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Virtual Reality Helps Penn State Health St. Joseph Pediatricians Solve a Problem

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Doctors at Penn State Health St. Joseph Downtown Pediatric Practice had a problem.

A patient – a 13-year-old boy – was recently in need of immunizations. Doctors also wanted to draw blood, as the boy was taking psychiatric medications that call for routine monitoring.

The problem was that the child, who had recently moved to Reading and was living with his grandmother, was suffering from the results of severe sexual and physical assault, explained Dr. Jerry Lee, a pediatrician at the Downtown Campus.

Post-traumatic stress disorder and other conditions resulting from abuse made it extremely difficult for the patient to interact with doctors or allow anyone to touch him.

“It’s really a sad situation,” Dr. Lee said. “He’d been through a lot, and even with some medication to calm him, he couldn’t tolerate these procedures.”

After doctors had twice attempted to treat the boy with no success, Dr. Lee started thinking outside of the box.

Even for patients without the types of problems from which the boy was suffering, procedures like getting shots or having blood drawn can be upsetting, Dr. Lee explained. That’s because patients tend to become hyper-aware of their surroundings and what is occurring, which can cause some distress.

That distress was greatly multiplied in the case of the young patient with the history of abuse.

“I started thinking that we might have success if we could use some sort of sensory distraction with this patient,” said Dr. Lee. “I wanted to find a way to divert his senses away from the procedures.”

With an idea in his mind and money donated by the Reading Elks Lodge, Dr. Lee went out and purchased a set of virtual reality (VR) goggles. With a little research, he found an app that he could download onto his phone to give it VR capabilities.

“I thought that if we could use the goggles to distract him, he might be relaxed enough to let us give him the shots and get the blood drawn,” he said.

Prior to his appointment, Dr. Lee asked the boy’s grandmother to bring him to the Pediatric Practice. The patient was given a tour of the facility, told exactly what would occur during his appointment and introduced to pediatric nurses Terry Fealtman and Malissa Argyle. He even had a chance to meet Toni Baver, the phlebotomist who would draw his blood.

Dr. Lee also showed the patient the VR goggles and explained how they worked, checking to make sure the boy was comfortable with the idea of using them. He was.

When he arrived for his scheduled appointment about a week later, staff applied a numbing cream to the boy’s arm and again explained how the procedures would work. When it was time for blood to be drawn, Dr. Lee inserted his smartphone into the goggles, creating a VR experience.

“We put on a nice, relaxing beach scene that he could look around and explore,” Dr. Lee said. “He was so interested in what he was seeing that he didn’t even notice what was going on around him.”

With the procedures completed, Dr. Lee and other pediatricians are considering other instances in which the VR goggles could be employed.

“We’ll be thinking about how else we might be able to use this technology to alleviate discomfort,” Dr. Lee said.

In addition to thanking the Reading Elks for the donation that paid for the goggles, Dr. Lee praised the staff at Penn State Health St. Joseph’s Downtown Campus.

“Their professionalism and technical expertise was just invaluable in this case,” he said. “This was definitely a team effort.”

While treating patients is all in a day’s work for medical professionals like Dr. Lee and other Downtown Campus pediatricians, Dr. Lee was humbled when he received a handwritten card from the patient’s grandmother, thanking him for his empathetic handling of her grandson, who had already suffered so much.

“If we can make things a little easier for patients and their families, then we’re doing our jobs,” Dr. Lee said.

Jerry Lee, MD specializes in pediatrics at Penn State Health St. Joseph Downtown Pediatrics Practice. The Downtown Campus is the largest ambulatory care center in the City of Reading and includes over 15 specialty services, primary care, women’s health and pharmacy services. Call 610-208-4554 for an appointment.

Rheumatoid Arthritis: A Chronic Affliction

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By Amal Kebede, DO, Penn State Health St. Joseph Rheumatologist
This article appeared in Women2Women Magazine, Fall 2018 edition

More than 20 years ago, I was diagnosed with juvenile rheumatoid arthritis. Today, I am a rheumatologist who helps others manage their own chronic rheumatologic illnesses, including rheumatoid arthritis. While no one wishes to have a chronic disease, my diagnosis dramatically shaped my life choices as I experienced the medical system firsthand at an early age and decided to pursue a career in medicine. My experience has also given me perspective and a unique insight into the kind of obstacles my patients experience daily. While dealing with a chronic disease like rheumatoid arthritis, can be enormously challenging, I believe that all things are possible when we work together, and I want to empower my patients to believe this, too.

