When finished, our McMurry West Tower and MRI building will have more than 3 miles of copper electrical wire laid within the walls. That’s enough to stretch from Wyoming Medical Center to the Casper Events Center.
The McMurry West Tower is set to open late this summer. It will provide 98,000 square feet for state-of-the-art medical care, 20 private surgical rooms and a new mother-baby unit with 12 private rooms.
As the weather turned colder this winter, workers for Haselden Caspar/ Pope JV moved inside to frame out the building’s interior with more than 11,000 steel studs. Crews have installed 5,000 batts of insulation and are now hanging the 4,300 sheets of drywall. Now, you can imagine the shape, layout and space the rooms will provide for patients and families. You can also see the outlines of our new main entrance, spacious dining area and the Cottage Gift Shop. The tower will also have space for a 7,000-square-foot Wellness Center.
Many more impressive numbers can be found inside the walls of our new tower, designed to create a better hospital experience for the thousands of Wyoming families who come to us each year. Here are a few:
2 air-handling units, each weighing 55,000 pounds, installed on the roof to ensure quick and efficient air ventilation
More than 100 windows framed and installed
15,000 cubic yards of soil removed for caissons and foundations
275 tons of rebar used
4,411 cubic yards of concrete poured
1,400 sheets of thermax sheathing installed
3,300 exterior steel studs installed
10,000 feet of 6-inch metal strap blocking used
240 sheets of ¾-inch fire treated plywood blocking used
More than 8,000 feet of ¾-inch metal electrical conduit laid
Thank you to the El Dorado Hills (Calif.) Fire Department for taking the time to recognize several members of our ER team.
Fire Chief Dave Roberts sent a letter on Sept. 10 thanking Dr. Jonna Cubin for the excellent care Wyoming Medical Center gave to a colleague and friend who’d wrecked his motorcycle on his way to the Sturgis rally. He asked her to pass on his department’s gratitude to WMC Emergency Department Senior Nurse Manager Corrine Arross, ER nurse Nicole Beckstead,Sam Baker, Paramedic Riley Becksted, and Wyoming Life Flight nurse Chuck Bright. He also sent along six coins he developed to award his staff for “performance above expectations.”
“It is a tradition in the military, law enforcement and the fire service to ‘coin’ someone for going above and beyond in the performance of their normal duties. In my opinion, your team far surpassed all of our expectations,” Chief Roberts wrote. “Very few of these El Dorado Hills Fire Department coins have gone outside the walls of our organization. I would be honored if you would accept a coin yourself and present each of the members I have listed with one of our coins.”
Read the entire letter by clicking on the images below. Please accept our belated appreciation, Chief Roberts, and we wish your friend a quick recovery.
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.
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.
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.
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.
There are some phrases you don’t want to hear over a plane’s intercom while suspended thousands of feet in the air. On Dec. 30, Amy Sorensen heard two of them: Are there any medical professionals on board? Then, a little later: Does anyone have flight experience?
Sorensen, 24, was watching “We are the Millers” when the first announcement sounded. She was returning from a family Christmas, flying United Airlines from Des Moines, Iowa, to Denver with 154 other passengers. Call lights started flashing almost immediately. She figured, there must be several doctors on board with more experience than me. She’d earned her Bachelor of Nursing degree from the University of Wyoming just a couple of weeks earlier and, while she had worked at Wyoming Medical Center since September 2012, she’d only worked the last six months in the Emergency Department.
But none of the call lights came from doctors. Responding flight attendants told worried passengers that they couldn’t give any more information and then moved to the next call light just to say the same thing. Only one other medical professional – ICU nurse Linda Alweis of California – had responded. When a second call came over the intercom, Sorensen flipped her switch.
We need you up front right now, the flight attendant told her. It’s the captain.
“I think I was just still shocked,” Sorensen said. “I didn’t know what to expect. But, by the look on the flight attendant’s face, I knew it was something serious. She looked frantic. She looked scared.”
Sweat had soaked through the pilot’s jacket by the time Sorensen got to the cockpit. His face was white and his lips were blue. He was covered in vomit. The copilot blocked his hands as he grabbed at the controls, obviously disoriented. He knew his name and nothing else. Heart attack, Sorensen thought, or something just as serious.
Are we diverting? Sorensen asked. We need to land as soon as possible.
Yes, the copilot answered. They were turning around to Omaha, Neb., the closest city with a medical center.
Sorensen, Alweis and another passenger unbuckled the captain and pulled him out of his chair. They lay him in the attendants’ galley, the small compartment between the cockpit and first class where attendants prep their carts. It had slightly more floor room than the aisle. Sorensen knelt next to his head, taking charge of interventions. Alweis took charge of medications and supplies.
