — Typically, patients
arrive at the facility one hour before
their procedures. They often depart
about one hour after leaving the
operating room.
• A calm, welcoming atmosphere —
Bright, elegant waiting areas help give patients and their families a sense
of relaxation, privacy and comfort.
• An experienced staff and advanced technology — Operating rooms
feature equipment designed for minimally invasive surgical techniques.
Staff members specialize in caring for outpatients.
• GW Hospital’s commitment and support — Surgeons who had been
operating exclusively at the hospital now operate at The GW
Surgery Center as well. The facility is fully equipped to manage any
complications. If needed, patients can be transported by ambulance
to GW Hospital.
“Surgeons evaluate every case individually, but in general, the factors
that determine whether a procedure can be done in The GW Surgery Center
are the health of the patient and the complexity of the procedure,” says Luu
Nguyen, MD, Medical Director of The GW Surgery Center.“In most cases, if
you could have your procedure done on an outpatient basis at the hospital,
you would be eligible to have it performed at The GW Surgery Center.”
In this issue of Health News, we’ll explore a few of the many procedures
available at The GW Surgery Center.
The GW Surgery Center is located at 2120 L Street, N.W. For more
information, please call 202-715-4600.
It is possible to treat many
conditions, such as hernias,
cataracts and torn rotator
cuffs, on an outpatient basis.
Patients often go home an
hour or so after leaving the
operating room.
Minimally Invasive Treatments Have Patients Home Quickly
Luu Nguyen, MD
Medical Director
A Wide Range of
Outpatient Surgeries
The center also offers procedures
in the following areas:
Colorectal surgery
Cosmetic and plastic surgery
Endoscopy
General surgery
Oral surgery
Gastroenterology
Gynecology (OB/GYN)
Ophthalmology
Orthopedics and sports medicine
Otolaryngology
Pain management
Podiatry
Urology
•
•
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•
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•
•
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•

3. www.gwhospital.com Summer 2006
T
he rotator cuff, composed of four muscles and
their tendons, is an injury-prone area of the
shoulder that helps lift and rotate the arm and
stabilize the shoulder joint. Trauma or repetitive
overhead movements can cause these tissues to tear,
resulting in pain and limited shoulder mobility.
“The surgical approach we use is determined
by the size of the tear, the condition of the muscles
and tendons and how easily we can move the tissue
in the joint,” says Robert Neviaser, MD, Chairman
of Orthopedic Surgery at GW Hospital.
“In the past, we needed to do an open procedure
to repair a torn rotator cuff, which involved making
a four-inch incision,” says Craig Faulks, MD, an
orthopedic surgeon at The GW Surgery Center.
“Now, we have two minimally invasive options:
arthroscopic repairs and mini-open repairs.”
An arthroscopic repair, the most common,
requires only three ¼-inch incisions. During a
mini-open repair, the first half of the surgery is done
using minimally invasive arthroscopic techniques.
The second half is done using a traditional open
procedure, but the incision is only one inch.
Dr. Faulks believes The GW Surgery Center
provides an ideal environment
for many patients requiring
shoulder surgery.“The whole
surgical process, from registration
to recovery, is streamlined and
efficient,” he says.“Consequently,
patients get to go home quickly
and start healing, and they’re back
to normal activities before they
know it.”
To schedule an appointment with
an orthopedic surgeon, please call
1-888-4GW-DOCS.
Tears of the rotator cuff muscles
or tendons may be caused by
severe tendinitis or a sudden
injury. In some cases, only a
small bit of tendon will tear
(partial tear). Or, the tendon
may tear all the way through
(complete tear). This can result
in pain and may cause shoulder
weakness.
Rotator
cuff tendons
Humerus
(arm bone)
Rotator
cuff tear
There’s No Need to Shoulder Rotator Cuff Pain
Arthroscopic and Mini-Open Repairs Are Available
Craig Faulks, MD
Orthopedic Surgeon
M
inimally invasive surgical techniques for
knee procedures are getting patients back to
their daily activities more quickly than ever.
