Kathleen Fox led a simple life, one most women dream about.
She had a career as a health care administrator. For fun, she attended her grandson's ball games. She traveled. She danced. She exercised. And, of course, she shopped.
In short, life was good.
Except for a nagging problem.
One that, over the years, changed her life.
As she neared 50, Kathleen stopped traveling, stopped dancing, stopped exercising. She even stopped shopping.
The day she hit rock bottom was the day she went searching for an answer.
"I look back to the one day I went out to see my mom and little sister. And I just broke down and started crying. I said I don't even want to go on anymore. I don't feel good. I don't do anything. I'm always on medication that's not helping. I don't even have any will to go on. I'm not even 50 yet. I don't want to live 30 or 40 more years spending my life in the bathroom every hour, she said to herself.
Kathleen Fox had been keeping a secret many women have nightmares about. She suffered from an embarrasing, debilitating condition called Stress Urinary Incontinence. Her body was unable to prevent accidental leakage when pressure was exerted on the abdomen. She would leak when she laughed, when she coughed, when she exercised. The inability to control herself kept her from living the life she once had and preoccupied her thought with locating the bathroom wherever she went.
The condition led to depression and eventually to sharing her story with you. Imagine the courage it takes to put a face on something so personal. But, Kathleen has worked 32 years in the healthcare profession. She currently is the administrator for the Center for Health Promotion at St. Charles Mercy Hospital. She knows how modern medicine can change lives from both a professional viewpoint and from a personal one. She hopes her story will move other women to seek help. It is estimated that by middle age, more than one-third of all women experience leakage at least weekly. Pregnancy, childbirth, menopause, strenuous exercise and gynecological surgery are all factors that can contribute to Stress Urinary Incontinence.
Kathleen had suffered bladder infections for years which led her to bladder suspension 12 years ago. While the surgery was successful at first,the infections continued and Kathleen spent years on antibiotics. The medicine and the condition left her tired all the time. Some nights she would wake up 5 or 6 times to use the bathroom. She would watch her productivity at work slip. She was beset with a number of embarrasing irritants. Eventually, she didn't want to go anywhere or do anything. Finally, when she hit rock bottom, she started talking about her problem. A family member recommend she see Dr. Andrew Croak who was having success with a non-surgical procedure called urethral bulking implant surgery.
Dr. Croak uses the Tegress Urethral Implant, a synthetic material that is injected into the urethral tissues and restores its integrity. The procedure is gentle, non-invasive, does not require an allergy skin test and is more durable than a commonly used natural collagen that also works, but degrades over time.
Dr. Croak said the implant can take up to 2 months to take effect, but for Kathleen the relief was immediate. She had the procedure in December. It took about 30 minutes and she went home the same day. Today, she has not had an infection and she has resumed her simple life. She gose to her gradson's ball games, dances occasionally, travels more and has decided to share her story with you.
Many women, like Kathleen once did, suffer in silence. They try Kegel exercises, wear pads or rearrange their lives around immediate access to a bathroom rather than undergo bladder suspension surgery. Kathleen knows what these women are experiencing. She hopes by telling her story they will find the courage to talk about this problem with their doctor. That, they won't wait until depression robs from them what it robbed from her - a simple life she dreamt about.
By John Szozda
Maumee Mirror - January 3, 2008
First Robotic Surgeries are Performed at St. Luke's Hospital
Following his father's legacy of utilizing the newest technology in surgery, gynecologist Dr. Andrew Croak completed the first two robotic surgeries at St. Luke's Hospital on December 21.
With the help of St. Luke's new da Vinci S HD Surgical System, he removed one women's ovaries and removed scar tissue from another woman with endometriosis.
As Dr. Croak made St. Luke's history, his father Dr. James Croak observed.
Dr. James Croak made his own history at St. Luke's in 1973 when he used laparoscopy for the first time and then again in 1980 when he used video laser laparoscopy for the first time.
"This is a fantastic surgical advance for women of our community who need to have gynecological surgery," Dr. James Croak said. "I've always believed that it's important for surgeons to use technology to move medicine forward. I'm proud that my son holds that value as well."
Dr. Andrew Croak described the da Vinci as the next generation of laparoscopic surgery.
Robotic-assisted surgery allows the surgeon to complete complex procedures through smaller incisions, instead of making a large incision in the body.
"Traditional laparoscopy limits the surgeon," Dr. Andrew Croak said. "The da Vinci allows my hand movements to be translated into tiny, precise movements of micro instruments inside the body."
