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Meet our Docs: Through robotics, urologist Dr. Todd Hansen offers minimally invasive surgeries with shorter recovery times

In 2008, Wyoming Medical Center got the state’s first da Vinci S™ HD Surgical System. Our doctors are the most experienced on the da Vinci and offer more procedures than any other hospital in Wyoming.

Dr. Todd Hansen, a urologist at Central Wyoming Urological Associates, has performed hundreds of surgeries with the robot, cutting his patients’ recovery times and improving their outcomes.

The Pulse recently sat down with Dr. Hansen to talk about the benefits of minimally invasive surgeries and how patients can determine the right treatment options for them.

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Dr. Todd Hansen poses between the surgical arms of the da Vinci robot. He has performed several hundred procedures with the da Vinci, resulting in smaller incisions and faster recovery times for patients.

Hansen: I grew up in a small rural town in Arizona called Joseph City. My grandfather was a big rancher, but my father went into dentistry. We lived right there with my uncles who took over the ranch and were highly involved. I liked ranching more than I did dentistry.

The Pulse: What interested you about medicine generally and urology specifically?

Hansen: I think it just kind of fascinated me. I was not certain at all when I got started with school that I was going to go into medicine, but it just kind of aligned with my interests and talents.

Urology is kind of a hidden specialty. It is not something a lot of people think of, and I was one of them. I never thought of it going into medical school, though I did feel myself getting pulled toward the surgical side of things.

I was working with a urologist when I began to realize that: One, they were a fun group to work with and, two, the procedures and the surgeries they were doing were very fascinating. I think most of us kind of think urology as old man’s health care. I realized that was anything but the truth. Really, we were on the cutting edge of a lot of surgical innovations, and we did extensive surgeries that I really enjoyed.

The Pulse: What do you mean cutting edge?

Hansen: For example, we do many laparoscopies, robotics and things like that. Quite frankly, urology has been the leader in robotics. Look at minimally invasive surgery, endourology with the ability to do things with scopes that we do. We do some really big, fascinating reconstructive surgeries as well. We do cystectomies and reconstruct a whole urinary system.

The Pulse: What are the advantages of minimally invasive procedures like those that can be done with the da Vinci S™ HD Surgical System?

Hansen: Before da Vinci, I had already done a tremendous amount of laparoscopy, where you are putting ports into the abdomen and doing surgery. The da Vinci is just an extension off of that, but you have a robot, so you have wristed instruments. It is kind of a natural step to be able to provide more care minimally invasive that you could not do with just a plain laparoscope.

With robotics, you do a complex surgery without making a big incision. An open surgery entails going through major muscles, even potentially taking a rib. There is much more pain and discomfort, a much higher chance of hernia and higher risk of infection; da Vinci makes smaller port sites, hernias are much less common. Infection rate drops a lot. Pain and discomfort drop immensely and there is a shorter hospital stay.

The advantages are fairly obvious. A large incision going through major muscle versus some small port sites is not a subtle difference.

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A closer view of the da Vinci’s surgical tools. With its wristed instruments, the da Vinci give surgeons greater precision than laparoscopy.

Hansen: That just depends on how you term recovery. The patient will forever be more comfortable without open surgery, because once you go through those muscles, a lot of times you end up with nerve injuries and some muscle paralysis. The short of it is: You are going to be dramatically more comfortable after minimally invasive surgery. Your ability to get back to work and do things is going to be increased significantly in terms of weeks probably.

The Pulse: What can you offer with da Vinci that others can’t?

Hansen: There is a huge gap in the community and their understanding of what is really offered here that is not offered anywhere else in this state urologic-wise.

For example, if you have a tumor in your kidney, we have the ability to remove that tumor without removing the entire kidney – what we call a partial nephrectomy. That results in longer life expectancy and decreased chance of renal failure. There are huge advantages to the patient to do a partial versus a total nephrectomy.

We not only have the ability to do that, and to do that well, but to do it without an open incision. That is not being done anywhere else. The ability to re-implant ureters and do it without an open incision is not being done anywhere else. We can do sacrocolpopexy, or female reconstructive surgery, without making an open incision.

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Surgeons operate the da Vinci via remote control, using a high-resolution and magnified image that offers a more detailed view of the procedure.

If you want to know the truth, I suspect there are a ton of patients out there that are getting total nephrectomies with the entire kidney removed when they should just be getting a partial nephrectomy. I can tell you that no one else is doing that minimally invasively. To be frank, I do not think the community has any idea how much further ahead we are than the rest of the urologic community in this area.

The Pulse: Is this something that patients should ask for? If their urologist doesn’t offer minimally invasive or laparoscopic surgeries, what should they do?

Hansen: It is a patient issue. Patients should ask for second opinions on the best treatment options, and that doesn’t mean going to Denver or Salt Lake City. A lot of people just don’t realize that we offer it in Casper.

I get some urologists who do refer to me, but there are a lot that do not. They either just remove the entire kidney, or they do an open surgery. You cannot say that is substandard care, but I do not think even our own hospital recognizes how much further apart we have set ourselves than the vast majority of the care that is getting performed.

I think it is appropriate for any patient in any situation to ask for a second opinion if they feel that it would benefit them. It is okay for a patient to ask for a second opinion. I have patients who do that. We all have patients who do it.

It’s OK to ask your doctor: “Is this something that can be done in a less invasive way?”

The Pulse: How many different procedures are you able to do on the da Vinci?

Hansen: The question anymore is, “What don’t we do on the da Vinci?” There are not very many abdominal surgeries that we are not doing with da Vinci and/or robotically.

Take a prostatectomy: You end up being able to do a better dissection because you can see better. You end up doing a better anastomosis because you can see better. You can actually perform the surgery better robotically than you can open.

Some people would debate that. This is not a hard and fast thing, but in my experience, I think you can actually get better outcomes doing it robotically. There is a fair amount of literature that suggests you can. Definitely, you can do it with a better recovery. If your surgeon said “Let’s take out your gallbladder laparoscopically versus doing an open gallbladder,” every person would choose a laparoscopic gallbladder.

The Pulse: What are the advantages of having these procedures in Casper as opposed to traveling out of state?

Hansen: One of the huge advantages is follow-up. You have a physician who is committed to taking care of you long term. Many of my patients have found it frustrating that they have gone elsewhere and then realized that there is really not much follow-up. These physicians are kind of like, “just go back and see whomever.”  That is probably one of the biggest advantages as there is much better follow-up care long term, not just immediately.

I still respect the fact that the patients need to do what they are comfortable with. I do not believe I lose very many to outside facilities. Most of them are very comfortable with the care we are providing. I know the hospital is very focused on that. I think I have more in-migration than out-migration. I get many more patients referred into me than I have leaving, by a huge number.

I do think there are patients who we never see to begin with because they do not know what we can do here. The biggest area that is true in is pediatric urology. That is probably education that needs to go on at the level of the pediatricians.

The Pulse: What trends do you see coming in urological medicine?

Hansen: There have been so many advances, mainly related to the da Vinci robots. When I started here, for example, we were doing all kinds of open procedures. Now, the number of open procedures has been cut down to just a trickle.

