Good afternoon everybody, welcome.
My name is Steven Craig, I'm the director of the wellness program
at Johns Hopkins, and I'm so glad everybody could be here
today to help us celebrate our two year anniversary of
being open as the center for wellness medicine and surgery.
We have six speakers in the lineup including myself and we
have two of those six speakers are special guest I call them.
And I'll be introducing them in a few minutes.
I wanted to, I didn't know what to call this seminar.
It was a combination of education and celebration.
To be honest.
Education to tell everybody here about how wellness medicine
works.
We have some of the experts in the field here
to tell you what we do.
And also a celebration of our two year opening and
I'm going to show you what we've done in the last two years.
So, somebody asked me after our last open house,
why did you start this program?
And I thought that was a good question and the short answer is
that my chairman and my department asked me to.
>> [LAUGH] >> But
after we had just a handful of patients I recognized right away
that Jehovah's Witness patients were some of the friendliest,
most appreciative.
And nicest patients that you could take care of.
>> [COUGH].
For example, we did a brain tumor surgery on a patient about
a year ago, and afterwards I go to talk to the family in
the family lounge after the surgery.
And five family members came up to me and hugged me and
some of them kissed me.
>> [LAUGH] >> Okay, so
I'm an anesthesiologist, I'm not used to that.
>> [LAUGH] >> And
it just blew me away how grateful and
how appreciative the family members and the patients are.
When you can do things that other hospitals can't do.
With that introduction, I'm gonna tell you how it works.
And how it really works is the people that we have
in our program.
And I'm gonna introduce seven people including myself, and
I'm gonna tell you who's speaking today.
To the right side of me is Linda Resar, and she's here today.
She's our hematology consultant.
She's an associate professor, she's originally from Wisconsin,
but she trained in Hopkins in pediatrics and hematology and
ontology.
She's a multi specialist and she helps us with our anemic
patients and she'll be giving a talk on anemia.
To the right is Liza Wick, she's a general surgeon that
specializes in every type of surgery from the chest to
the pelvis, so she's an expert in colorectal surgery.
And she's on our team, and she's not here today.
She's the only one that's not here today.
Then we have Liz Dackiw who is our nurse coordinator,
she's been with us since the beginning.
And Liz will be speaking on what happens when you call in and
ask about bloodless surgery.
Andy Pippa is here.
He is our Administrative coordinator.
He and Joan as you might asked are married.
[LAUGH].
And Joan is our communications director.
Andy and Joan work closely and Joan is responsible for
setting up this seminar today and
I think she did a wonderful job everyone give her a hand.
>> [APPLAUSE] >> This
is our newest member of our team.
Ish'shah's been with us for two months.
I didn't have her professional picture of her.
>> [LAUGH] >> I just grabbed whatever I
could off the internet.
>> [LAUGH] [APPLAUSE] >> I think this is on Facebook.
>> [LAUGH] >> So
Ish'shah was working over on MYER nine or MYER seven.
MYER seven and Andy found out about her and
said, do you know there is a Jehovah's Witness who's a nurse
who works on MYER seven?
And she's wonderful and I said well,
we gotta get her on our team.
We figured out how to steal her away from MYER seven and
her supervisor was not happy about that.
So, Ish'shah's been with us for two months, and
she won't be speaking today, but I'd like to introduce her,
if she could raise her hand.
>> [APPLAUSE] >> I
showed this slide a year ago, and I was amazed that after
one year of operation, that we had 154 Hopkins.
Physicians that have taken care of our patients without blood
transfusion.
And now Andy and I just update this slide,
I didn't have the updated version.
But we can add 40 more Hopkins doctors, four zero.
We're up to about 200 Hopkins physicians.
That have taken care of patients,
that agreed to provide care without transfusion.
And you might see down here, anesthesiology, 45 physicians.
In my department, in anesthesia, we had so
many doctors that had taken care of witness patients that there
were too many to list on this slide.
The special guest today that we have first Misop Han is here.
He's an associate professor of urology and
he trained at Hopkins, went to med school at Hopkins, and
he's climbed the ranks academically and
he's now one of the experts in the In the country when it comes
to minimally invasive prostate and bladder and urology surgery.
He's gonna give a talk on minimally invasive surgery and
we have, the highlight of the afternoon if you will,
is gonna be Tammy Martin Whorley.
And she's sitting right here in the second row in the blue
polo shirt.
There she is.
I call her one of our star patients because about,
six months ago, Tammy had a very very
difficult open heart surgery that we did
without blood transfusion after she was refused or turned down
at one of the other top three medical centers in the country.
And now she's here today, she's back at work and
she came with her mother and father.
And we're gonna hear her story from her herself.
>> [COUGH].
>> How we operate.
One of the unique things about our program that I don't think
any other bloodless program in the country can offer,
is we are always available.
That's 24 seven and three 65.
We have a pager number, it's even listed on our website.
We were afraid to put it out there at first because
we thought that the pager would ring, constantly.
>> [LAUGH].
>> But it turns out that most people respect the fact that
unless it's a dire emergency,
that things can usually wait 'til morning.
And either Andy or Ish'shah or myself carry this pager.
You can find it by googling Hopkins Bloodless.
And we are truly I think one of the only program in the country
that has someone available to speak to 24 seven.
At the rate we're enrolling patients now we're getting
400 patients a year.
Almost one new inpatient every day.
These are inpatients.
Actually more than one new inpatient every day.
And outpatients 1300 outpatients annually.
And if you add that up that's 1700 patients per year
that we're taking care of.
And we are twofold ahead of where we predicted we would be
at the two year mark.
So that's why we're celebrating two years.
Because we're doing really well.
[SOUND] I want to mention three challenging cases that are on
our website if you wanna see the details.