Robotic surgery systems have special instruments, such as scissors and needle holders, which are attached to robotic arms. These arms even have "wrists" that copy the movement of the real arm.
The surgeon can operate these arms from a remote area that includes a computer and video monitor.
The system makes it easier for doctors to complete delicate procedures with greater precision and dexterity.
"This all leads to better patient outcomes. There is less pain after surgery and faster recover," said Dr. Andrew Croak.
In late October, St. Luke's became one of three hospitals in the Toledo area and about 700 centers in the world to offer this type of surgical option.
At first, St. Luke's Hospital will use its da Vinci system for gynecology procedures, such as hysterectomies, and urology procedures, such as prostatectomies.
Toledo Blade, February 3, 2008
Robotic surgery making gains at local hospitals. Recovery often is speedier
Dr. Andrew Croak, a urogynecologist, works with the da Vinci robotic surgical system at St. Luke's Hospital. Such systems are in place at three other hospitals in the area. ( THE BLADE/DAVE ZAPOTOSKY )
In the early 1970s, Dr. James Croak was one of the first Toledo-area doctors to perform laparoscopic surgery, using small incisions and a telescopic system that has become routine for many operations.
Now his son, Dr. Andrew Croak, is among local doctors taking laparoscopy to the next level, controlling robotic arms that hold cameras and surgical instruments from a console near the operating table.
Led by St. Vincent Mercy Medical Center, where robotic surgeries have been performed for nearly five years, four Toledo-area hospitals now have da Vinci Surgical Systems - which cost roughly $1.5 million each - from Intuitive Surgical Inc.
University of Toledo Medical Center and St. Luke's Hospital doctors last year started using their robotic systems, which allow surgeons to make small incisions that decrease blood loss, pain, chance for infection, and recovery times. Toledo Hospital introduced its da Vinci system last month.
Tracy Hammond of Cygnet, a patient of Maumee urogynecologist Dr. Andrew Croak, had outpatient robotic surgery to have her painful ovaries and tubes removed at St. Luke's on Dec. 21. She took her last prescription for pain two days later, enjoyed the holidays, and returned to work in a week, she said.
"I didn't have any trouble at all," said Mrs. Hammond, 38. "I feel good now, as far as the surgery goes. I don't even realize I had surgery, except for the little scars."
Locally, urologic surgeries - such as prostate removal - are the most common done with robotic systems. But gynecologists, vascular surgeons, cardiothoracic surgeons, and others also are performing robotic operations.
Dr. Bernardo Martinez, who long has performed robotic surgeries at St. Vincent, is the only doctor nationwide who has received Food and Drug Administration approval to repair abdominal aortic aneurysms robotically. More than 200,000 of the bulging abdominal arteries are diagnosed nationwide every year; they often are fatal if the vessel bursts.
A good surgical candidate has not been found yet for Dr. Martinez's pilot research study, said Cathy Wiegand, manager of the Laparoscopy, Simulation & Robotics Training Center at St. Vincent.
Not everyone is a good candidate for robotic surgery. Patients cannot have a lot of abdominal scarring, for example, or be too overweight.
Toledoan Gary Masters had his prostate removed Jan. 8 at Toledo Hospital by Dr. Emmett Boyle, a urologist who started using robotic surgery at St. Vincent in 2003. Mr. Masters, a 56-year-old diagnosed with both colon and prostate cancer within six days last summer, said he spent less than 24 hours in the hospital instead of days and had a catheter for a week instead of at least two.
"I felt good even before the catheter came out," said Mr. Masters, who previously had a cancerous polyp successfully removed from his colon. He added: "I've come out of this with no problems."
Eventually, robotic systems will be used more widely in telesurgeries on patients in remote areas, including battlefields, Ms. Wiegand of St. Vincent said.
Robotic surgeries performed through incisions in natural orifices, such as mouths and rectums, also are in the future, said Dr. Jeffrey Gold, dean of UT's college of medicine, which includes the former Medical College of Ohio.
"To me, it's definitely a matter of time before the robots can be designed with a flexible arm," said Dr. Gold, who also is UT's executive vice president and provost for health affairs.
Other minimally invasive surgery techniques are being studied. High-intensity focused ultrasound proved too powerful to treat kidney stones, for example, but it may be used to destroy tumors in kidneys and prostates, said Dr. Boyle, Toledo Hospital's director of minimally invasive surgery.