The biggest advancements are going to continue to be learning to do things minimally invasive with better outcomes. That will still be the trend. Cystoprostatectomies are getting done robotically. That is probably something that we would bring in.

The other thing is that I think that there is going to become better screening for cancer. Two big areas in urology, other than minimally invasive, would be better cancer screening and detection so that we can differentiate who to treat and not to treat. New organs at some point, they are already in the process of developing things like bladders and that now. There will come a point when we use tissue that is grown in the lab to implant surgically.

 

Hansen Todd MD (1)Dr. Todd Hansen, M.D.

Dr. Hansen practices at Central Wyoming Urological Associates ,  1416 E. A St., Suite 101, in Casper. Reach him at 307-577-8600.

  • Medical School: University of Chicago
  • Residency: University of New Mexico School of Medicine, Albuquerque, N.M.; General Surgery and Urology
  • Board Certification: Urology

Meet our Docs is an occasional series introducing the physicians of Wyoming Medical Center. Click here for more interviews.

Survive. Don’t Drive: In case of a heart attack, dial 911

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Dr. Adrian Fluture reminds people to call 911 at the first signs of a heart attack. WMC doctors and staff can administer the best and fastest treatment when patients trust our EMS system, rather than driving to the hospitals themselves. (Photo by Dan Cepeda Photography)

It seems like common sense: At the first signs of heart attack, call 911. Do not lie down to see if the symptoms pass. Do not ask a friend or loved one to drive you to the hospital. Above all else, don’t think you can drive to the hospital yourself.

Americans wait an average of 2 hours after the first symptoms appear before deciding to do something about them, said cardiologist Dr. Adrian Fluture, Director of Regional Myocardial Infarction Care at Wyoming Medical Center. Only about 60 percent of those patients use EMS services, instead trying to make it to the hospital on their own.  Natrona County’s numbers are even worse. Here, only 30 percent of people who suspect heart attacks call 911.

That can be a deadly decision.

Heart attacks require immediate medical treatment. When a patient calls 911, Wyoming Medical Center shaves an average of 10 to 11 minutes off door-to-balloon time – the time from when a patient arrives at the emergency room to the time a balloon is inflated in the blocked vessel. The shorter the time, the more heart tissue doctors can save.

“Data shows that of the people who die from (heart) rhythm disturbances, most of them die within the first one hour of onset. Rhythm disturbances can be so bad that it can kill you within a couple or three minutes,” Fluture said. “You need to trust the system. Dial 911. Every minute a person delays medical treatment increases the likelihood of damage or even death.”

At the first signs of heart attack, call 911. Never drive yourself to the hospital or have someone else drive you.  Here are three reasons why:

1.       You may crash your car.

If you suffer a heart rhythm disturbance on the drive, you will likely crash. Worse, you may crash into another car or run over pedestrians.

“The thing I tell my patients is they may kill a mom with kids coming from school. Just be responsible,” Fluture said. “These are unpredictable things. You cannot say, ‘I just have a chest pain. I know I’m going to be fine until I reach the hospital.’ You can never guarantee that.”

2.       Cardiac resuscitation requires a team effort.

Even if a loved one is trained in cardiac resuscitation, one person is not enough. He needs help to arrive as quickly as possible, and calling 911 is the fastest way to get it. If a loved one decides to drive you to the hospital and you go into cardiac arrest, he can’t do anything for you while he’s behind the wheel.

Ambulances are mobile emergency medical clinics. When paramedics reach you, they can treat low blood pressure, administer IVs and aspirin, remove clothing and prep you for immediate admission to the hospital. If you go into cardiac arrest, paramedics are trained with defibrillators and can resuscitate you – at home or en route to the hospital. Casper Fire/EMS crews, which may arrive on emergency scenes before anyone else, also carry and are trained on defibrillators.

“The earlier you get these things done, the higher the chance the patient will survive if heart rhythm disturbance happens,” Fluture said.

3.       Time means muscle.

Treatment is started more quickly for patients who call 911. That means less chance for damage to heart tissue.

Natrona County’s fire crews and WMC’s ambulance crews have all been trained to start the first phase of treatment in suspected heart attacks. Upon arriving on scene, they will perform an EKG and send the results to the hospital right then. Hospital doctors will read the results and, if you are indeed suffering a heart attack, will prepare the Cath Lab team and forward the results to the cardiologist’s personal cell phone. The cardiologist can respond to the hospital while you are en route.

“Everything that we need to do at the hospital is already prepared when the patient is rolling in by ambulance. The whole time to treatment will be much shorter,” Fluture said.

Our heart program is among the best in the country, but you have to trust the medical professionals to take care of you. The American Heart Association’s Mission: Lifeline protocol recommends a 90 minute door-to-balloon time. Wyoming Medical Center averages 41 minutes, putting us in the top 90th percentile of American hospitals. But we can only save patients and provide the best outcomes when they get to us as quickly and as safely as possible.

 Heart attack symptoms: ‘From belt to teeth’

Warning signs of a heart attack can be hard to identify. They may start slowly, presenting as mild pain and discomfort, and may develop over days or weeks. They can feel similar to symptoms of other ailments, including heart burn, making them easy to discount.

Dr. Fluture recommends that you carefully weigh any pain or discomfort from “from belt to teeth” if you think you might be suffering a heart attack. Play it safe. If there is any doubt, call 911.

The more of the following symptoms present, the greater the likelihood of heart attack:

* Any pain, tightness, heaviness, pressure or squeezing in the chest. It may even feel like heart burn or a generalized apprehension or uncomfortable feeling.

* Pressure or pain spreading to the neck, jaw, left shoulder or both shoulders. You may feel tingling or numbness in the left arm and forearm, spreading to the inside of the arm. It may migrate to between the shoulder blades or, occasionally, to the back or spine.

* Feelings of fullness, pain or indigestion in the stomach.

* Shortness of breath or cold sweating with no good explanation.

adrian fluture

Dr. Adrian Fluture specializes in cardiology, interventional cardiology and vascular/endovascular medicine at Wyoming Cardiopulmonary, 1230 E. First St. in Casper. 

He is board certified in internal medicine, cardiovascular disease, interventional cardiology, nuclear cardiology, echocardiography and vascular medicine; and CT Angiography. He is also Director of Regional Myocardial Infarction Care at Wyoming Medical Center. For more information or referrals, call (307) 266-3174. 

 

 

New wig room offers comfortable place for cancer patients

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The new wig room at Rocky Mountain Academy of Hair, Skin and Nails will give cancer patients a private, comfortable place to pick out and style their new wigs.

Every month, Wyoming Medical Center Foundation’s Angels Cancer Care Program receives multiple requests from cancer patients needing a wig. With the help of local cosmetologists, the Angels have created a room to make the entire experience more comfortable and intimate for cancer patients.

The Angels have partnered with Kirby Morris – co-owner of Rocky Mountain Academy of Hair, Skin and Nails (RMA) – to create a wig room in the cosmetology school. Morris completely refurbished a room in his school with a washing and styling station, welcoming décor and a variety of wigs lining the walls.

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Cancer patients can have students at Rocky Mountain Academy shave their heads and style their wigs, or they can invite their own cosmetologists in to help.