Rheumatoid arthritis is an autoimmune disease that causes pain, swelling, and stiffness in joints. Autoimmune diseases occur when the immune system, which is the body’s defense system, loses its ability to differentiate between what is part of its body and what is foreign. This results in the immune system attacking the body. It is believed that genetics and environmental factors both play a role in developing autoimmune diseases such as rheumatoid arthritis. While rheumatoid arthritis can develop in a person of any age group, it is most commonly diagnosed in people between the ages of forty to sixty years of age, with a higher proportion of women as compared to men.

In rheumatoid arthritis, the body attacks the lining of the joint, which is called the synovium, causing swelling, redness, and pain of the affected joints. This is different than osteoarthritis, which is the wear and tear related arthritis that we will all develop if we become old enough. Rheumatoid arthritis typically involves the small joints of the hands, wrists, and feet, but can progress to involve other joints. Although rheumatoid arthritis is primarily a joint disease, it can also involve other internal organs such as the eyes, heart, lungs, and kidneys. Rheumatoid arthritis can have other complications including osteoporosis – thinning of the bones which increases the risk of breaking a bone, rheumatoid nodules – lesions under the skin, dry eyes and mouth, carpal tunnel syndrome – numbness and tingling in the thumb, index, and middle fingers, and lymphoma – a blood cancer.

Patients usually present to their medical providers with complaints of pain and swelling. The patient’s history, physical exam, and additional data such as laboratory tests (rheumatoid factor and anti-cyclic citrinillated peptide antibodies) and x-rays can help to make this diagnosis. Many pieces of the puzzle have to fit together in order to be diagnosed with rheumatoid arthritis.

Treatment usually involves medications, lifestyle modifications, and therapy.

Medications are often required to control rheumatoid arthritis. Over time, inflammation associated with rheumatoid arthritis can cause joint deformity. Early aggressive treatment is required to help reduce the risk of irreversible joint damage which can cause pain, decreased mobility, and disability. There have been dramatic advancements in the medications for treatment of rheumatoid arthritis over the past twenty years, with many additional medications in the pipeline. The major classes of medications include Disease Modifying Anti-Rheumatic Drugs (DMARD’s) and biologics. Many treatment options are available – but each treatment plan needs to be tailored to each patient’s specific needs. Working together with your healthcare provider is critical to obtaining successful treatment outcomes.

Additional treatments such as physical therapy, occupational therapy, exercise, adequate rest, and counseling may also be needed. As with any chronic illness, getting a new diagnosis can be challenging – both physically and emotionally. Addressing both the physical and emotional aspects of the disease is integral to any treatment plan. Unfortunately, the emotional and mental components of these illnesses are often overlooked in favor of more tangible treatment options. Often, consulting a psychologist to help discuss fears and concerns as well as develop coping skills is helpful in processing the diagnosis and managing the treatment of any chronic illness, including rheumatoid arthritis.

Overall, although having rheumatoid arthritis can be challenging, it is important to note that people with rheumatoid arthritis can still live productive, independent lives.

Tips for all patients:

Be involved in your healthcare. Take the time to learn about your disease process, the treatments you’re on, and the natural course of the disease.
Be your own advocate. Speak up about your symptoms and concerns.
Ask questions. Medicine is a different language. If there’s something you don’t understand, don’t be afraid to ask for clarification.
Have a positive attitude. Studies show that positive attitudes improve outcomes and life satisfaction. Not always seeing the glass half full? Try simple things like recognizing a positive event each day, recognize and practice small acts of kindness daily, and smile.

Amal Kebede, DO, Rheumatologist If you are experience pain, swelling and stiffness in your joints, contact Penn State Health St. Joseph Rheumatology for an appointment with Dr. Kebede at 610-378-2996.

Penn State Health St. Joseph – A Key Supporter of Women2Women

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Healthcare providers and staff at Penn State Health St. Joseph understand the strength that can be found in a community of women. That understanding, along with an ongoing, overall commitment to women’s health, were driving factors when St. Joseph stepped up to become a founding presenting sponsor of Women2Women (W2W), an organization managed by the Greater Reading Chamber Alliance that works to help empower women to become leaders in our community.

“We believe in the power of women connecting with each other and supporting each other,” said Julia Nickey, Director of Patient and Organizational Engagement at Penn State Health St. Joseph and a member of the W2W Advisory Board. “With that support and camaraderie, women can lead more satisfying and healthy lives.”

In addition to providing key financial support, St. Joseph is active in W2W programming and has provided presenters for events since the organization’s founding eight years ago.