Sorensen told Alweis to cut off his clothes and asked an attendant to gather all the medical supplies, including the Automated External Defibrillator – AED. The pilot had a heart rate of 200 beats per minute, suffering ventricular tachycardia with a pulse. In other words, his ventricles were beating way too fast to adequately pump blood through the body. He needed a short burst of electricity to shock the heart into a more stable rhythm, but the plane’s AED had just two buttons: on/off and a full-force defibrillate shock.
Sorensen gave him a nitroglycerin tablet, but without an equipped emergency room or a team of doctors and nurses, she went back to the ABCs – Airway, Breathing, Circulation.
“You are totally out of your element. You don’t know what you have to work with. I was just talking loudly to the nurse saying, man if I had this or if I had that, and they’d go find it. I said, ‘You know we need to get vitals on him’ and out of nowhere a blood pressure cuff comes flying at me,” Sorensen said. “At one point, I looked up and saw all these heads just leaning in the aisle looking down at us.”
The pilot’s blood pressure was 70-over-40, about half of what it should have been. His condition deteriorated as the flight continued. They put him on oxygen. Sorensen set up an IV and taught an attendant how to push the fluids through more quickly. When his breathing slowed and he started to lose consciousness, Sorensen administered a chest rub – a trick to arouse a patient with pain. She and Alweis worked on him for 25 to 30 minutes before Sorensen got scared.
I think we’re going to have to start CPR, she told Alweis. She knew that a patient’s chance for recovery decreased significantly once it got to that point.
Just about then, a flight attendant told them to brace for a rough landing. Sorenson grabbed onto the oxygen tank and her patient, trying to keep both from jostling around in the galley. The attendant asked if they could taxi to the gate.
There isn’t time, Sorensen answered.
The plane came to a stop and the doors flung open. Firefighters and medics removed the pilot while the plane was still on the runway.
Alweis and Sorensen stayed in the galley to help clean up and to collect their own composure. “It looked like a yard sale with medications and supplies strewn everywhere, just like you see in an ER when you get a critical patient. They were all traumatized,” Sorensen said. Passengers cheered as she walked back to her seat, but Sorensen could only think about what else she might have done.
Passengers stayed overnight in Omaha. Sorensen went for a glass of wine in the hotel bar and several passengers offered to buy her a drink. They all flew to Denver together the next day. The pilot had made it to the Cath Lab in time and was in stable condition, an attendant told her. Sorensen felt good.
“I’ve been an ER nurse for six months. I don’t know how I would have reacted if that had happened before my time in critical care,” she said. “My experience here (at WMC) and what I’ve learned from my coworkers has definitely taught me stuff to take out in the real world.”
Corrine Arross, Emergency Department senior nurse manager, agreed: “I do have the say that the girl is cool under fire. I’ve seen her in action and she’s got a good head on her shoulders.”
United assigned Sorensen a seat at the back of the plane for the flight into Denver where she faced a seven-hour layover. She was content to sit back, relax and maybe finish an entire movie that go around. One passenger wouldn’t hear of it. He offered Sorensen his seat in first class and didn’t let her refuse it.
As for that second phrase nobody wants to hear on an airplane — Does anyone have flight experience? — Sorensen isn’t exactly sure when she heard it in all the commotion. Sometime after she and her help pulled the captain from his pilot’s seat. Sorensen remembers hearing the copilot say that while she’d done it before, landing was more the captain’s duty. It wasn’t part of her routine and, if at all possible, she’d like someone in the cockpit with her.
“Fortunately, we had a retired Air Force pilot on board,” Sorensen said.
Today, Ninja Dorian checked off an item on his bucket list.
Air Methods, which operates Wyoming Life Flight and transports patients to and from Wyoming Medical Center, took Dorian Layton for a short helicopter ride around Casper. Dorian’s big brother, Julien, and mother, Krishelle, rode with him.
Wyoming Medical Center has seen a few cases of the dreaded H1N1 influenza virus this month, but it’s nothing to get excited about, said Dr. Mark Dowell, medical director of infection control at WMC.
H1N1 (also called swine flu) got a lot of media attention in 2009 because it hadn’t been seen in United States for many years and, as a result, the population was more susceptible. Young adults, who typically fend off most flus, fell ill. It caused more than 100 deaths in non-immunized pregnant women. Ever since, H1N1 has been one of three strains included in the influenza vaccine.
“H1N1 is just one of the many influenza viruses that are circulating right now internationally. It is no different really than most of the other strains of flu that go around every year,” said Dowell, who is also the Natrona County Health Officer. “It just is a little more aggressive in some people and it has hung around longer year to year than other strains. And it really doesn’t do too well in pregnant women.
“But it’s not a superstrain of virus. It’s another strain of virus.”
Flu cases at Wyoming Medical Center are still fairly sporadic, but they signal the start of Natrona County’s flu season. Cases will likely peak in 4 to 6 weeks, before tapering off again, Dowell said. If the season follows the typical pattern, cases will straggle in through March or April.
Here’s what you need to know to get ready for the worst season of the year – flu season:
Is it a cold or the flu?
