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Surgery Without a Knife

Dr. James Richardson Turville Bay Radiation Oncology Madison Wisconsin

It’s called stereotactic radiosurgery (SRS) but it’s not surgery in the traditional sense. There's no incision. One of the tools in our arsenal at Turville Bay is a non-surgical radiation therapy used to treat abnormalities and tumors of the brain. This surgery is far less invasive than neurosurgery which requires incisions to skin, skull and membranes surrounding the brain tissue itself. For the patient, SRS nearly eliminates surgical recovery time.

It begins with an incredible piece of technology, a linear accelerator called TrueBeam. Our team of radiation oncologists use our TrueBeam LINAC to deliver radiation therapy every day to patients from south-central Wisconsin.

But with stereotactic radiosurgery, Dr. Michelle Mackay teams with a neurosurgeon and a team of others using 3D imaging to target high doses of precisely-targeted radiation. The equipment is specialized, focusing many small beams of radiation on the tumor or other target. Each beam has very little effect on the tissue it passes through, but when all the beams intersect a powerful dose is delivered cutting off blood flow to the tumor and disrupting the DNA of tumor cells so they can no longer replicate. There are few side-effects usually limited to a headache. We recommend resting after the procedure.

Weeks of preparation and calculations go into preparing for the radiosurgery at Turville Bay. But to the patient the process is incredibly fast and life altering. In a single outpatient treatment appointment, the tumor begins to shrink rapidly. SRS is used to treat noncancerous (benign) and cancerous (malignant) brain tumors, including meningioma, paraganglioma, hemangioblastoma and craniopharyngioma. It may also be used to treat cancers that have spread to the brain from other parts of the body (brain metastases).

The success of Turville Bay’s stereotactic radiosurgery program is notable. An additional TrueBeam LINAC is currently being added at Turville Bay and will be in use by summer.

Beyond Radiation Therapy

Dr Michelle Mackay Turville Bay

Caring for a patient’s health sometimes means treatment beyond the radiation therapy that about three quarters of cancer patients receive. As a radiation oncologist I am often called upon to help patients in other ways through a cancer diagnosis and treatment. Like palliative care, given throughout a patient’s treatment, to improve a patient’s quality of life. A recent post to Turville Bay’s Facebook page was written by a woman with metastatic cancer. She is one of the millions of Americans living with chronic cancer. Frustrated by the interchangeable use of the terms hospice and palliative care, Sarah Debord is on a mission to stop “medical illiteracy.” What are these two very different kinds of care and when are they used?

Hospice care is given most often in the last 6 months of life. It may be given in a hospital setting, in a specialized facility, or it can be received at home by a visiting nurse, as our SSM Health at Home colleagues offer.  End of life is a part of life and hospice care helps patients and their family’s transition through it.

Palliative care, however, can be offered at the time of diagnosis or anytime thereafter in a patient’s cancer journey. Palliative care focuses on treating symptoms of the cancer and sets the goal of improving quality of life. Since it is also designed to reduce stress and worry, palliative care may include pastoral care. It can be financial counseling for those struggling with the cost of treatment and childcare. It might include nutritional care. Here at Turville Bay it is a type of radiation therapy used to treat metastatic cancer, to reduce pain, control symptoms, and to provide patients with better quality of life. Sarah says, “It won't change the outcome of their disease, but it will improve the completeness of care they receive along the way.” Think of palliative care as the support we need when a cancer diagnosis may not be curable, but manageable.

We advocate for palliative care at the appropriate times and we deliver a form of it here in our center.  It treats the patient as a whole, with appropriate goals given the disease state, and can significantly improve quality of life.

A Vaccine That Prevents Cancer? Opt In.

Cancers related to HPV, or human papilloma virus, are on the rise in the United States with about 32,000 new cases diagnosed in 2017. Closer to home, we’re seeing more cancers related to HPV in our clinic here in Madison, WI, particularly cancers of the head, neck and throat. These cancers are affecting a younger population aged 25-50.