“Injuries and normal wear and tear of the knee
may cause conditions ranging from torn cartilage to
instability or abnormal alignment of the kneecap,”
says James H. Graeter, MD, an orthopedic surgeon
at The GW Surgery Center.
The key device that makes minimally invasive
knee surgery possible is the arthroscope: a thin,
telescope-like device inserted through a one- to
two-inch incision.The arthroscope has a miniature
video camera on one end that transmits images to a
television monitor, allowing the surgeon to see inside
the joint.The surgeon may insert instruments through
neighboring small incisions to perform the surgery.
“Most knee arthroscopy patients don’t require
general anesthesia that renders them unconscious; they
require only enough anesthetic to completely numb the
knee joint. In fact, some of my patients enjoy watching
the television monitor as I perform the procedure,”
says Kenneth Fine, MD, an orthopedic surgeon at
The GW Surgery Center who operates on many
athletes ranging from professionals to weekend
warriors.
Knee arthroscopies take approximately one hour.
During a 60- to 90-minute stay in the recovery area,
trained staff members fit patients with crutches and
provide post-operative instructions. In many cases,
doctors encourage patients to start putting as much
weight as possible on their repaired knees to encourage
healing.
Arthroscopic surgery has many benefits over
traditional open surgery. Because the image on the
monitor is magnified, surgeons can closely examine it
to detect very small defects. Due to smaller incisions,
arthroscopic procedures cause much less tissue damage
than open procedures, which reduces the risk for
infection and promotes faster, safer and less painful
recoveries.
To schedule an appointment with an orthopedic
surgeon, please call 1-888-4GW-DOCS.
Arthroscopic Knee Surgery
Can Get You Back on Your Feet Faster
James H. Graeter, MD
Director, The Joint
Replacement Center
Kenneth Fine, MD
Director, Sports Medicine
Assistant Professor of
Orthopedic Surgery
Robert Neviaser, MD
Chairman,
Orthopedic Surgery
Front View of Shoulder
Illustration©TheStaywellCompany.Allrightsreserved.

4. T
oo often, we take our
feet for granted while
lavishing attention on
our footwear. Unfortunately,
fashionable shoes are often
tight, narrow and high-
heeled. Over time, wearing
these shoes may yield ugly
results, such as painful bone
and tissue deformities.
“When conservative
treatment and sensible shoes
fail to fix the problem,
surgery may provide
long-term relief,” says Michael S. Stempel, DPM,
FACFAS, a podiatrist and Director, Division of
Podiatry, Department of Surgery, at The George
Washington University Hospital. Dr. Stempel, who
is board certified in foot surgery, performs a number
of outpatient podiatric procedures at The GW
Surgery Center, including bunion and hammertoe
surgeries.
Bunion Surgery
A bunion is a
misalignment in the
joint that connects the
big toe to the foot. It
causes the base of the
big toe to swell and
protrude. According
to the American
Orthopaedic Foot and
Ankle Society, more
than half of the women
in the United States
have bunions, often
caused by shoes that
squeeze toes into unnatural positions. Arthritis
and heredity may be contributing factors.
“Bunion surgery involves removing excess
bone, repairing damaged joint surfaces and
realigning the toe joint,” Dr. Stempel says. “Most
patients experience a dramatic reduction in pain
after surgery.”
Hammertoe Surgery
A hammertoe occurs
when the second, third
or fourth toe bends at
the middle joint, giving
it the appearance of
a miniature hammer.
Often, shoes with
narrow toe boxes are
the primary cause.
Eventually, the toe
becomes frozen in this
bent position, causing
the knuckle to rub
painfully against the
tops of shoes.
“Hammertoe surgery involves removing a
small portion of bone from the toe. That allows
it to lie flat again,” Dr. Stempel says.