Influenza, including H1N1, will make you sicker than you normally get. It sometimes presents with a cough but more usually with a 100-degree-or-so fever, headache and tremendous muscle and joint pain. A stuffed-up nose is typically not a sign of the flu.
“You will often say, ‘This is as sick as I’ve ever been in my life,’” Dowell said. “I have had influenza as a teenager, and believe me, you will not forget it.”
Is it serious?
It can be. About 36,000 people a year die in this country from influenza. It is typically most dangerous to the very young, the very old or people with weakened immune systems – people with heart or kidney disease or cancers, for example. Complications can include flu pneumonia or developing bacterial pneumonia on top of your flu.
But, in most healthy people, the flu can be fought off at home.
“We don’t want to put patients with influenza in the hospital if we can help it because it tends to spread by droplet. The majority of people never get hospitalized for influenza. The treatment works if you start it early when you recognize the disease, otherwise it does nothing,” Dowell said. “The complications that occur usually mainly occur in those that are least healthy.”
How can I prevent it?
Get the vaccination, plain and simple. The CDC recommends that everyone six months and older get a flu shot, particularly people who are very young or very old or who may suffer from other chronic illnesses. Pregnant women should also get it since they have two lives at stake.
H1N1 can still seem like a big, bad monster because it’s been around for just a few years. “And since, a lot of times, only 30 to 50 percent of the population gets immunized , there is a whole population that is still susceptible. Because of that, it spreads,” Dowell said.
In the elderly, the flu shot may protect 50 percent of the time. But 50 percent is 50 percent, Dowell said. If you’re not willing to get the shot, be diligent about washing your hands and using hand gel. Use common sense. Flu is spread through fluids, so avoid fluids secreted by infected people.
But I’ve heard the shot will give me the flu?
The flu shot uses a dead virus. It cannot infect you. Symptoms you might experience afterward are caused by your immune response and only about 7 percent of people even get a fever from the shot, Dowell said. The nasal vaccine does contain a live virus, so only choose this option if you have a fairly good immune system.
“Here at Wyoming Medical Center, we have more than 99 percent of our employees immunized against flu. We do not want our employees bringing influenza into our sick patients,” Dowell said. “We have done this for several years. We are very proud of it, and our employees just go for it.”
Ok, I’m convinced. But do I still have time to get the shot and be protected?
Yes. Get it now.
The shot lasts four to six months but is strongest after two to four weeks. So, you will likely be protected when the Natrona County season peaks in the next month or so.
As a general rule, people in Wyoming should not get their flu shots any earlier than October or November, despite the signs in supermarket parking lots. Our flu seasons typically come later than other parts of the country. Talk to your health provider.
Dr. Mark Dowell is an infectious disease specialist with Wyoming Medical Center and Rocky Mountain Infectious Diseases, 1450 E. A St. He is also the Natrona County health officer and is board certified in infectious disease and internal medicine. Reach his office at (307) 234-8700.
If you do nothing else today, take the time to read this story from Casper Star-Tribune reporter Patrick Simonaitis. “Through sickness and health” tells about Thermopolis couple Marie and Bob Richter who have been driving to Casper weekly since June in a fight against Bob’s esophageal cancer. Tuesday, the couple renewed their vows in Bob’s hospital room at Wyoming Medical Center.
“We’ve had a great 36 years. We’re going to have 36 more,” Richter told the Star-Tribune.
The Richters have stayed at the Masterson Place since the summer, driving home to Thermopolis on weekends. The Pulse first met Marie just before Thanksgiving when she attended a potluck for guests of Masterson Place — a home away from home for out-of-town patients of Wyoming Medical Center and Rocky Mountain Oncology.
“Each week, they give us the same room. It feels like we’ve come home whenever we get here,” Marie told us then.
Last week, though, Bob took a turn for the worse. Doctors didn’t expect him to make it, but he hung on for another day and then another. Marie decided to surprise her husband with the renewal ceremony on Tuesday night, the couple’s 36th wedding anniversary, according to the Star-Tribune.
“I felt this was the best anniversary to repeat our vows because I didn’t know if I’d get to keep him or not,” Richter told the paper.
The whole story is worth a read, especially now with less than a week until Christmas.
The Masterson Place serves thousands of patients every year. At a cost of $40 per night with both short- and long-term rooms, it is a comfortable refuge for those who need it most. Each room has a small eating area, microwave and refrigerator. Through contributions, the Wyoming Medical Center Foundation continues to make significant upgrades to the Masterson Place each year. For reservations or more information, contact the Masterson Place at (307) 237-5933 or visit our website.
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:
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.
* 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.
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 Tvedt is a certified diabetes educator and has managed theDiabetes Care Centerat 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 Diabetesis a weekly series focusing on education, prevention and tips for living with the disease. Find it on The Pulse each Thursday. Past stories include:
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.
“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.
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
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
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