“Opening the wig room at the Rocky Mountain Academy of Hair Skin and Nails is allowing us to pool our resources.  It’s giving patients a place to have privacy while having their head shaved and to choose a wig that fits them,” Morris said. “It’s giving our school a place to teach our students about giving back to our community and to cancer patients while using the skills that they are learning here at RMA.”

In the wig room, cancer patients can have their head shaved, pick out a wig and have it styled either by RMA students or their own cosmetologist. It presents another facet of cosmetology that is not typically covered in the academy curriculum and offers an opportunity for students to learn how to handle sensitive situations with cancer patients, Morris said.

Angels Cancer Care Coordinator Jillian Riddle said the Angels are looking forward to serving hundreds of cancer patients in the new room.  “Our goal is to not only give patients privacy during this difficult time, but make them feel special when choosing their new wig. We are thrilled the wig room has come to life.”

About the Angels

The Wyoming Medical Center Foundation’s Angels Cancer Care program serves hundreds of Wyoming cancer patients every year offering emotional support and financial assistance with wigs, gas cards, transportation and more. To learn more or to make a donation, call (307) 577-4355 or visit our website.

If you are a cancer patient needing a new wig or would like more information about the wig room or the Angels Cancer Care Program, contact Jillian Riddle at jriddle@wyomingmedicalcenter.org.

About RMA

 Rocky Mountain Academy of Hair, Skin and Nails is located at 315 E. Fifth St. in Casper. Call them at (307) 237-4247.

Alisha HavensAlisha Havens is development director of the Wyoming Medical Center Foundation. For more information about the foundation or how to give, go to wyomingmedicalcenter.org/giving.

Decoding diabetes: 11 easy snack ideas with 200 calories or less

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If you are living with diabetes or have been diagnosed with prediabetes, you’ve likely heard about the virtues of healthful eating and maintaining a healthy weight.

It’s often easier said than done.

Healthful eating takes planning and a well thought out grocery list. It may also mean cutting down – not cutting out – on some of your favorite foods. Don’t deprive yourself.

Aim for three meals and one to two snacks per day. Think of snacks as mini-meals that contribute nutrient-rich foods. You can fit snack calories into your day without over-spending your calorie budget. The Academy of Nutrition and Dietetics offers the following tips to make snacking work for – not against – your healthful eating plan.

  • Choose nutrient-rich foods from the grains, fruit, vegetable, dairy and protein food groups. Snacks can boost your energy between meals and supply essential vitamins.
  • Snack only when you’re hungry. Skip the urge to nibble when you’re bored, frustrated or stressed. Feed the urge to do something by walking the dog or working in the garden.
  • Keep portion control in mind. Have a single-serve container of yogurt or put a small serving of nuts in a bowl. Eating directly from a multiple-serving package can lead to overeating.
  • Plan snacks ahead of time. Keep a variety of nutritious ready-to-eat supplies on hand, such as whole-grain crackers and low-fat cheese.

Keep it interesting with these 11 snack ideas with 200 calories or less. Get creative by swapping out different fruits, vegetables and grains to give yourself even more options.

  1. One tablespoon peanut butter spread on slices of a medium apple
  2. One cup tomato soup with five whole-grain crackers
  3. Three cups air-popped popcorn sprinkled with three tablespoons grated parmesan cheese
  4. Tri-color veggie snack: 6 baby carrots, 10 sugar snap peas (or green pepper strips), 6 cherry tomatoes and 2 tablespoons reduced-fat ranch dressing for dipping
  5. Small baked potato topped with salsa and 1 ounce low-fat cheese
  6. Toaster waffle topped with ½ cup blueberries and 2 tablespoons low-fat yogurt
  7. Six whole-wheat crackers and one slice low-fat Colby cheese
  8. Fruit smoothie: Blend 1 cup fat-free milk, ½ cup frozen strawberries and ½ a banana
  9.  One 6-inch fl our tortilla with ¼ cup black beans and 2 tablespoons fresh salsa
  10.  Quick-to-fix salad: 2 cups mixed greens with ½ cup mandarin oranges, 1 tablespoon sliced almonds and 2 tablespoons reduced-fat dressing
  11. Mini-sandwich: Whole-grain dinner roll with 1 slice deli turkey, 1 slice low-fat cheese and mustard

Mary TvedtMary Tvedt is a certified diabetes educator and has managed the Diabetes Care Center at Wyoming Medical Center for the past seven years. She has a bachelor’s degree in foods and human nutrition with a minor in child development and family science from North Dakota State University. If you have concerns about diabetes talk to your doctor. To learn more about services at the Diabetes Care Center, call (307) 577-2592. 

Decoding Diabetes is a weekly series focusing on education, prevention and tips for living with the disease. Find it on The Pulse each Thursday. Past stories include:

Dec. 7: Seven steps to prevention

Nov. 22: A case for regular screenings

Nov. 14: What you should know for World Diabetes Day 

Meet our Docs: Neurosurgeon, professor and trauma doctor – the many caps of Dr. Don Penney

Related story — Meet our Docs: ‘Rock ‘n’ Roll Surgeon’ Dr. Don Penney reflects on some of his most memorable cases

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As a neurosurgeon, Dr. Don Penney is enjoying a remarkable career. He once restored a mother’s sight so she could watch her baby daughter grow. He pioneered a technique to treat brain tumors that gave a father several extra years with his wife and sons. And he protected a young stroke victim’s brain from swelling by removing the top of her skull, helping her heal in time for high school graduation.

But Dr. Penney is not only a neurosurgeon. He is board-certified in emergency medicine, practicing in the famous Cook County Hospital on which the show “E.R.” was based. He consults with the FBI and is a member of its hostage rescue squad. He is a full professor and is passionate about teaching. He is an avid photographer who always takes a camera in his operating room and music lover with more than 25 guitars.

Dr. Penney recently moved to Casper to join the team at Wyoming Brain and Spine Associates and Wyoming Medical Center.  The Pulse recently sat down with Dr. Penney for a two-part interview about his career and some of his most memorable cases.

Dr. Don Penney poses in a Wyoming Medical Center operating room (Photo by Dan Cepeda Photography)
Dr. Don Penney poses in a Wyoming Medical Center operating room (Photo by Dan Cepeda Photography)

The Pulse: Tell us a little about yourself. Where did you grow up and what got you interested in medicine?

Dr. Penney: I came from a medical family. I was born and raised in Toronto, Canada. My mom was a nurse, and my dad was an engineer at a hospital. He worked in the power house and was responsible for all the mechanics of the hospital – from the furnaces down to the elevators.

At 16, I got my first job and went to work in a hospital. Right from the very beginning I was exposed to medicine. It had always been my dream to go into medicine.

The Pulse: We understand you had a pretty serious illness growing up which required hospitalization. Did that pique your interest, do you think?

Dr. Penney:  I played a lot of hockey when I was young, what Canadian doesn’t? I lost a lot of teeth. I got kicked once in a scrimmage and ended up having osteomyelitis of the left leg.

The Pulse: What is that?