Meanwhile, robotic surgery may not be an option for all types of surgeries, such as the removal of large tumors to be analyzed by pathologists, some doctors and experts said.
For doctors, robotic surgery has many advantages over laparoscopic surgery, they said. While images used to guide surgeries during laparoscopic procedures are two-dimensional and instruments are rigid - which Dr. Boyle described as being like using chopsticks - doctors get three-dimensional views with robotic systems and instruments that move more freely as they would if wielded by hands.
There is a learning curve for surgeons, who have been trained to use their hands to guide them while operating, said Dr. David Franzblau, chief medical officer for Mercy Health Partners.
Robotic systems, meanwhile, eliminate tremors and fatigue that can be experienced during surgery, said Dr. Andrew Croak, who operates at St. Luke's.
"It's going to expand," said Dr. James Croak, a retired Maumee gynecologist who watched his son perform some robotic surgeries at St. Luke's. He added: "We've seen it come from very crude instruments to very sophisticated surgical robotic tools."
Toledo Blade, December 22, 2008
Hold on tight, Spring will be spectacular
IT WAS still summer - just barely - when this journey began for the two of us, my wife and I. On the other side of the expansive glass windows the forested hills in the distance were blanketed in a vibrant green. On our side of the glass, the toxins dripped into her arm and we both prayed for deliverance from a disease we have come to hate.
Slowly, with each visit and each new infusion of chemicals, we watched as summer relinquished its hold on the trees, and the staggeringly beautiful colors of autumn lit up the hillside - reds over here, yellows and browns over there, the evergreens holding firm. Never had fall looked so lovely.
Now it is winter. The crimsons and golds have disappeared, and the blanket on the other side of the glass is the brilliant, eye-searing white of a fresh snow glistening in the sunlight. It is finally time for my wife's final chemotherapy session, an unwelcome but necessary Christmas present. When the IV is pulled, there will be no more twice-monthly trips to Ann Arbor and the University of Michigan Hospitals' cancer center. We will miss the people, all of them, but we do not care to go back.
I remember a book from the early 1980s called When Bad Things Happen to Good People. It seems to me now that it must have been written with people like my wife in mind.
Ten years ago, she was diagnosed with ovarian cancer, a silent and cruel killer with a scary prognosis unless caught early. Fortunately, hers was, thanks to a caring and dedicated family physician in Waterville named Mark Bruss, who noticed something wasn't right and sent her to one of the best ob-gyn surgeons anywhere, Dr. James Croak.
I instantly remembered Jim, now retired, as a long-ago high school classmate and baseball teammate at Oregon Clay. After my wife's surgery and recovery, Dr. Croak called her one of his "angels," patients who made it through initial treatment and then survived the agonizing wait of several years to be declared cancer-free.
This time it is breast cancer. Since her diagnosis it has been another roller-coaster ride of emotions - anger and frustration that it was necessary to go through this again, and certainly euphoria for any piece of good news. Self-pity, however, is not part of her makeup. From day one, I've envied her ability to remain so positive and upbeat when it is I who should be lifting her spirits.
Before starting chemo, we met our daughter and son, their spouses, and our five grandchildren at Disney World for a little escape from reality. My wife even designed matching T-shirts for all 11 of us bearing the name she's given our year of living dangerously. She called it the "Hold on Tight Tour, 2008."
Ultimately, after chemo did what chemo does, she lost her hair and, for a time, her appetite. But never her sense of humor. Whenever anyone mentions that her "hair" looks nice, she reminds them that it isn't a wig. It is, she said - picking up on that techno-jargon that only health insurers could conceive and love - a "cranial prosthesis." Of course, they didn't love it enough to pay for it.
A faint circle of hair remains. Wigless, she describes herself as a hard-boiled egg with a halo. It's okay to laugh at the image, and in fact, hard not to.
Every other Tuesday since mid-September, we have made the drive to Ann Arbor for two to three hours of a slow IV drip. At each session, arrayed on either side of my wife in a semi-circle of "infusion chairs" in front of those big windows, were another two dozen or so cancer patients - some women, some men - fighting their own battles and facing their own fears. They were an inspiration then, and they still are. Attitude counts for so much in this struggle. As Henry Ford once said, "whether you think you can or whether you think you can't, you're right."
We came to know the road to Ann Arbor very well. Twenty-four hours after each infusion, we had to make the same trip north again, this time for an injection of white-blood cells. For reasons neither we nor the folks at the hospital could understand, insurance would only pay for the injections if administered at the hospital. If self-administered at home, which was her UM physicians' original plan, it would have meant thousands of dollars out of our pocket over the course of four months of chemo.