The virus that causes at least 6 cancers is so prevalent the Center for Disease Control estimates 1 in 4 men and women in the US are currently infected with it. HPV is transmitted by intimate skin to skin contact and, in most cases, goes away on its own with infected cells returning to normal before causing health problems. But in some cases, the body does not clear the infection and eventually cancer of the mouth, throat, cervix and others can occur. We know that HPV causes cancer, but there’s a lot we do not know, and so research continues. Complicating the issue is this: only one of these cancers is routinely screened for, cervical cancer in women. 

There’s a solution to this problem. It begins with a remarkably effective vaccine that actually blocks the virus and prevents cancer. "This vaccine is the best way to protect our youth from developing cancers caused by HPV infection," says CDC Director Robert Redfield. 

We know the vaccine exists, it has for years. Though proven safe we have failed to protect our population. The CDC said that last year nearly 66 percent of adolescents aged 13-17 received the first dose in the vaccine series, and nearly 49 percent of adolescents received all the recommended doses to complete the series. We’re falling dramatically short of Wisconsin’s goal to vaccinate 80% of all boys and girls by the age of 13 with just 35-37% of all kids vaccinated. That’s not enough to protect the next generation from the 6 types of cancer we know are HPV-related.

Here’s how we prevent 6 cancers-

  1. Vaccinate everyone by the age of 13. In fact, evidence now shows there is some benefit to vaccinating adults (link to https://www.medpagetoday.com/obgyn/cervicalcancer/75551 ) until age 45.
  2. Pediatricians strongly recommend the vaccine for children, and parents need to opt in to prevent cancer.
  3. Our public healthcare policies should step up outreach like the innovative project on the UW campus encouraging students getting their flu shot to immunize against HPV and prevent cancer.
  4. Develop a system to screen for HPV-related cancers. Currently the best screening for oral cancer comes from your dentist. Ask for a screening every year. But there are other cancers related to HPV infection and we need to screen for them as well.

On a personal level, take control of your health.

  • Know the benefits of using condoms correctly and consistently. 
  • Reduce the number of sexual partners, it lowers risk of infection. 
  • Understand the role oral sex plays in the spread of HPV.
  • And as with all cancer prevention, taking good care of your personal health can make a difference.

The Patient at the Center

In the flurry of a cancer diagnosis, the symptoms suddenly explained, the lessons in patience, managing fears, and sharing the diagnosis with family and friends, it’s understandable when the patient succumbs to exhaustion both emotional and physical. So much to learn, so many appointments. A cancer diagnosis is daunting.  There is one constant at Turville Bay Radiation Oncology Center. It’s a pole star that every physician and nurse, every staffer from therapists to medical physicist lives for: the patient at the center. We put the patient right here, in the center of everything we do. Every discussion we have and each decision we make with a patient takes time as we help them find acceptance and the will to step forward again and again. The patient’s radiation oncologist, their oncology nurse and radiation therapist work in tandem to lift up that patient and as we work to heal, we work to make them whole again.

Patient centered care is more than a slogan. It is the desire, the mission, to lead and at times coax the patient through a journey that would test anyone. Not surprisingly, it is a remarkable experience for our healthcare teams as we plumb each patient’s strength in an effort to help them. We have technologies, therapies, protocols, and a deep well of knowledge in applying it. We’ve found that the outcomes are best when the patient is at the center of the diagnosis and remains there right through recovery.

HPV and Women’s Cancers

Dr. James Richardson Turville Bay Radiation Oncology Madison Wisconsin

Almost all cervical cancer cases are caused by HPV, which is a family of very common viruses. “HPV is very prevalent amongst the population,” says Dr. Richardson, radiation oncologist. Most women will be exposed to HPV through sexual contact at some point in her life. Fortunately, the vast majority of women infected with HPV will never get an HPV-associated cancer because the body’s immune system keeps the infection in a dormant and benign state. But in some cases, the HPV infection causes changes in the body’s cells. If these abnormal cells are not identified and treated, they may become cancer. Because of this and because HPV doesn’t cause any symptoms, cervical cancer screenings are very important. Click here for screening guidelines from the American Cancer Society for cervical and other women’s cancers.