Dr. Penney: It’s a deep-seated infection in the bone. I spent six weeks in the hospital and had to have (intravenous) and (intramuscular) antibiotics. They did not have ports and PICC lines and things like that in those days. The disappointment about that whole thing was that one time the Beatles came to Toronto – which I had tickets for – and I missed it. That broke my heart.

Anyway, a long story short, it was really bad exposure to medicine. I think it kind of firmed up what I wanted to do.

The Pulse: You’re a neurosurgeon, which is already pretty impressive to us, but you’re also board certified in emergency medicine. Why the two disciplines?

Dr. Penney: All through my medical school – and even through my neurosurgery – I was interested in trauma. I always had this fixation on Cook County Hospital [a Level 1 Trauma Center in Chicago with one of the most respected emergency rooms in the country]. This predated the television show “E.R.”

I thought, what better place to get your feet wet than in Cook County where there is so much trauma? When I finished my neurosurgery fellowship, I moved to Chicago to the University of Illinois and Cook County Hospital. I should say, too, that part of my training in my internship was in emergency medicine. I really loved emergency medicine, and I thought how can I put the two together?

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Dr. Don Penney keeps this plaque in his office.

The Pulse: What is it you love about emergency medicine?

Dr. Penney: I love medicine and being a full doctor. To give you an example, when I was in my residency training, I remember rounding with my attending. If there was a neuro problem, of course, the attending would address it. If they had any other kind of medical problem, they kind of delegated it to other specialists. I refused to give up the whole aspect of the patient.

Emergency medicine allowed me to keep all the skills. So, when I finished my residency training, before I moved to Chicago and awaiting licensing, I did a year of emergency medicine. I was then able to qualify to take my boards in emergency medicine.

The Pulse: Will you be treating trauma cases at Wyoming Medical Center?

Dr. Penney: Yes. I have already applied for privileges here. When you speak a language, you have to speak it or you lose it. I do not want to lose my emergency training and my experience.

The Pulse: In 1993, after several years in Chicago, you moved to Georgia to open your own practice and join the medical staff at Gwinnett Medical Center near Atlanta. Why did you make that move?

Dr. Penney: Gwinnett was in desperate need of a neurosurgeon. They only had one, and they were on trauma bypass 53 percent of the time. They were getting a lot of bad press because paramedics/EMS were picking up head injury patients and having to transport them down to Grady (Memorial Hospital), which is the equivalent to Cook County but in Atlanta. As a result, they felt, “Why do we have a community hospital and not have a neurosurgeon?” So they recruited me to Atlanta.

The Pulse: What about the opportunity interested you?

Dr. Penney: It was trauma. And, where I was going, if you look at the demographics of 1993, the fastest growing county in the United States was Gwinnett County. There was a huge population, and there was a lot of trauma. A lot of it was highway – not the gun and knife stuff that I was dealing with in Chicago.

Plus, the weather was a draw. To be able to leave Chicago, the Windy City, and be able to go to Georgia, which as you know can be nice from a weather aspect.

The Pulse: Haha. You must not have heard about Casper’s wind! Why relocate to another city known for its blistery winters?

Dr. Penney: What brought me here is that at this point in time, my wife and I are empty-nesters. Our youngest daughter is 20 and is a junior at Georgia State, living on campus. We had the freedom to do this. I am a photographer, and the state of Wyoming is beautiful.

With the FBI, I have been up to Montana, Salt Lake City, and Wyoming appealed to me as far as photography. And Wyoming Medical Center is kind of similar to the situation in Gwinnett.  I had already done the same thing in Atlanta when I joined them. There was one other neurosurgeon, so I was able to kind of rebuild the program, up until the point that I left.

The Pulse:  So, yes, one of your goals is to rebuild the neurosurgery program at Wyoming Medical Center. What new services will you be able to bring to Wyoming patients?

Dr. Penney: From my visits here, and meetings with many different types of physicians, I think we really have not had somebody here on a steady basis since Dr. Sramek and Dr. Hollis left. I feel we have been pinch-hitting with locums. I think that one of my goals to try and stabilize things, to try to build up the practice [at Wyoming Brain and Spine Associates].

I think I will see a significant amount of trauma, but I’ll also build up the spine practice and try to encourage folks within the state – not just the city of Casper – to get their care here. I want to try to stop some of the bleeding that goes on into neighboring states like Colorado or Utah or Montana.

We are building this program for this institution. When I got to Atlanta, the hospital was in the newspaper negatively about twice a month because of the bypassing. The trauma coordinator and I went to every fire station in the county and brought lunch. I told them, “Hey, I am here. This is over, no more of this bypass stuff.” I kind of bonded with them, and from that point forward it put out the fires.

This was important because the hospital, as you know, is supported by the community. If the community is not happy with you, it can be a disaster. What I am trying to do here is to let people know we are rebuilding here. I think we need to establish ourselves. We need to establish that we are good and we have excellent results here. The outcomes will speak for themselves. I have already talked with the other neurosurgeon that is coming here. He sounds excellent and has great background. I am looking forward to him joining me and doing what we do with a dual approach.

The Pulse: We understand that you are a health consultant for the FBI and a member of the FBI’s hostage rescue squad. Tell us about this relationship.

Dr. Penney: In private practice, 70 percent of your business as a neurosurgeon is spine, 30 percent is cranial – brain tumors, hemorrhages, etc.  Over the past 17 years in Atlanta, I continued to build a spine practice. As a result, I was considered the incumbent, in other words, the go-to guy for the FBI.

The Pulse: You mean you were treating the agents?

Dr. Penney: Agents, hostage rescue teams. The FBI in Atlanta came to me. I did their spine surgeries there and sent them back to Quantico.

Because I am credentialed with the FBI – which is something I did after 9/11 – once they know there is someone out there who is one of the group, there is a trust bestowed on you. That’s my interpretation. Those ties only strengthened, as I was deployed many times as a member of the Hostage Rescue Team out of Quantico. There was a point when I was going to Quantico once every two months.

The Pulse: Will you be able to continue your FBI relationship from Casper?

Dr. Penney: I had lunch just last week with the director of the whole southeast United States – Georgia, North Carolina, South Carolina, Tennessee, Florida, Alabama, and Louisiana – and he has already talked to the Denver office that oversees Wyoming. He has already put the word out that I am out here.

In my practice I have a strong association with law enforcement. Because of that background, and because I have a son who is the assistant district attorney in Savannah, Georgia, I have my connections through all of that. They are a loyal group. Once you operate on one of them, or you see one of them, they tend to come back in and they tend to refer other people.

The Pulse: Thanks for taking the time to sit down with us today. Before we go, is there anything else you think readers should know about you?

Dr. Penney: I want to become part of the Casper community. I want to be a supporter of this city. I am going to be involved in Rotary – I have been in Rotary for about 17 years. I am going to join a church here in town.

I am here to stay, and I am here to become part of the community. I want to grow here. Two of my kids are coming for Christmas in our little apartment. We hope to buy a house eventually and become a full-fledge Casper family.

Dr. Don Penney, M.D.

Family: He and his wife have four grown children.

Education: Dr. Penney attended medical school at McMaster University in Montreal, Canada and completed a surgery internship at Montreal General Hospital, McGill University. He completed his residency and fellowship at the Montreal Neurological Institute, McGill University.