So we burned the gas each time and drove back. Maybe Barack Obama can figure it out. I can't. What in the world do people without health insurance do when their lives are threatened by this insidious disease? It's a question I've asked myself many times, though I know the answer.
Now that chemo is ending, radiation is next, and then we start the clock again and wait, optimistic that we'll get another all-clear down the road. The lumpectomy, the PET scans, the slow drip of life-saving chemicals, the injections - all that is behind her, and she can rejoice in the birth just six days ago of our newest grandchild, Titus Justin Walton.
When I was growing up, my mother used to tell me that women were stronger than men. I was a naive kid who wondered how that could be. I could lift more weight than she could. Now I understand, and I realize that strength comes in many forms.
My father was the strongest man I ever knew because he fought in World War II and survived horrors his children could never imagine. But my mother gave birth to four sons and raised them virtually alone because Dad's job as a chief engineer on Great Lakes ships took him away from us most of the time. That's strength.
And so it is with Dianne. Her fight - our fight - is not over, but we are encouraged and hopeful. While we wait for this storm to pass, we'll keep dancing in the rain, and we will celebrate every change of season.
Next up after winter retreats: spring. April showers bring May flowers. Daffodils and tulips first. Then the purple clematis and finally the roses. We can see the colors now in our mind's eye, and we can't wait. It will be spectacular.
Thomas Walton is retired Editor and Vice President of The Blade. Contact him at: twalton@theblade.com.
St. Luke’s Hospital Care Magazine
Winter 2009
IT'S NOT YOUR MOTHER'S HYSTERECTOMY
The decision to have a hysterectomy isn’t easy – especially if you’ve helped your mother through a sometimes painful two-month recovery.But advances in robotic – assisted surgery can mean less pain and a speedier return to normal life for women who need this operation.
“Fortunately, I had enough time to do a lot of reading about the different options for hysterectomies,” says Britt Smith, age 37, a working mom of three teenage boys.
As she did her research, it was important to Britt to find an option that provided as short a recovery time as possible.
“My husband and I both work full time.And, our family leads a very busy, active life.The boys are definitely not used to Mom mot feeling well or not being able to get around,” Britt explains.“Robotic – assisted surgery seemed like a good option for me.My physician, Jonathan Detrick, MD, said I was a candidate for it.”
TINY INCISIONS, BIG BENEFITS
Britt had her robotic – assisted hysterectomy at St. Luke’s Hospital, where the Surgery Department has a state-of-the-art da Vinci S HD Surgical System.
Her surgeon, Dr. Detrick, is the Section Head for Gynecology at St. Luke’s.He says, “A robotic – assisted hysterectomy involves making very small incisions on the abdomen.A laparoscope is inserted through one incision to guide the surgeon. Instruments inserted into the other incisions are used to perform surgical tasks.”
Smaller incisions can result in less pain and blood loss, shorter hospital stays, fewer wound infections, and quicker recovery than with an abdominal hysterectomy.While it may take one to two months to return to normal activity with an abdominal hysterectomy, many women are able to recover in one to two weeks with a robotic – assisted hysterectomy.
QUICKER RECOVERY TIME
A shorter recovery time was also important to Christine Barnocki, age 50.An occupational therapy assistant, Christine was concerned about lifting restrictions.After her robotic – assisted hysterectomy, she was able to go back to work in three weeks and was released from her lifting restrictions after four weeks.
“When my doctor, Andrew Croak, DO, offered robotic surgery as an option, I really liked the idea of it being less invasive,” Christine explains.In fact, five days after her surgery she could attend her father’s 80th birthday party, and four weeks after surgery she was playing tennis again.
“The incisions themselves are very tiny,” Christine says. She has one above each hip bone, one right below her belly button and hip bone, and one on her right side about 2 inches above her hip bone. “I joke with my husband that I got my belly button pierced for my 50th birthday!”
“In addition to hysterectomies, the da Vinci can be used for other gynecological procedures, such a removing fallopian tubes and ovaries,” offers Dr. Croak, Christine’s surgeon and a urogynecologist who uses the da Vinci system for surgical procedures at St. Luke’s.
Dr. continues, “Before performing robotic surgery, surgeons must be specially trained.Patients must also be properly selected.Not everyone may be candidate for this type of surgery.