>> [COUGH].
>> And these are surgical cases that a few.
>> [COUGH]. >> If any,
bloodless programs in the country would be able to
perform.
And Tammy has one of the three cases.
I'll show her third.
First of all we have a case on our website of
a Fenestrated endovascular aortic stent graft.
It turns out there's only 13 hospitals in the country
that can do this procedure because its new.
And we had a lady come in on a Sunday night
with a rupturing aortic aneurysm.
It's one of the worst problems you can have.
It's associated with a high mortality.
And she came in on Sunday night.
One of our vascular surgeons is credentialed
to do this new procedure.
What makes it new is it has holes for the real arteries.
Like windows.
That's the fenestrations.
And other places are unable to do this.
We were able to fix her aortic aneurysm without opening her
abdomen and without giving her a blood transfusion.
And by the way she's 83 years old.
>> [SOUND] >> And
she walked out of the hospital.
>> [APPLAUSE] >> The second.
Challenging pace that's on our website again is an open, well,
it's a beating heart off pump coronary bypass surgery.
>> [COUGH].
>> So what this is it's a minimally invasive type of
cardiac surgery where you don't have to stop the heart.
You don't have to go on the bypass machine.
And circulate the blood through a machine,
because you keep the heart beating on its own.
And we were able to do this coronary bypass without blood.
And partially we were able to do that because we
didn't stop the heart and we didn't use the bypass machine.
This is another challenging case we did successfully.
And then there's Tammy's case, who's sitting right here.
Tammy presented just around 40 years of age.
She's young, and she had severe aortic valve disease.
And she also had aortic aneurysm.
She had a dilation of the largest blood vessel
in her body.
Which is the aorta, and you can see, so
this is before surgery you see the ballooning out
of her aorta and then inside her aortic valve was not competent.
It was leaping so the blood was going backwards through
the valve and when Tammy presented, well before she came
to us she went to another major academic center in the Midwest
and they said, we can't help you without a blood transfusion.
We can't do your survey.
And have this be one of the top four hospitals in the country
that turned her down.
And so we took her to Duke [INAUDIBLE] and
he was the chief of cardiac surgery at Hopkins.
And we sat down with an hour, Me, Tammy, and her
parents sat down for an hour and he said I think we can do this.
It's a high risk surgery, but we can replace your aortic valve,
and your aortic root.
And if we give you [INAUDIBLE] and
iron to pump up your hemoglobin before the surgery,
then we can get you through this.
And that's what we did, this was her surgery, or
a surgery like it, actually.
On the right it's a very, very complicated procedure.
Lots of equipment, lots of machine.
We use the cell saver which i'll talk about in a minute.
We have a paper that just came out last month called Risk
adjustment clinical outcomes and
patients enrolled in a bloodless program.
We basically show that our patients without blood
transfusion do better than patients who accept
blood transfusion.
In all the outcomes we looked at, which I show here, for
example, heart attack.
No difference, okay, between the bloodless in the blue and
the blood patients in red.
No difference for heart attack, no difference for
respiratory complications, no difference for renal failure.
When you look at infection, the difference was there,
it wasn't quite significant with less infection in the bloodless
patients.
When we looked at mortality, that's death in the hospital,
we have a lower mortality in the bloodless patients shown here,
less than one percent compared to
the other patients who took blood.
Not only that but the cost of care was less.
When we look at direct cost and
total cost of taking care of bloodless patients.
It was about a 14 percent less cost to compare for
our bloodless patients, compared to the other patients.
Last thing I wanna say before I introduce our next speaker is,
I wanna talk about the Cell Saver.
So the Cell Saver was invented in 1978.
>> [COUGH]. >> It's a machine that we use to
recycle the blood that you lose.
You lose the blood, we collect the blood during surgery.
We clean the blood and give it back to you.
Not all Jehovah's Witnesses accept the cell saver, but
in my experience about 95 percent of them do.
It's a personal choice as you know, and
we have had the cell saver save people's lives during surgery.
And I'm gonna tell you how it works.
And a paper that we had on the cell saver that came out last
month.
[SOUND] It's basically recycling blood, and
we compared the quality of the recycled blood to the stuff that
comes from the blood bank.
So the recycled blood is fresh.
It's only been out of the patient for maybe half an hour.
But the blood bank blood has been sitting in the blood bank
for up to six weeks.
We have this paper where we compare.
>> [COUGH].
>> The quality of the fresh recycled blood compared to
the blood bank blood.
Have been sitting in the blood bank for up to six weeks.
And we've found that the cell saver blood was higher quality. OK?
The red blood
cells were fresher.
They had better membranes, function.
And when we published the paper it got written up in
The Washington Post.
Saying we recycle a lot of things.
Paper, plastic, metal and blood.
And no one ever thinks about recycling blood, but
it's really the best blood we can get.
The New York Times also picked up on our paper and
talked about reusing a patient's own blood.
And then they interviewed me and talked about our study,
telling how we demonstrated that cell saver blood was better.
I'm going to end with this.
Then I'm going to introduce doctor Pan who's our neurology
visiting professor today.
This is a direct quote from a Hopkins surgeon.
And this is from one of our orthopedic surgeons,
he sent this email to us last week.
It said thanks to you and your team.
Your team is amazing, I wish I had you for all my patients.
Mister Patient X is still weak but
stronger each day and I expect a full recovery of his strength.
And doctor Shuba is the orthopedic surgeon, and
he was so grateful that we were there to follow
his patient through surgery to help him avoid the need for
transfusion and still have a good outcome.
So this is how our surgeons feel about us.
And with that I'm gonna introduce Lisa Pan and
I'll get your slides up for you.
>> [APPLAUSE]