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Experience: Trained in and practiced emergency medicine at the University of Illinois and Cook County Hospital in Chicago and joined the teaching staff as an Assistant Professor of Neurosurgery. He ran a solo practice in Atlanta, Ga., for 17 years where he was also a full professor of emergency medicine at Medical College of Georgia, Augusta. In 2006, he helped establish the Philadelphia College of Osteopathic Medicine, Georgia Chapter where he directed the neuroscience program. He has authored numerous chapters in textbooks and scientific papers in addition to delivering multiple national lectures for the American College of Emergency Medicine.

Practice:Wyoming Brain & Spine Associates, (307) 266-2222
1020 E. Second St., Suite 200, Casper, WY  82601.

Related story — Meet our Docs: ‘Rock ‘n’ Roll Surgeon’ Dr. Don Penney reflects on some of his most memorable cases

Meet our Docs is an occasional series introducing the physicians of Wyoming Medical Center. Click here for interviews.

Meet our Docs: ‘Rock ‘n’ Roll Surgeon’ Dr. Don Penney reflects on some of his most memorable cases

Related story — Meet our Docs: Neurosurgeon, professor and trauma doctor – the many caps of Dr. Don Penney

A radio DJ once introduced Dr. Don Penney as the “Rock-n-Roll Surgeon from Atlanta.” He plays rock music in his operating room and insists on a cool, positive vibe. He tells his patients to picture themselves on a beach in the Caribbean, the sun coming up, the waves rolling in. Healing begins with positive thinking, he says.

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Neurosurgeon Dr. Don Penney reflects on his career at his office at Wyoming Brain and Spine Associates in Casper. (Photo by Dan Cepeda Photography)

Dr. Penney wears the iconic Rolling Stones logo on his surgical cap. The Atlanta Journal Constitution snapped a photo of Penney in his operating room and Mick Jagger happened to see it. He sent Penney two second-row tickets to an upcoming concert. Dr. Penney likes that story, one of many from a long and accomplished career. But it’s not a story that gives the neurosurgeon goose bumps. Those come from the patients and families he’s treated.

Like the woman from Peoria, Ill., who just happened to hear Dr. Penney on the live Atlanta radio show.

“I know Dr. Penney. He took out my father’s brain tumor,” she announced on air.

Dr. Penney didn’t really know what to say: “One thing in neurosurgery is you never ask anybody how they are doing, especially with a diagnosis of a brain tumor. So many of them are fatal, so it was the last thing I wanted to ask her.”

The DJ asked instead. My father’s doing great, the woman answered.

“I chatted with her on the radio and it gave me goose bumps. I thought, how can this be that all these years later a woman in Peoria, Illinois, would remember me? Out of all the calls, it was incredible,” Penney said.

Dr. Penney recently moved to Casper to join the team at Wyoming Brain and Spine Associates and Wyoming Medical Center.  He sat down with The Pulse for a two-part interview about his career, some of his most memorable cases and the reason he closes every operation with ACDC’s “Thunderstruck.”

The Pulse: Let’s start with James Oxford – a patient of yours in Atlanta who developed a malignant brain tumor at age 35. You removed the tumor once and treated with radiation. When it came back, you were one of the first to implant wafers of chemotherapy drugs directly into his brain. Do you mind telling us about that?

Dr. Penney:  You do not cure malignant brain tumors, so anything you can do to improve a patient’s quality of life post diagnosis and treatment, and increase their longevity, I am very aggressive in that manner. I will re-operate on someone, with their permission, that has a surgically accessible tumor to sustain life as long as that is what they wanted.

On television shows and things like that, they talk about diagnoses and about how long patients have to live. I am not a big believer in that. The internet, text books and libraries are full of statistics if you want to go and read those numbers. I am a great believer in the man above, and my patients know that. Mr. Oxford was somebody that came to me and I made the diagnosis of high-grade glioma which is a malignant brain tumor.

The Pulse: He was a teacher with two young sons, correct?

Dr. Penney: Yes. What do they say? A person does not get cancer, a family gets cancer. So, this involved all of them.

With Mr. Oxford, we first of all did the surgery. He did great. If you look statistically, the life span of somebody with a high-grade malignant brain tumor is in the ballpark of nine months. Again, those are numbers I do not use. I am very aware of them; but, at the same time, I really feel that we can help and improve their quality of life.

The advent of chemotherapy wafers suggested that implanting these wafers within the brain on recurrence of tumor can sustain life.

The Pulse: What do you mean by wafers?

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Dr. Don Penney poses in a Wyoming Medical Center operating room. (Photo by Dan Cepeda Photography)

Dr. Penney: Actually, they are the size of a nickel. If you look at a host that a priest would give you on Communion, they look exactly like that. They are white and very friable and breakable. The down-side is that six of those tiny wafers cost $25,000. So, at the beginning, the company was allowing us to get them because they wanted some success stories. I was the first one to approach. When Mr. Oxford recurred, and it was a point that I was going to re-operate, we approached them and got the approval.

I implanted those chemo wafers right in the resection cavity. With a tumor, you can only remove what you can see macroscopically. You cannot see microscopically where the cancerous cells are.

That nine month statistic ended up being three years for Mr. Oxford. When you think about somebody who is dying and they know it, that is kind of significant. It allows them to spend time with family, to get their things in order. Patients are most appreciative of that.

The Pulse: Is the wafer technique more common now?

Dr. Penney: It is a treatment that is available. In all truthfulness, it has become very difficult to try to get it pre-certified (for insurance coverage). It will take a fight from myself, a fight from the patient who has been paying for insurance for the past 30 years or whatever.

The Pulse: Let’s talk a little about Ashley Brown. Two months before high school graduation, she was in a car crash and treated for broken legs. But small globules of fat made it to her brain, and she had a stroke. When her brain swelled, you performed a decompressive craniectomy – basically removing part of her skull and implanting it in her abdomen until the brain swelling went down. Tell us about this technique.

Dr. Penney: When I was in Chicago, one of my partners at Cook County was John Oldershaw who was a neurosurgeon out of Vietnam. During the war, they had a lot of American soldiers with traumatic brain injuries with swelling of the brain. After surgery, doctors were often not able to re-implant the bone that was removed from the skull because it was either thrown away or it was wrapped in gauze, put in a plastic bag and put in the refrigerator. A lot of times in Southeast Asia, the skull bone did not make it back with the patient.

John Oldershaw taught me that you can actually have the patient carry their own bone flap. You could go in the abdomen, make a little incision and open a subcutaneous pocket, put the bone in there, and then close the skin. The patients became their own containers. Then, in three months or so after the brain swelling went down, the bone could be removed and re-implanted. You would not have to worry about infectious risks, sterilization and all because it was their own tissue. That was a great thing.

If you look at that story on Ashley Brown, she had no brain injury, but she had two femurs that were broken. When the orthopedists rodded her femurs to do an internal fixation, she got a fat emboli. This is a known problem when working with bone. The emboli went to the left side of her dominant hemisphere and caused a stroke.

Here she was with a left-sided stroke and not able to talk. Her right arm and leg were paralyzed. I can remember that I was not the neurosurgeon on that case. The father met with the neurosurgeon who said, “Look you need to go pick a box as your daughter is not going to make it.”