Dr. Jessika Kissling, an Obstetrics & Gynecology Physician presented “Hey Ladies . . . Here are the Top Five Reasons You Need a Primary Care Physician and a Gynecologist,” and Dr. Krista Schenkel, Family Medicine Physician, Penn State Health St. Joseph Strausstown, spoke on “Women & Anxiety, What Your Body is Telling You.”

Karen Marsdale, President of the Greater Reading Chamber of Commerce & Industry, praised St. Joseph’s commitment to the Women2Women organization.

“Penn State Health Saint Joseph was one of the very first W2W investors,” Marsdale said. “Not only do they believe in our goals to grow more women leaders, they have provided so many resources to help our organization grow and thrive, including experts to provide education for our members. We are truly grateful to this institution.”

Penn State Health St. Joseph Hand Therapists Help Patients Get Back to Life

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An injury to the hand can be devastating, resulting in an inability to perform basic tasks, to work or to enjoy favorite activities. Hand therapists at Penn State Health St. Joseph have seen the results of injuries to the hand again and again, and are dedicated to helping patients improve their conditions and get back to their lives.

Jennifer Neiheiser, a certified hand therapists, demonstrates a therapy technique.

“It’s amazing what you take for granted when it comes to your hand,” said Jennifer Neiheiser, an occupational therapist who has been certified as a hand therapist for 14 years. “Just stop and think about everything you would not be able to do if you didn’t have the use of your dominant hand.”

Hand therapists also treat wrist and elbow problems, and some address shoulder injuries, as well.

Although physicians and therapists have recognized the need for specialized therapy for patients with hand injuries since World War II, the first certification program was not established until 1991.

“It’s a relatively new specialty,” explained Monica Rush, director of rehabilitation services. “People were doing hand therapy, but there wasn’t that structure around it.”

Injuries to hands and fingers are among the most common workplace injuries, and can be complicated because of the way the hand is constructed. There are 28 bones in each hand.

“It’s a lot concentrated in a little area,” Neiheiser said. “When you think about it, your hands are your connection to the world.”

Someone working toward certification as a hand therapist is an occupational therapist with a minimum of three years of clinical experience, completion of 4,000 hours of direct practice in hand therapy, and passing of an exam. Once certified, hand therapists must complete ongoing continuing education in order to maintain their status.

Aaron Dearstyne, occupational therapist, exhibits a device used when working with hand therapy patients.

Aaron Dearstyne is an occupational therapist at Penn State Health St. Joseph who is working toward becoming a certified hand therapist. It is a demanding undertaking, he said, but the work is important.

“Patients who lose the use of one or both of their hands really suffer,” Dearstyne said. “That often leads to depression because they can’t work, or support their families or enjoy the activities they used to. If we can help someone to come back from a devastating hand injury, we’re making a difference.”

A hand injury can be caused by a traumatic event, such as a hand getting caught in machinery or a fall. Hand pain also can be caused by a condition such as arthritis or carpal tunnel syndrome.

St. Joseph is seeing more patients with serious damage to their hands, such as that caused by a crush injury, because patients are being referred to the hospital from Hershey Medical Center. Four or five hand surgeons at Hershey refer patients to St. Joseph therapists, who treat over 100 patients a month on an outpatient basis.

The first step in hand therapy, said Dearstyne, is to work at healing any wounds.

“We work with the physicians and physician assistants at Hershey to make sure the wounds heal properly,” he said. “After that, we can start our work with the patient.”

One of their goals, explained Neiheiser, is to teach patients exercises they can do at home in order to assure that their progress continues.

“Our goal is always to help patients get as much function back as possible,” Neiheiser said. “So, a big part of what we do is teaching patients what they can do at home to improve function and keep their healing going.”

While patients are still being treated at the hospital, they work with therapists in a specialized setting that enables them to practice tasks of daily living and regain as much use of their hands as possible.

While the goal is complete recovery, sometimes that is not possible, Neiheiser said. In those cases, therapists become psychologists and cheerleaders, urging patients to focus on what they can do, instead of what they cannot.

“So much of it is the attitude a patient has,” she said. “If somebody is only thinking about what they can no longer do instead of about the things that they can do, they tend not to do as well. We work really hard to try to keep our patients positive.”

Hand Therapy is available at the Medical Office Building at St. Joseph Medical Center.
Call 610-378-2975 to schedule an appointment or learn more here

Three Physicians and Friends Team up in a New Medical Practice in Robesonia

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Similar goals and values, mutual admiration for one another and some fortuitous timing resulted in three friends and colleagues becoming partners in Penn State Health St. Joseph’s newest medical practice in Robesonia.