Podiatric surgery generally lasts from 30 minutes
to two hours, and patients stay in the recovery
area for about an hour. The GW Surgery Center
provides a perfect place for these procedures,
says Dr. Stempel.“Patients have a cheerful, calm
environment in which to relax and recover from
anesthesia, and they’re usually ready to leave three
to four hours after they enter the doors,” he says.
To schedule an appointment with a podiatric
surgeon, please call 1-888-4GW-DOCS.
Find Footwear
That Fits
Pay attention to comfort
and fit when you are
shoe shopping. The
American Academy of
Orthopedic Surgeons
offers these tips:
Have both feet
measured every time
you purchase shoes,
since foot size may
change as you get
older. Because
feet tend to swell
during the day, shop
for shoes in the
afternoon or evening.
Avoid shoes with
heels higher than
2¼ inches.
There should be a
½-inch space from
the end of your
longest toe to the
end of the shoe.
Make sure shoes are
comfortable enough
to wear when you
buy them. There is
no such thing as a
“break-in period.”
•
•
•
•
The George Washington University Hospital Summer 2006
Foot Surgery That’s a Step Ahead
Procedures Help Correct Damage From
Ill-Fitting Shoes, Arthritis and Heredity
Michael S. Stempel,
DPM, FACFAS
Director, Division
of Podiatry
Bunion
Bone
removed
Screw
Hammertoe
Part of
the bone
removed
Illustrations©TheStaywellCompany.Allrightsreserved.

5. www.gwhospital.com Summer 2006
F
or women with excessive
menstrual bleeding,
monthly periods can
be an ordeal. However,
in general, women with
this problem are healthy
and hospitalization is not
required.
“At The GW Surgery
Center, we offer effective,
minimally invasive
procedures that enable
women to be treated for their
bleeding problems and leave
in a few hours,” says Damian
P. Alagia, MD, MBA, Director of Minimally
Invasive Gynecologic Surgery at The George
Washington University Hospital.
Fibroids Are Common Causes
About 40 percent of women who have excessive
menstrual bleeding can trace the problem to
fibroids, a noncancerous growth in the uterus.
These fibroids can protrude from the uterine lining
into the uterine cavity, or they can be buried in the
uterine wall.
Thermal Balloon Ablation as Treatment
Dr. Alagia’s preferred method for treating heavy
bleeding is thermal balloon ablation. This
technique thins out the uterine lining and hinders
the ability of the endometrium (the uterine lining
that sheds during the menstrual cycle) to grow. The
procedure is only appropriate for women who do
not want to bear children. Here’s how it works:
• A mild sedative is given to the patient, and
anesthesia is used to numb the cervix. A small,
flexible balloon attached to a thin tube is then
passed through the vagina to the uterus (no
incision is required). The balloon is filled with
fluid so it conforms to the size and shape of the
uterus.
• The fluid is heated and circulated in the
uterus for eight minutes. The heat alters the
composition of the endometrium.
• When treatment is complete, the fluid is
withdrawn from the balloon and the balloon
is removed. The treated uterine lining sheds,
like a period, over the next few days. Following
treatment, most women have much lighter
periods, and 20 to 30 percent of women stop
having periods altogether.
Treatment for Protruding Fibroids
For women whose bleeding is caused by uterine
fibroids that protrude into the uterine cavity, the
surgeon may remove the fibroids first, using a
procedure called a myomectomy, then perform
thermal balloon ablation. The procedures may be
performed back-to-back, according to Dr. Alagia.
To schedule an appointment with a gynecologic
surgeon, please call 1-888-4GW-DOCS.
Effective Solutions for
Excessive Menstrual Bleeding
Fibroids are almost always benign and do not increase the risk for
uterine cancer.
Fibroids are growths in the uterus composed of muscle cells and other tissue.
They grow singularly or in clusters and range in size from as small as a raisin
to as large as a grapefruit.
Not all women with fibroids experience symptoms, but in some cases fibroids
cause heavy bleeding during or between periods, a feeling of fullness in the
pelvic area or low back pain.
