Union Memorial Hospital

Spring/Summer 2011

®
how far would you go for your health?

twins get foot up

on identical problems
Read Alexandra
and Victoria
Chittams’ story
Page 2

Better bone healing

PAGE 4

Don’t ignore
leg pain
PAGE 6

Sinus relief is AN
inflation away
PAGE 9

unionmemorial.org
Union memorial ORTHOPEDICs and sports medicine
identical twins
identical surgeries
Flat fleet and bunions once meant double trouble
for Alexandra and Victoria Chittams.
A
s tenth graders at Washington Latin Public
Charter School in Washington, D.C., 15-year-old
Alexandra and Victoria are accustomed to the
curiosity generated by being a twin. Yes, they’re identical.
They’re 10 minutes apart. Alex was born first…no, they
don’t like to dress alike. Yes, twins run in the family.
But even as they try to distinguish themselves by wearing
different hairstyles and clothing, they can’t change their
identical genetic makeup. Each characteristic inherited is
matching, including congenital bunions and flat feet.
“I always say they got their grandmother’s feet,” said
their mom, Patricia Howard-Chittams, a registered nurse.
“I really had hoped they’d miss that gene.”
Congenital bunions form when the metatarsal bone
of the foot moves outward and the big toe grows in the
2 unionmemorial.org
Victoria (left) and
Alexandra Chittams
enjoy a game of golf.
direction of the second toe. The worst of this, said the
twins, is not the bony protrusion, horrific foot pain or
proclivity to walk toe-out. It is shoes.
“I couldn’t wear the shoes that look nice,” Vicki said.
“My goal was to wear chucks…the All-Star shoes. I have
wanted to wear them forever.”
Mom explained, “If a dress shoe was large enough to fit
the front of the foot it wouldn’t fit the back of the foot.”
Making matters worse, the growth of the bunion is
often hastened by flat feet.
By all appearances flat feet are not unlike a baby’s: on
top of the foot there is little or no arch and the instep is
low to the ground. But in fact, the lack of support in the
foot naturally leads to the body compensating in other
ways. At a young age, the twins were already coping with
Meet our foot and ankle specialists
The orthopedic foot and ankle specialists at Union Memorial Hospital bring vast experience in treating all types of foot and
ankle problems, from the simple to the complex.

Dr. Greg Guyton Dr. Stuart Miller Dr. Lew Schon

Specializes in sports Specializes in Specializes in tendon
injuries, arthritis ankle replacement, reconstruction,
conditions, tendon tendon and ligament ligament repair,
degeneration, diseases reconstruction, bunions, fractures, sports
of muscles and nerves, forefoot problems, injuries arthritis,
adolescent foot arthroscopic treatment ankle replacement
disorders. of ankle injuries. and deformities.

To request an appointment, visit unionmemorial.org/destinations or call 1-877-346-7846.