They brought me in as a second opinion. I said “There is a controversial procedure that is out there,” and I told them about it. The father was horrified. He said, “You want to take half of my daughter’s head off and put it in her belly?” The family didn’t want to do it.

What ended up happening was my wife and I were going to church at 4 o’clock the next day, Sunday. She was driving when I got the page. They said that Ashley Brown just blew her left pupil, which is a sign of herniation. They said the father wants you to come back.

I went in and did the procedure and three days later she was moving two fingers. She went off and finished her high school, and so it was a life saved.

The Pulse: That’s amazing. How often do you think of these stories? Or do you only think of them when asked, like right now?

Dr. Penney: Those moments, I think you carry them around with you; especially those special cases. Those early occurrences are never lost, you never lose them. They are always there for me.

Now, the practice of doing this and putting bone in the abdominal wall cavity has become very common. At first, there was not a lot of evidence to show that by doing this procedure you could save lives. The evidence has come out. Now, on middle cerebral artery stokes we are able to go in and do the same thing. I’m not recommending this for 70- and 80-year-olds, but for young people, it has become very commonplace throughout the country and is well known as acceptable technique to treat this. By doing this procedure, you can save a life.

Miracle sight
The Atlanta Journal Constitution wrote a story about Ebony Brown, the young mother who lost her sight a week after giving birth. Dr. Don Penney restored her sight by removing her brain tumor. He hung the article in his office. Many years later, just before moving to Casper, the woman and her daughter came into Penney’s office to say ‘Thank you.’

The Pulse: Finally, tell me about Ebony Brown, the young mother who lost her sight seven days after giving birth to a daughter.

Dr. Penney: I happened to be in the office when I got a call from the ER. They said they had a woman that just delivered a baby, and was one week postpartum. They said she had gone blind and had a pituitary tumor. As soon as I heard that, I knew it was a pituitary apoplexy and said to get a stat MRI. I ran over to the hospital and I met her on a gurney there. I put two fingers ten inches in front of her eyes, and she could not see them.

To remove pituitary tumors, I usually go transsphenoidal through the gum, or you can go alongside the nose. That is how we get to the base of the skull. I usually let an Ear-Nose-Throat doctor do this because nobody wants a funny looking nose afterwards. Dr. Roth came in and he did the approach to the skull then I went in and took out this tumor.

After the surgery, I was wiped out. The surgery did not begin until 10:30 or 11 at night and I did not get out of there until about 4 in the morning. I went home and crashed. The next day I came in around 2:30, and on rounding, I was wondering whether or not we did anything to help her. I remember sitting on the bed, and I can remember the clock on the wall. I said to her, “Can you tell me what time it is?” She looked up and said, “It is 4:20.”

Wow. I got goosebumps. That was unbelievable to me.

The Pulse: Have you ever heard of a case where a surgeon restored someone’s sight in a case like this?

Dr. Penney: Not me personally. I am sure they are out there, but that was a first for me. Behind all this is that she had a known pituitary tumor and she was on a drug to make it shrink. She went off it because she got pregnant and it just blossomed, but she did not know it.

It’s so funny because about three months ago, before I moved here, my secretary in the office said a lady was there to see me. I went out and there was this woman who had a girl who was now 7 or 8.

She said, “Do you remember me?” I said, “Sure I do.” She hugged me and all that. It was cool. That girl was her daughter who had grown up, and she got to see her grow up.

The Pulse: Do you ever find yourself in awe of the brain, and what, as a neurosurgeon, you do for a living?

Dr. Penney: I am in awe. As a funny anecdotal comment on that, when I am in the operating room and finishing surgery, I have closing music. My closing music is “Thunderstruck” by AC/DC. I feel that for the human nervous system; That song signifies that for me.

Yes, it is a job. You become very familiar with the processes. But at times you take steps back and there is an amazement and appreciation of what goes on. We know so very little about the brain. We are decades behind the cardiac surgeons because they know so much more about the cardiovascular system than we do about the nervous system. We are growing and gaining, but we are not there yet.

Dr. Don Penney, M.D.

Family: He and his wife have four grown children.

Education: Dr. Penney attended medical school at McMaster University in Montreal, Canada and completed a surgery internship at Montreal General Hospital, McGill University. He completed his residency and fellowship at the Montreal Neurological Institute, McGill University.

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Experience: Trained in and practiced emergency medicine at the University of Illinois and Cook County Hospital in Chicago and joined the teaching staff as an Assistant Professor of Neurosurgery. He ran a solo practice in Atlanta, Ga., for 17 years where he was also a full professor of emergency medicine at Medical College of Georgia, Augusta. In 2006, he helped establish the Philadelphia College of Osteopathic Medicine, Georgia Chapter where he directed the neuroscience program. He has authored numerous chapters in textbooks and scientific papers in addition to delivering multiple national lectures for the American College of Emergency Medicine.

Practice:Wyoming Brain & Spine Associates, (307) 266-2222
1020 E. Second St., Suite 200, Casper, WY  82601.

Related story — Meet our Docs: Neurosurgeon, professor and trauma doctor – the many caps of Dr. Don Penney

Meet our Docs is an occasional series introducing the physicians of Wyoming Medical Center. Click here for interviews.

Decoding Diabetes: 7 steps to prevention

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As many as 79 million people in the United States have prediabetes, yet more than 90 percent of them don’t know it. People with pre-diabetes usually have no symptoms, and many who learn about their pre-diabetes think it’s no big deal.

The best way to get your blood sugar into the normal range is with a coordinated plan of healthy nutrition, increased physical activity and lifestyle strategies that support modest weight loss if you are overweight – 5 to 10 percent of your body weight.  Research shows that such a plan reduces diabetes risk even better than using medication.

You may see improvements in glucose levels in as little as three months. If you have pre-diabetes, don’t wait to make lifestyle changes. The window to turn around elevated glucose levels is only three to six years.

You have the power to prevent diabetes. Here are seven ways to get started:

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1. Move more. Get up, get out, and get moving. Try walking, dancing, bike riding, swimming or playing ball with your friends or family. It doesn’t matter what you do as long as you enjoy it. Try different activities so you don’t get bored.

2. Eat the healthy plate way. Focus on eating less and making healthy food choices including dried beans, whole grains,  three to five servings of vegetables and one to two servings of fruit per day. Cut down on fatty and fried foods. Eat the foods you enjoy, just eat less of them.

 3. Lose some weight. Once you start eating less and moving more, you will lose weight. By losing even 10 pounds, you can cut your chances of developing diabetes.

4. Set goals you can meet. Start by making small changes. Try for 15 minutes of activity a day this week.  Add 5 more minutes each week after until you are active 30 minutes a day, 5 days per week. Try to cut 100 calories (or one can of soda) out of your diet each day. Slowly reduce your calories over time and talk to your health care team about your goals.

5. Record your progress. Keep a food and exercise diary. Write down all the calories you eat and drink and the number of minutes you are active. This is one of the best ways to lose weight and keep it off.

6. Get help. You don’t have to prevent diabetes alone. Involve family and friends in your plans and activities. You can help each other move more, eat less and live a healthier life. Active groups in your area can also help, as can your healthcare team.