Physicians Meredith Gable, Robert Mandel, and Roland Newman began staffing the new family practice in May, and have been busy getting assimilated in the Western Berks community.

So far, they report, business is good.

“We do everything from newborn to palliative and hospice care,” explained Dr. Mandel. “Patients have their choice of doctors, but then we will always pick up for each other if one of us isn’t available.”

The physicians met in 2013 when Dr. Gable, 29, and Dr. Mandel, 33, and were residents in St. Joseph’s Family Residency Program and Dr. Newman, 39, was a faculty member there. They got along well, enjoyed each other’s company and discovered that their philosophies regarding the field of medicine were closely aligned.

With graduation looming on the horizon for Dr. Gable and Dr. Mandel , they began thinking about their options.

Knowing that Penn State Health St. Joseph was looking to expand its healthcare services to Western Berks, where it did not yet have a presence, the doctors decided to look into staffing it. They got Dr. Newman on board, and the three of them presented themselves as a team.

“I came to Dr. Newman and Meredith and asked what they thought about us coming together as a group,” said Dr. Mandel. “It seemed like the timing was good, and we all thought we’d be good partners.”

Leadership agreed, and the doctors got working to help design their new office space at 410 E. Penn Avenue in the former Giannotti’s Italian Kitchen, just across from Conrad Weiser High School.

EKG, lab services, physical therapy, and x-ray also are offered at the site.

“We were able to contribute our ideas regarding the design and look of the space,” Dr. Gable said. “We wanted to make it a comfortable and functional place for our patients and staff.”

The doctors also were able to hire their staff and set the tone for the practice.

“We want to offer high quality, comprehensive care in a family-oriented and collaborative atmosphere,” said Dr. Gable.

The doctors work well together, discussing concepts and problems in shared office space.

“This room is our fish bowl of ideas,” said Dr. Mandel. “I can’t tell you how many times a day I turn around to bounce idea thought off of Dr. Gable or Dr. Newman. I think that’s a good way to work.”

The friends and partners are excited about their new venture and are already planning how they’ll expand the practice. Family practice is an important specialty, said Dr. Newman, and in the past residents of the western part of Berks County did not have much high quality family care readily available in their community.

Their practice is accepting new patients, and the doctors are looking to engage community members in becoming partners in their health care. Each of the doctors spends a half day each week at nearby Phoebe Berks Village and Health Care Center, and are looking to become increasingly involved in the community.

“We look forward to working with our patients and the Greater Western Berks area,” said Dr. Newman. “Quite honestly, family medicine is the backbone of the medical system, and all of us are very committed to it.”

Robesonia's primary care physicians are available for adult and children wellness visits and routine screenings, non-emergency illnesses like earaches and sore throats, sports physicals and immunizations, and conversations about your health questions and concerns.
Call 484-987-3456 for an appointment or learn more here

Penn State Health St. Joseph’s welcomes Dr. Jorge Bustillo, Orthopedic Surgeon

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Dr. Jorge Bustillo has joined the medical staff and the orthopedics team at Penn State Health St. Joseph. He specializes in the diagnosis and surgical treatment of patients with diseases, degenerative conditions and injuries affecting the body’s bones and joints including sports injuries. He also focuses on the foot and ankle, including Achilles tendon problems, ankle instability, heel pain, flat feet, sprains, and fractures, and is particularly capable of addressing foot and ankle reconstructive surgeries, including ankle replacement.

He completed a medical internship at Greenville Memorial Hospital, Greenville, South Carolina and his orthopedic surgical residency at SUNY at Buffalo. He completed a fellowship in Orthopedic Foot & Ankle Surgery at Allegheny General Hospital, Pittsburgh, Pa.

He is board certified in Orthopedics and is a member of the American Academy of Orthopedic Surgeons and the American Orthopedic Foot and Ankle Society.

He also has served as an Assistant Professor in the Department of Orthopedics and Rehabilitation at the Pennsylvania State University College of Medicine.

Dr. Bustillo earned his undergraduate degree at the University of Florida, Gainesville, Fla., and his medical degree at Meharry Medical College, Nashville, Tenn.

He joins Chief of Orthopedic Surgery Dr. Martin Ross and Wayne Luckenbill, physician’s assistant, in the medical office building on the St. Joseph Bern Township campus.

Appointments can be made by calling 610-378-2996.