The cause of fibroids is not certain.They are more prevalent in women of
childbearing age and African American women.
Fibroids may be diagnosed during a pelvic exam. However, imaging tests,
such as ultrasounds or X-rays, sometimes may be required to confirm their
presence.
Medications may shrink problematic fibroids, but they are most often treated
with surgery.
•
•
•
•
•
•
Other Gynecologic Procedures
Performed at The GW Surgery Center
Hysteroscopy — A diagnostic procedure in
which the surgeon inserts a thin, telescope-like
device called a hysteroscope through the cervix
to view the inside of the uterus
Ovarian cystectomy — A procedure to remove
fluid-filled growths in the ovaries
Dilation Curettage (DC) — A procedure
that involves dilating the opening of the cervix
and scraping tissue away from the lining of the
uterus
Bladder neck repairs — A procedure to
strengthen the opening of the bladder and
correct incontinence by implanting a sling-like
support
•
•
•
•
Damian P. Alagia,
MD, MBA
Director of
Minimally Invasive
Gynecologic Surgery
Facts About Fibroids
Insertion
Treatment and Monitoring
Deflation and Removal

6. Y
our abdominal muscles continuously work to
assist with breathing, support the muscles of
your spine and hold your abdominal organs in
place. Over time, these muscles may weaken, bulge or
rip, leaving you susceptible to a hernia.
A hernia occurs when the inner lining of the
abdomen pushes through the weakened abdominal
wall, forming a sac.A portion of the intestine or
abdominal tissue slips into the sac, often causing
it to bulge beneath the skin.
Inguinal (groin) hernias account for 80 percent
of all hernias and are most common in men.They
usually occur when weakened abdominal muscles
are strained from heavy lifting, sudden twists or
pulls, or chronic constipation.
Surgery Is the OnlyTreatment Option
Symptoms of a hernia include a visible bulge, a dull
ache, and weakness or pressure in the groin. Surgical
closure of the hole in the abdominal wall is the only
treatment option for a hernia.
“Hernia procedures are tailor-made for outpatient
surgery facilities because they’re relatively quick and
easy to recover from,”says Juliet Lee, MD, a general
surgeon who operates at The GW Surgery Center.
“At The GW Surgery Center, we have everything we
need to give patients advanced medical care and a
streamlined, personalized experience.”
Many hernias do not require immediate
treatment. In rare cases, the abdominal muscles
squeeze off the blood supply to the protruding tissue,
causing it to die and become infected.This is called
a strangulated hernia, and it requires emergency
surgical treatment, which is done in the hospital. In
most other cases, hernia surgery may be scheduled
at The GW Surgery Center.
ThreeTypes of Procedures
“Any of the three types of hernia repair will yield
good results,”says Gordon H. Hafner, MD, FACS, a
general surgeon.“The hernia repair itself takes about
45 minutes to an hour. Patients then spend about
90 minutes in post-op recovery, after which they are
ready to go home.”
Surgeons at The GW Surgery Center offer three
types of hernia procedures:
• Conventional method — An incision is made at
the hernia site, and the protruding tissue is gently
pushed back into the abdominal cavity.The hole
in the abdominal wall is stitched shut.
• Open mesh repair — The surgeon covers the hole
with a piece of biocompatible mesh that gradually
becomes a permanent part of the abdominal wall.
• Laparoscopic mesh repair — A laparoscope is a
telescope-like device that is passed through a small
incision, allowing the surgeon to see the hernia on
a video screen.The surgeon inserts instruments
through neighboring incisions and sutures a mesh
covering to the inside of the abdominal wall.
To schedule an appointment with a surgeon who
does hernia repairs, please call 1-888-4GW-DOCS.
Turn to Us for
HerniaSurgery
“Any of the three types of hernia repair
will yield good results. The hernia repair
itself takes about 45 minutes to an hour.
Patients then spend about 90 minutes
in post-op recovery, after which they
are ready to go home.”