knee pain and being sidelined from most of the sports

they loved. foot pains you
The Chittams knew about flat feet all too well. Five
years ago, the twins’ older brothers both needed surgery
shouldn't ignore
to correct flat feet. Ralph Jr., now 25, suffered both hip
and knee pain and Justen, 20, developed arthritis.
Pay attention to what these foot problems
That’s when the family met Dr. Gregory Guyton,
could be telling you. If pain is ongoing, it’s
a foot and ankle surgeon with Union Memorial
time to get it checked out.
Orthopedics and Sports Medicine.
■■ Pain on inside of ankle: Often misdiagnosed
“The girls were suffering multiple problems that
as a sprained ankle, the culprit could be the
were identical to each other, not unusual in twins,”
posterior tibial tendon, which helps hold up
Dr. Guyton said. “We were able to create an arch in
the arch of the foot. If left untreated, it
surgery and correct the bunion, which straightened
could lead to the arch collapsing, causing
out their foot and lengthened the Achilles tendon.
flat foot and arthritis.
This helped give flexibility from the calf to the foot.”
“This type of pain is often seen in middle-
Six months after healing from the surgeries on one
aged women who are overweight but it also
foot, Dr. Guyton performed the same procedures on the
can affect athletes,” said Dr. Stuart Miller,
second foot of each twin. “While one was in recovery, we
orthopedic foot and ankle surgeon at Union
operated on the other one,” he said. “It was like déjà vu,
Memorial.
except that the girls elected to start their surgeries with
■■ Achilles tendon: Pain in the back of the heel
the opposite foot.”
where the large tendon connects the heel to
Fully recovered and able to resume their love of golf,
the calf muscle. If pain continues to worsen,
basketball and running, the girls are pain-free. And, said
the tendon can tear, leading to surgery.
Vicki, “It was so weird to see an arch in my foot and my
■■ Pain on top of foot: If pain is accompanied
toe being straight and me being able to wear the shoes I
by swelling or gets worse when putting
love. I was so used to seeing the bunion. I had to get used
pressure on the foot, it could be a stress
to it.”
fracture, a tiny crack in a bone. Stress
“We could only wear Mary Janes before the surgery,”
fractures are common overuse injuries
Alex said. “Now we wear heels. We can wear slingbacks.”
in activities where feet get a pounding,
like running, dancing and basketball. Over
time, pain will worsen if treatment is not
Don’t let foot pain keep you from the activities you enjoy. undertaken.
Request an appointment with one of our foot and ankle “With each of these conditions, the pain is
specialists. Visit unionmemorial.org/destinations or call harder to get rid of the longer it lasts,”
1-866-346-7846. Dr. Miller said.

Spring/Summer 2011 3
the curtis national hand center

steady hand
Bonnie Mitchell discovered the
unique expertise of The Curtis
National Hand Center.

B 
onnie’s love of cooking shows in her vast
assortment of recipes. From her teenage years, she
has made a hobby of collecting them, even ones
from her high school home economics class. Whatever
her family or friends may be hankering for, chances are
Bonnie has a recipe for it, from breads, cakes and pies
to beverages and healthy eating.
Two years ago, however, Bonnie struggled to do
much of anything. An injury to her right arm made
even the simplest movements extremely painful. The
injury occurred during an accident on an all-terrain
vehicle while visiting friends in Martinsburg, W.Va.
Bonnie suffered a broken radius bone, the larger Bonnie Mitchell
forearm bone that is the main support for the wrist. is an avid collector
At a local hospital, doctors screwed a plate to the of recipes.
bone to hold it in place.
“I’ve always wanted to ride one; it was likely the first
and last time,” said Bonnie, 66, of Hampden.
Although Bonnie traveled back to West Virginia
several times to see the doctor there, she sensed her
arm wasn’t progressing as well as expected.
“I could see it myself on the X-ray that the bone
wasn’t right,” said Bonnie. “I couldn’t use my hand; The radius bone in Bonnie’s arm wasn’t healing
it was very painful.” properly. There are several reasons this can occur,
Her search for answers led her to The Curtis including less than optimal plate fixation. Such was
National Hand Center at Union Memorial Hospital Bonnie’s case. So Dr. Higgins turned to a novel
and Dr. James Higgins. Her experience was exactly what technique known as microsurgical bone transfer. It
you’d expect from the nation’s largest and most consists of taking bone and blood vessels from the knee
experienced hand specialty center. and attaching them to the injured bone.
“Dr. Higgins said he could fix my arm and all that “The bone heals faster and better,” said Dr. Higgins,
could have gone well went well,” Bonnie said. chief of The Curtis National Hand Center, who also

Meet Dr. Higgins

Dr. James Higgins is chief of The Curtis National Hand Center. He specializes in complex reconstruc-
tion after trauma, microsurgery, congenital hand surgery and fractures of the arm and wrist. Visit
unionmemorial.org/destinations or call 1-877-UMH-HAND to request an appointment.

4 unionmemorial.org
 Hand center locations new option
for Dupuytren’s
In your neighborhood
The Curtis National Hand Center has physician and contracture
therapy locations throughout central Maryland.