The most common cancer-causing types of the HPV are HPV-16 and HPV-18. These two strains alone cause about 70% of all cervical cancer. The good news is a vaccine now exists that protects against these two HPV strains. According to Dr. Richardson, “The vaccine has been very effective in eliminating the risk of cervical cancer.” But for the vaccine to work, it must be administered to girls or boys before they are exposed to the virus, so before any sexual contact. Dr. Mackay, radiation oncologist, adds, “It’s a huge step in modernized medicine that we have a vaccine that’s targeted against virus strains that cause cancer. Getting this vaccination before exposure occurs, can help that person decades down the line.”

In addition to cervical cancer, HPV can lead to other less common women’s cancers, including vaginal, vulva and anal cancers. “Because HPV doesn’t necessarily cause symptoms, it’s very important to be conscious of your health and be aware of any changes. If you have symptoms that last longer than 2-3 weeks, then it’s time to see your primary care physician for an evaluation,” says Dr. Richardson.

Women and Cancer

Many cancers affect women, but there are eight that we address in this risk factor graphic. While most people recover from cancer with treatment, others do not. It’s important to remember that some cancers may be preventable. We’ve known for decades the tobacco causes lung cancer. Now we know that about half of all smokers will lose their life to a lung related disease including lung cancer. We also know there is a small but serious family history for some lung cancers. The risks for women are especially cruel: estrogen adds to the our risk, secondhand smoke is a risk factor, as is radon exposure in the home. Knowing your risk factors and taking action could save your life.

Of rising concern is a group of viruses known as HPV, cancer causing strains that are sexually transmitted. It is so widely occurring that it’s quite common in our population. HPV strains 16 and 18 cause 70% of all cervical cancers and other high-risk HPV viruses include 31, 33, 45, 52, 58 and a few others. The good news is that most women’s bodies clear the virus often without knowing they were infected, sparing them from cervical cancer. Further, cervical cancer is highly treatable when caught early. But cervical cancer causes almost no symptoms, the cells silently replicating until the cancer is terribly serious. A group of 3 vaccines are changing the dynamic of this disease. I recommend them.

These are just two of eight cancers we as women are at risk of in our lifetime. We know that we can reduce that risk by understanding them. And by advocating for ourselves and our health we take back a little of the control that’s lost to this difficult disease.

When Your Body Sends a Message

“Turville Bay’s patient centered care is central to my life as a physician and as a radiation oncologist. But in order to receive a diagnosis, to enter our doors, to begin treatment, cancer care begins with screening,” says Dr. June Kim. In our busy lives, she says, we often don’t listen to our body as it signals a change. Dr. Kim advocates for her patients at Turville Bay. The state-of-the-art technology and the compassion of a well-educated and well-trained staff allows her to care for her patients. But first, patients can help themselves by having a conversation with their doctor about concerns or changes in their health. And, keeping up with recommended screenings for breast cancer, colon cancer, prostate cancer and now lung cancer, can identify issues before symptoms begin.

What advice does Dr. Kim offer? “Advocate for yourself. See your doctor each year and get recommended screenings. Take care of yourself by eating sensibly and getting plenty of exercise. Rest your body and your mind. Tune in. Pay attention to changes in your body and ask your physician when something concerns you.”

Is it common for patients to put off screening? “It’s a very human trait, to procrastinate. But with cancer, early detection is best.” And, Dr. Kim offered a unique perspective. “One patient said recently that she was grateful for her diagnosis, that she wouldn’t be here if she hadn’t been diagnosed.” Finding her cancer had shocked the patient but subsequent treatment gave her a future. “It takes courage,” she adds, “to face a potential cancer diagnosis. But that’s when the caring begins, and the road to recovery.”