— Gordon H. Hafner, MD, FACS
“At The GW
Surgery Center,
we have everything
we need to give
patients advanced
medical care and
a streamlined,
personalized
experience.”
— Juliet Lee, MD
The George Washington University Hospital Summer 2006
Gordon H. Hafner,
MD, FACS
General Surgeon
Juliet Lee, MD
General Surgeon

7. www.gwhospital.com Summer 2006
W
hen it comes to outpatient surgery,
ophthalmic medicine is, in a word,
visionary. Ophthalmic procedures were
some of the first surgeries to be performed on an
outpatient basis. Today, they continue to be the
most common outpatient surgeries.
These procedures especially are suited for
outpatient surgery centers because:
• They involve relatively little pain or bleeding.
• They usually last no more than an hour.
• Recovery generally is easy.
At The GW Surgery Center, ophthalmic surgeons
perform many procedures, including cataract
surgery and glaucoma procedures, to help restore
and maintain clear vision.
Cataract Surgery
During a cataract procedure, the surgeon removes
one or both of the eyes’ lenses, which may become
cloudy with age or illness. The cloudy film makes
it difficult for light to reach the back of the eye,
resulting in blurry or dimmed vision.
The surgeon breaks up the lens using sound
waves (a process called phacoemulsification), then
collects the fragments with a tiny vacuum device.
The lens is replaced with an artificial implant
that may, in some cases, correct the patient’s
nearsightedness or farsightedness, as well as give
clear, unclouded vision.
Glaucoma Procedures
Glaucoma procedures relieve fluid pressure inside the
eye that degrades the optic nerve and causes vision
loss.The surgeon may perform a trabeculectomy, a
procedure in which a laser beam is used to stretch the
eye’s drain, allowing excess fluid to filter out of the
eye.Also, the surgeon may implant a shunt to create
an extra passageway for the fluid to drain.
David A. Belyea, MD, FACS, is an ophthalmic
surgeon who performs glaucoma and cataract
procedures at The GW Surgery Center.“Even
complex cases, such as a procedure that involves
both a cataract extraction and a glaucoma operation,
can be performed in this facility,”he notes.
Seeing a New You
Oculoplastic procedures include cosmetic, corrective
and reconstructive surgery of the eyelids and area
surrounding the eyes. Several of these procedures
are performed at The GW Surgery Center:
• Blepharoplasty involves removing excess skin,
muscle and fat from the upper and lower eyelids.
It may be done for functional reasons to fix
sagging eyelids that interfere with vision, or it
may be done for cosmetic reasons to redefine the
shape of the eye for a more youthful appearance.
• Ptosis repair involves fixing eyelids that droop
due to muscle paralysis or weakness.
• Ectropion and entropion repairs correct eyelids
that turn outward or inward, which causes
irritation or excessive tearing.
“The new facility has an operating room
dedicated to eye procedures with the advanced
equipment surgeons need,” says Craig E. Geist,
MD, FACS, an oculoplastic ophthalmic surgeon
at The GW Surgery Center.“Also, patients’ needs
are catered to at every turn. For example, we have
reclining, rolling chairs that patients can remain on
from pre-op to recovery, so they don’t have to climb
onto and off of the operating table. This is especially
important for older patients with mobility issues.”
To schedule an appointment with an ophthalmic
surgeon, please call 1-888-4GW-DOCS.
See What Eye Surgery Can Do for You
Outpatient Procedures Can Improve Vision and Appearance
“Even complex
cases, such as a
procedure that
involves both a
cataract extraction
and a glaucoma
operation, can
be performed at
The GW Surgery
Center.”
— David A. Belyea,
MD, FACS
Removing a cataract
During phacoemulsification, an ultrasound probe
is inserted into the lens through a corneal incision.
Sound from the probe breaks the cloudy lens into
pieces that are removed with a tiny vacuum device.
“The new facility has an
operating room dedicated to eye
procedures with the advanced equipment
surgeons need. Also, patients’ needs are
catered to at every turn.”