Locations:
Baltimore • Catonsville • Lutherville • Perry Hall The Curtis National Hand Center at
To request an appointment: Union Memorial Hospital offers a
visit unionmemorial.org/destinations new treatment option for Dupuytren’s
or call 1-877-UMH-HAND contracture. It’s called collagenase.
Dupuytren’s is a disabling hand
140
83 condition that makes it difficult
1
to perform everyday activities. It
affects the tissue under the skin of
27 95 the palm of the hand. The tissue
795 Lutherville-Timonium
produces too much collagen, leading
Perry Hall to knots of tissue under the skin.
695 The condition usually develops
26 slowly, eventually forming a thick
32 cord or band that pulls one or more
70 fingers into a bent position.
Collagenase consists of injecting
Baltimore a medication that breaks down the
Catonsville thickened tissue rapidly and
aggressively. The day after the
injection, the patient returns to the
doctor who gently stretches out the
cord until it loosens, causing the
95 10 fingers to become straight again.
100 “It’s a dramatic difference
195
compared to surgery,” said
97 Union Memorial hand surgeon
29 32 Dr. Ken Means. “Recovery is much
replaced the plate in Bonnie’s arm. “What makes this approach so faster for patients and they are
much better than conventional methods is re-establishing the able to make a full fist the day
blood supply that speeds up healing. It’s an uncommon treatment after the injection. There’s typically
for a common injury when all else fails.” no therapy and they only wear a
Dr. Higgins’ expertise in the new technique is rare nationally splint at night for a short time.”
and allows for the treatment of complex radius fractures when If you’re experiencing symptoms
traditional methods are unsuccessful. of Dupuytren’s contracture, the
Within a few weeks, and with a little therapy at Union specialists at The Curtis National
Memorial, Bonnie could tell a dramatic difference. “I could Hand Center can help. Risks, benefits
see it and feel it healing, especially when getting control back and alternatives to any treatment for
in my hand,” she said. Dupuytren’s should be discussed with
Today Bonnie is quite happy with her outcome. She has full a hand surgeon first.
movement of her right hand and there’s nothing she can’t do.
“It’s pretty amazing when you think about it,” she said.

If pain in your hand, wrist, arm or elbow is keeping you from the Call 1-877-UMH-HAND or visit
activities you enjoy, let us help you. To request an appointment, unionmemorial.org/destinations
visit unionmemorial.org/destinations or call 1-877-UMH-HAND. to request an appointment.