7. Keep at it. Making even small changes is hard in the beginning. Try adding one new change a week. If you get off track, start again and keep at it.

Know your risk

The American Diabetes Association recommends you be tested for pre-diabetes if:

* You are overweight and 45 years or older
* You are 45 or older and your doctor recommends testing
* You are overweight with a family history of diabetes, high blood pressure, low HDL cholesterol and high triglycerides
* You are a woman who had gestational diabetes and/or gave birth to a baby weighing more than 9 pounds.
* You are of an ethnic group with a high risk of developing diabetes and have discussed the risks with your doctor. Ethnic groups with a higher risk include African American, Native American, Hispanic and Asian.

WMC Diabetes Care Center

If you have diabetes or are at risk of developing it, our nationally recognized Diabetes Care Center can guide you through all types of the disease – type 1, type 2 or gestational. We offer individual sessions or a series of diabetes education classes to help people live with the disease, help with meal planning, glucose monitoring instruction, foot screening and much more striving to reduce the risk of complications from type 2 diabetes.

Wyoming Medical Center’s Diabetes Prevention Program has shown that simple lifestyle changes can decrease the chance of developing diabetes by 58 percent. Our 12-week program can improve blood sugars, reduce weight and decrease or delay the development of type 2 diabetes among those with pre-diabetes.

For more information, call 577-2592 or visit the center’s webpage.

Anyone with pre-diabetes, diabetes or impaired glucose tolerance is welcome. Please contact your physician to coordinate services.

If you feel you are at risk for developing diabetes, we have screening options available. Call our laboratory at 577-2354 or visit our laboratory page to see the health fair and wellness screenings we offer.

 

Mary TvedtMary Tvedt is a certified diabetes educator and has managed the Diabetes Care Center at Wyoming Medical Center for the past seven years. She has a bachelor’s degree in foods and human nutrition with a minor in child development and family science from North Dakota State University. If you have concerns about diabetes talk to your doctor. To learn more about services at the Diabetes Care Center, call (307) 577-2592. 

Decoding Diabetes is a weekly series focusing on education, prevention and tips for living with the disease. Find it on The Pulse each Thursday. Past stories include:

Nov. 22: A case for regular screenings

Nov. 14: What you should know for World Diabetes Day 

Help us welcome our ‘Thanksgiving’ baby

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Our Thanksgiving baby, Parker Camp, was born at 6:57 a.m. Wednesday to Kristin and Dallas Camp.

Help us welcome Wyoming Medical Center’s Thanksgiving baby to Casper.

While a baby wasn’t born on Thanksgiving proper, Parker was born to Kristin and Dallas Camp at 6:57 a.m. Wednesday, Nov. 27. She’s wearing her turkey baby cap donated to The Birth Place a couple of weeks ago.

We are still looking for whoever crocheted these caps. (Click here for the full story.) If you think you might know our anonymous donor, please let us know.

We hope to post photos of babies wearing their Christmas-themed caps, so stay tuned!

We are thankful for the Kelly Walsh student council

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Kelly Walsh students Roy Cady-Kimble (left) and Tom Ladd (right) kneel with breast cancer survivor Sharon Gunyan in her home last week. Students delivered turkey dinners to cancer patients to help them celebrate Thanksgiving.

This Thanksgiving, we at Wyoming Medical Center are thankful for the Kelly Walsh student council!

This summer, the council raised $34,000 for WMC Foundation’s Angel Cancer Care Program with its Trojan Trek. Last week, students helped us deliver Thanksgiving meals to 23 Casper cancer patients.

The Angels feel blessed by the partnership we have forged with these students. It started last spring when I was asked to talk to the student council about the Angels program. The students were planning their second annual Trojan Trek — a cancer awareness relay that positions walkers on the track 24 hours-a-day throughout the month of June. Walkers collect pledges, and the students wanted the money to help local cancer patients so they could see how the project impacted their community. They chose to donate their money to the Angels. The $34,000 the students and community members raised through Trojan Trek will help us provide wigs, gas cards, groceries and much more to Wyoming cancer patients.

I’m happy to say that our partnership has not ended. Last week, 17 council students helped the Angels deliver a turkey and a roasting pan filled with Thanksgiving fixings to 23 cancer patients across Casper. Students chatted with patients, checked in on them and made sure that they did not need anything else.

That’s what our Angels do.  They are the wings of cancer patients while they go through their treatment so they can focus on getting better.

Fundraising is a talent that the students of Kelly Walsh possess and something they do a lot of for many organizations here in Casper.  The partnership with the Angels is one that brings joy according to student Roy Cady-Kimble. Usually, the students just see the monetary side of it – delivering checks to the groups they are helping. But delivering the Thanksgiving meals let them interact with real people who benefitted from the students’ hard work, he said.

Delivering meals is just one way that the student council has impacted the Angels program and the patients we serve.  But it is an experience that I hope they hold onto as they make their way in this world.  Their smiles and youthful energy bring hope to many.  They bring joy and encouragement.

This partnership is one that brings gratitude to the Angels.  At this time of Thanksgiving, we are thankful that they believe so unrestrainedly in what the Angels do.  We are thankful for youth who want to give back, who want to be the good that they see in the world.

About the angels

The Wyoming Medical Center Foundation’s Angels Cancer Care program serves hundreds of Wyoming cancer patients every year offering emotional support and financial assistance with wigs, gas cards, transportation and more. To learn more or to make a donation, call (307) 577-4355 or visit our website.

For more on this story, read Elysia Conner’s article in the Casper Journal.

JillianJillian Riddle is the volunteer coordinator for Wyoming Medical Center and the Angels Cancer Care coordinator with the Wyoming Medical Center Foundation. She is a native of North Carolina with a love for the outdoors. She has one daughter, Princess Petunia Pants, and an awesome husband.

How a rare Evansville murder almost took – then saved – the chief’s life

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Evansville Police Chief Zachary Gentile poses at his desk recently. While investigating a rare Evansville homicide in July, he suffered a ruptured abdominal aortic aneurysm. He credits staff at Wyoming Medical Center for saving his life — and for catching the cancer he didn’t know he had. (Photo by Dan Cepeda Photography)

It’d been a long night and Zachary Gentile lay down almost as soon as he hit his front door.

A rare homicide had pulled Gentile and his Evansville officers out of bed just after midnight on July 25. A 21-year-old man allegedly shot another man in the parking lot of Taylor’s Sports Bar, and the officers worked the case for 12 straight hours. At noon, Gentile decided they needed a break, and he took his folks to lunch. His stomach started to hurt soon after arriving home.

“The pain was just astronomical. So, I went into the bathroom and I am sitting down and the pain got to the point where I could not breath, OK?” said Gentile, Evansville police chief. “I fell down, hit my head and cut my eye. My wife called the EMTs.”

Sometimes, Gentile jokes that he must have landed in the witness protection program to find himself in Evansville. He grew up in New York City, retired from Miami’s Metro Dade Police Department after 24 years, and came to Wyoming 15 years ago to take the chief job.

But he will tell anyone that asks that his care at Wyoming Medical Center rivals the care he would have gotten in cities 10 times the size of Casper.  The medical team here saved his life, he says, no two ways about it.