The Honor of Caring for Cancer Patients

Dr. Kim and TomoTherapy machine

Many patients that hear the words “you have cancer”enter our doors at Turville Bay Radiation Oncology Center. They are often apprehensive, overwhelmed, and sometimes fearful initially. During our first consultation we begin to address those emotions with patient centered care. At Turville Bay, my colleagues and I believe that medical skills and technology are best delivered with emotional support, physical support, and the involvement of family and friends when possible. Radiation therapy requires state of the art technology combined with a highly trained team of people. Our consultations allow plenty of time for patients to talk, absorb new information, and ask questions. Patients accustomed to a more passive role in their healthcare are often surprised by our conversations. As we sort through information together, we build relationships between patients and staff. Why this emphasis on relationships? We believe it’s best for the patient, and we’re not alone.

Research shows that the quality of personal, professional, and organizational relationships matters in healthcare and never more than when serious illness arises. Patients that are active participants in their care do better. If we are mindful, empathetic and informative with a patient we find solidarity and a healthy collaboration begins. It promotes communication about things that matter and in turn lifts the fog of apprehension. And feeling understood may contribute to better self-care during treatment. Together we strive to improve their health through treatment and into recovery.

Helping Us Help You

Dr. James Richardson

When it comes to caring for patients at one of the most vulnerable times of their life, our care extends to a carefully forged relationship. It begins when the patient is referred to us and continues through treatment and sometimes beyond.

How do we build a strong relationship so quickly? We begin immediately, working together as a team to give the patient the best experience possible. From the simple things like a warm greeting every day, to the more complex like the time needed with doctors and oncology nurses to discuss every question that patient has. In candor we share knowledge with each other. As the patient opens up with us we help the patient find clarity regarding their diagnosis and their treatment while in our care. Each step of the way our patient relationship strengthens as our team gains understanding of each patient’s needs, fears, and challenges. Every person on our team from our schedulers to our therapists, doctors, and nurses is trained to work with those that are suffering and deliver comfort.

Through these relationships, the patient gains trust in their healthcare team. They trust us to answer questions faithfully, and honestly. To guide them through treatment as it affects them, their family, and caregivers. Delivering this patient centered care is a core belief at Turville Bay: every patient deserves to be treated with respect and with the best care we can deliver.

Turville Bay’s Mission? It’s All About the Patient.

Barb Thiermann

Treating cancer and other serious illness at Turville Bay has strengthened the value of the patient centered care we offer here. We created a space that comforts and supports patients throughout their treatment. When our center was founded in 1986 its mission was to provide the community with the finest technology and care, keeping pace with innovation. Madison’s healthcare community built this center on the premise that great care flows from those that put the patient first. Since then, important research conducted by the Harvard Medical School with recently discharged patients, their family members, physicians, and non-physician staff confirmed its relevance. But we knew this. In the 23 years I’ve been with Turville Bay we’ve used certain care principles because the patient has a better experience.

Building the center on the shores of Lake Monona provided its non-institutional ambiance. Huge windows flood the waiting areas with light. And patients enjoy soothing views of the water. It’s good for staff, too. We tend a healing garden just outside our doors and patients often sit there before treatment enjoying its serenity. There are puzzles and coloring books to occupy thoughts, and knowing the staff is always at hand is comforting. You’ll find our spaces are rather quiet, with a soft hum of activity as patients come and go each day after spending time with our therapists, nurses and doctors.

The values of respect and dignity are at the core of what we do. Sensitivity to each patient’s culture and situation is important. Emotional support is key. We deliver it through our people and through our facility. Our approach to patient centered care has never wavered, and it is at the heart of our decision making. Technology decisions, the healing garden, patient waiting area all were planned with patient care in mind. It’s our mission. The patient comes first.

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