Spring/Summer 2011 5
Union Memorial Vascular institute
sigh of relief
Leg pain no longer slows Shirley Hartwell
S
ometimes it would happen when taking a few steps.
Other times it would come on during the short
walk to the beach from her condo. The pain in
Shirley’s lower calf of both legs wasn’t bad at first. But
when it literally stopped her in her tracks, it was time
to take it seriously.
“The pain would go away and come back,” Shirley
said. “I thought it was just my medication.”
What was ailing her was actually a common vascular
problem known as peripheral artery disease (PAD).
PAD is a blockage of the arteries in the legs or arms
caused by a buildup of plaque. When blood to the leg
is blocked, you get leg pain called claudication. The
classic symptom is painful cramping of the calf muscles
while walking that goes away upon rest. Yet even those
with symptoms often mistake them for something else.
6 unionmemorial.org
Shirley went to see her cardiologist Dr. George Bittar
at Union Memorial, who after performing a pulse test on
her legs, referred her to vascular surgeon Dr. Mojtaba
Gashti. Shirley was startled to learn she had severe
blockages in both legs.
“I’ve never heard of vascular leg pain,” said Shirley, 78,
of Columbia, who also lives with heart disease. “I knew
I had problems with plaque in my heart, but I never
worried about my legs.”
Fortunately for Shirley, major surgery was not
necessary to clear the blockages. Given the intricacies of
the vascular system, vascular procedures require highly
specialized training and skills, like those at Union
Memorial’s Vascular Institute.
The vascular system is made up of arteries and a
multitude of blood vessels that supply blood, oxygen
and nutrients to every part of the body. A variety of
conditions can result in blood flow becoming insufficient
to meet the body’s needs.
Shirley Hartwell is up
and moving without
vascular leg pain.
 Meet Dr. Gashti
Dr. Mojtaba Gashti is chief of vascular surgery at Union Memorial. He specializes in minimally
invasive treatment for leg pain, carotid artery disease and aortic aneurysms. Call 1-866-511-3000
or visit unionmemorial.org/destinations to request an appointment.
“Leg pain related to circulation is very specific; the
same symptom happens every time you walk a certain
distance,” said Dr. Gashti. “A lot of people think it is
arthritis or a back problem. It is a common problem that
is greatly underdiagnosed.”
In a delicate procedure, Dr. Gashti first opened an
artery in Shirley’s left leg by way of a catheter inserted
into the groin, then placed a tiny stent to keep it open.
Two months later, Dr. Gashti repeated the same steps
to open three blockages in Shirley’s right leg.
“There’s no incision and patients go home the
same day and are back to their normal activities,” Dr.
Gashti said.
Shirley’s symptoms were completely gone and she
came away with high praise for Dr. Gashti.
“It was life-changing,” said Shirley. “He’s really
incredible and so easy to talk to.”
If you’re suffering from persistent leg pain, find out if
it could be PAD. Talk with your doctor or request an
appointment with one of our vascular specialists. Visit
unionmemorial.org/destinations or call 1-866-511-3000.
Keep vascular health in check
Did you know that there’s a strong relationship
between heart disease and vascular health? That’s
because the same problems that affect blood vessels
of the heart — like smoking, high blood pressure and
diabetes — also put you at risk for vascular disease.
Vascular disease often begins without symptoms,
but if it’s caught early enough, the better the chance
of avoiding serious problems later on. Talk with your
doctor about simple screenings for vascular health.
Union Memorial’s vascular specialists offer several
noninvasive tests.
To request an appointment with one of our vascular
specialists, visit unionmemorial.org/destinations or
call 1-866-511-3000.
Spring/Summer 2011
leg pain: arthritis or
peripheral arterial disease?
If you suffer from leg pain while walking, you
may blame arthritis. But the problem might
be peripheral arterial disease (PAD), which
can have serious consequences.
PAD causes an aching, heaviness or
cramping in your calves, thighs, hips or feet
that occurs while walking or climbing stairs.
The discomfort gets better after you rest.
The most common cause of PAD is hardening
of the arteries, which over time blocks blood
flow to leg arteries. This causes cramping and
pain when walking because the muscles need
more oxygen when they are working.
Signs of PAD
PAD starts slowly and early on, you may not
notice any symptoms. Rest usually helps, but
raising your legs — as when you lie in bed —
may make the discomfort worse. Other
symptoms include:
■■ Skin on your leg turns pale or bluish when
elevated
■■ Your foot turns a dusky red when you stand
or sit
■■ You have sores on your toes, feet or legs
that heal slowly or not at all
See your doctor if you have any of these
symptoms. PAD can be diagnosed with a
simple test called an ankle-brachial index,
which measures blood flow by comparing
blood pressure in your arms and legs.
Quitting smoking and keeping high blood
pressure, cholesterol and diabetes under
control are important in reducing the risk
for developing PAD.
7
union memorial Hospital foundation