“I have run into a couple of nurses that were there. They are just amazed that I am actually back to work. They told me my condition is mostly discovered in an autopsy,” he said.

“So, yeah. I do feel thankful. It obviously was not my turn to go yet. I don’t know why I did not chip in, but here I am. And I am glad.”

***

Gentile bypassed the WMC emergency room for an immediate CT scan. His doctor and nurse noticed an 6-centimeter rupture in his aorta. Gentile didn’t have time to report back to the Emergency Room and wouldn’t survive an emergency flight.  Emergency staff called Dr. James Anderson who responded within five minutes to meet Gentile in surgery. Gentile’s aortic artery had ruptured, and he was bleeding into his abdomen.

A healthy aorta branches into smaller arteries, carrying blood to the kidneys, abdomen and legs.
A healthy aorta branches into smaller arteries, carrying blood to the kidneys, abdomen and legs.
An aneurysm forms when part of the aortic wall weakens and bulges out like a balloon. When an aneurysm ruptures, as in Zachary Gentile's case, it bleeds into the abdomen.
An aneurysm forms when part of the aortic wall weakens and bulges out like a balloon. When an aneurysm ruptures, as in Zachary Gentile’s case, it bleeds into the abdomen.
An arteriogram of a healthy aorta (left) compared to an aortic aneurysm.
An arteriogram of a healthy aorta (left) compared to an aortic aneurysm.

“ER staff caught it and recognized that it was life threatening. If they did not catch it, who knows what would have happened,” Gentile said.

The aorta is the body’s largest artery, about the circumference of a garden hose. It carries oxygenated blood directly from the heart to the kidneys, abdomen and the lower body. A healthy artery is smooth inside allowing easy flow of the blood.

For years and without him knowing it, the lining of Gentile’s aorta had been growing weaker – a condition that likely ran in his family. His aorta bulged outwards like a balloon, stretching the walls and weakening them further. His blood pressure dropped, but he displayed no outward symptoms. At 170 pounds, he could have stood to lose a few pounds, but which of us couldn’t?

Then his phone rang shortly after midnight on July 25. His blood pressure almost certainly rose as he and his officers investigated the shooting at Taylor’s Bar, putting more pressure on his weak aortal walls. By the time he lay down for his nap, the walls could no longer withstand the pressure. His aorta ruptured.

“Murder is not something that happens in Evansville very often. Chief does a good job and he takes his job very seriously. I’m sure his blood pressure was elevated,” Anderson said.

Within about 20 minutes of Gentile’s arrival at WMC, Anderson was in the operating room with his patient. Gentile had suffered a ruptured abdominal aortic aneurysm – a condition that is fatal if not immediately treated.

There are two ways to fix an aortic aneurysm, Anderson said. One is with a catheter inserted into two small incisions in the groin and threaded through the artery. Doctors place the graft inside the aneurysm using X-ray guidance. That wasn’t an option for Gentile.

“When the aneurysm is ruptured and the patient is bleeding to death, you don’t have time to get there with a catheter. You just open them up and put a clamp on the artery and sew the graft inside,” Anderson said.

The national survival rate for ruptured aortic aneurysms is about 50 percent, said Anderson who sees 8 to 10 such cases a year. When the patients get to the emergency room with a blood pressure, Wyoming Medical Center surgeons save about 95 percent of them.

That’s an advantage of having a community hospital with expertly trained specialists and subspecialists so close to where we live, Anderson said. In emergencies, patients recover more often when they are treated within a few minutes to a few hours following trauma. If patients must be transported to another hospital – especially in Wyoming where the next trauma center might be hours away and out of state – the delay in care increases the chances of death or a longer, more difficult recovery.

“There’s not many things we can’t take care of right here. Basically, we are so far from anywhere else that if we don’t take care of it here, they don’t do well,” Anderson said. “The hospital recognizes that if we make sure we provide the highest quality care that is available, people will come to see us. We as surgeons have committed to that.”

***

Gentile woke up the next day in the Intensive Care Unit. He considers himself lucky to be back at work, and knows how close he came to being Evansville’s second fatality that day.

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Zachary Gentile poses under the insignia of the Evansville Police Department. He is now back to work after doctors removed his kidney. (Photo by Dan Cepeda Photography)

He likes to tell people about the care he got at Wyoming Medical Center because he thinks it’s an asset the community is fortunate to have.

“I tell you what, those people in the Intensive Care Unit never left my side. I had one nurse assigned to me, and if I wanted something, they were there. I never had to use my call button because they were always there asking me if I was okay, checking on me, making sure I had my medications on time,” he said.

“I had to walk three to four times a day before they would let me go home. They were not pushy, but they let you know that, ‘Hey. You got to get your dead butt out of that bed and start walking, Jack, or you’re not going home.’ They treated me with respect and I appreciate that.

“As far as your cleaning folks, three to four times a day they were in there. The food was actually good. It really was. When you ordered it, it was up there and still hot.”

Gentile has since lost 35 pounds and makes sure he keeps his weight under 145. Because he’s had one aneurysm, he has a 10 to 15 percent chance of developing another. Doctors will monitor him at least annually for the rest of his life.

Getting to the hospital in time obviously saved Gentile’s life. It also probably caught his cancer and gave him more time with his three grandchildren.  In the process of all the tests, doctors spotted a mark on his left kidney. His doctor told him it was probably cancerous and the kidney should come out.  He recently underwent that procedure at Wyoming Medical Center.

“Well, you know, it is like the bad thing that happened to me was the ruptured aorta. But if I did not get it, I would have never known about this; so eventually, I would have died from it. One way or the other, bad things happened for good reasons.”

So what about that rare Evansville homicide, the stress of which likely started this medical odyssey? Did Gentile get his man?

“Of course we did,” Gentile said. “He goes to trial in December.”

Know your risk

Abdominal Aortic Aneurysm is often called a “silent” problem because it rarely causes symptoms. It’s often found by healthcare providers conducting other tests. The aneurysm could create a pulsatile abdominal mass – a pulsating in your stomach that you can feel, usually in people who are not overweight. Your doctor should be able to feel this and can easily diagnose the aneurysm with an ultrasound.

Anyone can develop this type of aneurysm, but certain factors increase the risk:

  • Having a family history
  • Smoking
  • Having high blood pressure
  • Having a blood vessel disease in another part of the body
  • Being over age 55 for men and 65 for women

Symptoms of a ruptured aneurysm

A ruptured Abdominal Aortic Aneurysm is a medical emergency that requires immediate treatment. Call 911 if you:

  • Have severe abdominal or back pain
  • Your blood pressure drops noticeably

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Dr. James Anderson is board certified in general surgery and vascular surgery. He has worked in Casper for 33 years, 25 of which he was the only board-certified vascular surgeon in Wyoming.

Medical School: University of Colorado School of Medicine, Denver
Internship: University of Washington School of Medicine, Seattle, General Surgery
Residency: University of Washington School of Medicine, Seattle, General Surgery

Practice: Wyoming Surgical Associates, PC

419 S. Washington St., Suite 200
Casper, WY 82601
(307) 577-4220