— Craig E. Geist, MD, FACS
David A. Belyea, MD, FACS
Ophthalmic Surgeon
Craig E. Geist, MD, FACS
Oculoplastic Ophthalmic
Surgeon
Lens
Cornea
Ultrasound
probe
Illustration©TheStaywellCompany.Allrightsreserved.
Iris
Small
corneal
incision

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Information in Health News comes from a wide
range of medical experts. If you have any concerns
or questions about specific content that may affect
your health, please contact your healthcare provider.
Models may be used in photos or illustrations. Any
opinions expressed by an author whose article appears
in this publication are solely the opinions of the author
and do not necessarily reflect the views of The George
Washington University Hospital or Universal Health
Services, Inc. Physicians mentioned in this publication
are on the medical staff of The George Washington
University Hospital but, with limited exceptions, are
independent contractors who are not employees or
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©2006. All rights reserved. Printed in the U.S.A.
health news
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Legs for Life!
Free Screening for Peripheral
Vascular Disease (PVD)
Tuesday, Sept. 12, 8 AM – 4 PM, Free
If you have leg pain when walking or
exercising, don’t assume it’s a normal
part of aging. You may be suffering from
a disease of the arteries called Peripheral
Vascular Disease (PVD). Symptoms may
include cold feet and/or legs, numbness
and tingling in your feet and/or legs, pain
in legs while moving but no pain at rest.
Location: Hospital Lincoln Room. If
you are age 55 or older, join us for this
important screening. Please call 1-888-
4GW-DOCS to schedule your PVD
screening appointment.
Frequent Urination? Simple and
Effective Solutions for an Enlarged
Prostate
Wednesday, Sept. 27, 7 PM – 8:30 PM,
Free
Presenters: Michael H. Phillipps, MD,
FACS, Clinical Professor of Urology
and Ramez Andrawis, MD, FRCS,
MSc, Assistant Professor of Urology.
If you’ve been changing your lifestyle
to accommodate urinary problems,
we invite you to a seminar that will
detail the latest procedures that could
help you regain your freedom. New,
minimally invasive surgical treatments
may reduce prostate size and relieve
urinary obstruction without damaging
surrounding tissue — resulting in
faster recovery and fewer side effects.
Location: Hospital Auditorium. To
register, please call 1-888-4GW-DOCS.
Senior Health Expo 2006
Saturday, Oct. 28, 9 AM – 4 PM, Free
Senior Citizens won’t want to miss
this year’s FREE Senior Health Expo.
Enjoy informative exhibits on health,
fitness and finance. Register for FREE
cholesterol, glucose and blood pressure
screenings. Win door prizes and more!
Sponsored by the GW Senior Advantage
Program. Location: Hospital first
floor. For more information, please
visit www.gwhospital.com or call
1-888-4GW-DOCS.
Free Prostate Screenings in September
September is Prostate Cancer Awareness
Month. The GW medical community
is hosting free prostate screenings
by appointment on designated days
during September (includes a PSA test
and digital rectal exam). Screenings
are suggested for all men age 50+ and
African American men age 40+. African
American men
and those with
a family history
of the disease
are at increased
risk for prostate
cancer. This
is a screening
appointment
and not to be used for a second opinion.
Space is limited, so register today by
calling 202-741-3100.
October is Breast Cancer
Awareness Month
Look for the GW Mammovan in your
community during October and get your
screening mammogram.
Oct. 9, Springfield/Franconia Family
Resource Center, 7224 Commerce St.,
Springfield, VA
Oct. 18, Chartered Family Health
Center, 3924 Minnesota Ave., N.E.,
Washington, DC
Oct. 25, Casa of Maryland,
34 University Blvd., Silver Spring, MD
To schedule your screening
mammogram, or for a complete
calendar of upcoming screening sites,
please call 202-741-3270.
Fall Seminars 2006
To register, please visit our Web site at www.gwhospital.com or call 1-888-4GW-DOCS.