give in honor of a caregiver

Many patients want to express gratitude for their care at Union Memorial. A
gift to Union Memorial Hospital is a meaningful and enduring gesture to thank
an outstanding physician or other caregiver. Recognizing donors
You can make such a gift online by visiting unionmemorial.org/foundation
Union Memorial Hospital has taken
or sending it by mail. Please remember to include the name of the caregiver
a new step in remembering and
being honored or thanked. Gifts may be mailed to:
celebrating its dedicated donor
Union Memorial Hospital Foundation
community with the unveiling of
201 East University Pkwy.
a new donor recognition display.
Baltimore, MD 21218
The interactive display features a
Over the past year, patients have honored these Union Memorial physicians:
touch-screen monitor to highlight
annual donations and information
Dr. Jose Roman Almario Dr. Mojtaba Gashti Dr. David Nasrallah pertaining to fundraising efforts at
Dr. Paul Asdourian Dr. Greg Guyton Dr. John Nesbitt Union Memorial. Surrounding the
Dr. Raja Ayash Dr. Davis Hahn Dr. Nan Ni monitor are names of lead donors
Dr. Stuart Bell Dr. Richard Heitmiller Dr. Verinder Nirankari who have contributed $1 million
Dr. George Bittar Dr. James Higgins Dr. Ajay Parikh or more or included the hospital as
Dr. Henry Boucher Dr. William Howard Dr. Larry Perry part of their estate plans.
Dr. Robert Brumback Dr. Peter Innis Dr. Raymond Plack The commitment and
Dr. Philip Buescher Dr. Allan Jensen Dr. Michael Randolph compassion of our generous
Dr. Wayne Campbell Dr. Kavita Kalra Dr. Walter Roche donors has helped Union
Dr. Issam Cheikh Dr. Miguel Karacuschansky Dr. Waiel Samara Memorial achieve numerous
Dr. Nancy Clark Dr. Dawn Kershner Dr. Lew Schon milestones and the many
Dr. Miriam Cohen Dr. Ramesh Khurana Dr. Pamela Schroeder challenges facing health care
Dr. Frank Criado Dr. Brad Lerner Dr. Keith Segalman organizations places a greater
Dr. Shawn Dhillon Dr. Richard Levine Dr. John Senatore priority on philanthropy. The
Dr. Luis Dibos Dr. Momina Mastoor Dr. Michael Shear support of our donors — friends,
Dr. Shailaja Didolkar Dr. Robert Mathieson Dr. Mansur Shomali organizations and grateful
Dr. Frank Ebert Dr. Leslie Matthews Dr. Peter Sloane patients — continues to play an
Dr. Ibrahim Elsamanoudi Dr. Arthur McTighe Dr. Frederick Sutton important role in ensuring that
Dr. Veronica Epstein Dr. Henry Meilman Dr. Gregory Walker Union Memorial provides the
Dr. Betsy Fay Dr. Stuart Miller Dr. John Wang greatest value to our community.
Dr. Michael Fiocco Dr. Luis Mispireta Dr. Sam Westrick
Dr. Joyce Zeno

innovation fund
Union Memorial Hospital has created the Dr. Lew C. Schon
Innovation Fund to support vital research and new
discoveries in the treatment of foot and ankle disorders.
Dr. Schon, director of the foot and ankle program at
Union Memorial, is an award-winning researcher and
inventor in his field. He founded the Orthobiologic
Laboratory at Union Memorial, where he and his colleagues
work toward a singular goal of improving the care and
outcomes of patients affected with foot and ankle pain.
The Orthobiologic Laboratory is an important
training environment in which great ideas can be
studied, tested and perfected for use in real-world
settings. Many come from all over the world to study
under Dr. Schon’s mentoring.
To learn more about opportunities to support the
important research of the Innovative Fund, please
contact the Union Memorial Hospital Foundation
at 410-554-2662.

8 unionmemorial.org
 Noteworthy News

Take a deep breath

Your sinuses are blocked, making it
impossible to breathe. You often get
terrible headaches and your teeth
actually hurt! You have a sore throat
that won’t go away. These symptoms
go on for weeks leaving you
exhausted. Cold medicines and nasal
sprays don’t help. What’s going on?
Your doctor says you have sinusitis
and prescribes antibiotics — they
help, but your symptoms return.
Eventually, you consider surgery as
a last resort, even though it could
mean weeks of discomfort and a slow
recovery. You decide the cure is worse
than the problem. performed the first cases in Maryland the opening so that the sinuses
But now there’s a better way to a year later. drain properly. Studies have shown
find relief, according to Dr. Alan Here's how it works: A balloon that this less invasive procedure is
Shikani, chief of ear, nose and is guided into the sinuses and safe and highly effective.
throat at Union Memorial Hospital. inflated. This enlarges and reforms
It’s a minimally invasive, effective
alternative called balloon sinuplasty. Don’t suffer with chronic sinus problems any longer.
The procedure was approved by Find out if balloon sinuplasty is right for you. Call
the FDA in 2005 and Dr. Shikani 410-554-2266 to request an appointment.

Hazy days of summer

S
ummer means baseball, trips to the ocean, cookouts
and fun in the sun. It also means high temperatures
and humid conditions that can take the starch out
of even the most physically fit among us.
Whether you’re a yoga practitioner or a marathon runner,
how do you effectively continue your regular workouts in
these daunting temperatures? Should you even try?
“Absolutely,” said Dr. Kari Kindschi, sports medicine
physician with the Arnold Palmer Sports Medicine Center
at Union Memorial Hospital. “One of the important
things about working out in high heat is to take the time
to slowly and carefully acclimate your body. Start out with
short periods and build up, and avoid the hottest part of
the day. Early mornings and evenings are best.”
Staying hydrated is critical. “When you get
dehydrated, your core body temperature rises, putting a
strain on the heart and decreasing your performance,”
Dr. Kindschi said. “Drink before,
during and after. For less than
60 minutes of exercise, water is a
good choice. For longer periods,
consider a sports drink to replace
electrolytes.”
But don’t wait until you’re thirsty.
By the time you sense thirst, you’ve
already lost about two percent of water.
What’s more, wear lightweight and
light-colored clothing.
Need help fast for a sports or activity-
related injury? See a sports medicine
specialist within 48 hours of calling the
Arnold Palmer SportsHealth Center. Call
1-888-44-SPORT to request an appointment.

Spring/Summer 2011 9
destinations Union Memorial Hospital
201 East University Parkway
Postmaster: Please deliver within
May 2 – 6.
Non-Profit Org.
U.S. Postage
how far would you go ® for your health? PAID
Baltimore, MD 21218-2895 Union Memorial
destinations is published by the Marketing & Communications Hospital
Department of Union Memorial Hospital. The information
­provided in this publication is intended to educate readers
about subjects pertinent to their health and is not a substitute
for a consultation with a personal physician.
Ken Samet: President and CEO, MedStar Health
Eben D. Finney III: Chairman, Board of Directors
Bradley S. Chambers: President, Union Memorial Hospital
Jo Anna Shuba: Director, Marketing and Communications
Mark Hoeflich: Editor/Writer
Debra Schindler: Writer
Ray Studios: Photography

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Visit our Web site: unionmemorial.org

IT’S SPRINGTIME and yard work is calling

But what is your back telling you?
Most back pain gradually improves with minimal care. But in
some cases, back pain can signal a serious medical problem.

Free Back Pain Seminar

Union Memorial Hospital
Saturday, June 11
11 a.m. to 1 p.m.
Light refreshments, free parking

Join Dr. Justin Tortolani, Dr. Abraham Rasul and Dr. Ibrahim Elsamanoudi to
learn about the latest conservative and surgical treatments for back pain.

Call 1.877.346.7846 or visit unionmemorial.org/backpain to register.

 let us be your
health destination!
Conveniently located in northeast Baltimore, Union Memorial Hospital is just
minutes­from both downtown Baltimore and Towson. We’re also located near
several educational institutions, including Johns Hopkins University and
Loyola University. Our specialty services extend far beyond the reach of
Baltimore, drawing patients from many surrounding states.
For directions, location and other details, please visit
unionmemorial.org/destinations

[ ]
Union Memorial Hospital is part of MedStar Health, a not-for-profit, regional
healthcare system with nine hospitals and more than 20 other health-related services
in the Maryland and Washington, D.C., region. More than a half million patients
trust their care to MedStar Health each year. medstarhealth.org
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I’d like to start taking charge of my health! Please send me the following
FREE information­ (check all that apply):
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■ The Curtis National Hand Center Brochure about Union Memorial services and
■ Sports Injury Prevention Guide events by e-mail.
■ Diabetes and Endocrine Center Brochure ■ Please remove my name from this
­mailing list.

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  go where the
pros go
Union Memorial is the
official medical team
of the Baltimore Ravens,
but we also take care of athletes
and individuals of all ages.
To speak with a certified
athletic trainer or get a physician
referral, call 1-888-44-SPORT
(1-888-447-7678).

unionmemorial.org/destinations

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