Preventing Frostbite and Hypothermia

With the recent snow that blew through and the temperatures that are going to stay low over the next few days, many of us are still digging out our cars or way out of our driveways. Anyone can end up with frostbite or hypothermia, it’s important to know the risks of frostbite and hypothermia, especially for those that are at higher risk and are more susceptible to extremely cold weather. Some groups that be at higher risk include:

  • Very young children and our older senior population
  • Diabetic patients and other with conditions leading to poor circulation
  • Patients with heart conditions or those who take beta blockers

Don’t Ignore Shivering!

When you’re exposed to cold temperatures your body begins to lose heat faster than it can be produced. Prolonged exposure to cold will use up your body’s energy, resulting in hypothermia. Some warning signs of hypothermia include:

  • Shivering
  • Exhaustion
  • Confusion
  • Trembling hands
  • Memory loss
  • Slurred Speech
  • Drowsiness

If you notice any of these signs, please seek immediate medical attention.

Frostbite is literally the freezing of body tissue; fingers, toes, ears and nose are the most vulnerable. Frostbite is caused by prolonged exposure to cold temperatures, or shorter exposure to extremely cold temperatures. The warning signs of frostbite are:

  • Red or pale skin
  • Prickling
  • numbness

Frostbite and hypothermia can be prevented; here are some tips to help keep you safe:

  • Limit the time you’re outside in cold, wet or windy weather
  • Stay well hydrated
  • Dress in several layers of loose, warm clothing
  • Wear a hat or headband that fully covers your ears
  • Wear mittens rather than gloves
  • Wear socks and liners that fit well and wick moisture
  • Keep moving




New Hope for Inoperable Aortic Stenosis: Transcatheter Aortic Valve Replacement (TAVR)

Reposted with permission; originally posted in the 2015 spring edition of Cardiac Advantage

Traditional treatment for severe aortic stenosis – a narrowing of the valve that allows blood to flow from the heart to the body- has been to open the chest, remove the fault valve and replace it with a new one.

Many patients are too sick or too frail to tolerate open-heart surgery. “For a long time, we had little to offer patients with severe aortic stenosis if they were unable to undergo open heart surgery because of their age and/or the severity of their medical condition,” said cardiothoracic surgeon Andrew Pruitt, MD, at St. Joseph Mercy Ann Arbor. “Now there is new hope. In August 2012, we began performing an exciting new procedure, transcatheter aortic valve replacement (TAVR), that is holding great promise for patients who formerly had no options.”

Some people with aortic stenosis have no symptoms at all, but for most patients symptoms include: shortness of breath, fatigue, difficulty exercising or performing other strenuous tasks, chest pain, lightheadedness or fainting.

“In its earlier stages, aortic stenosis can be treated with medication, but in more advanced form traditional surgery, and now, TAVR are the only options.”

How does TAVR work? The surgeon makes an incision in the groin (transfermorally) or through a space in the rib cage (transpically) and threads a catheter into the blood vessel to reach the aortic valve. A balloon on the end of the catheter is inflated forcing open the stiff leaflets of the damaged aortic valve. This leaves room to replace the original catheter with a second one. The second catheter not only has a balloon on the end, but also a compressed replacement valve. The replacement valve is made of cow heart tissue that is sewn onto an expandable stainless steel stent. The new valve is placed on the center of the disease valve and then expanded into proper position with the aid of the balloon. Physicians can choose replacement valves to fit a wide range of patient sizes.

A key advantage is that the procedure is performed on a beating heart and the patient does not have to put on a cardiopulmonary bypass machine, so it is far less stressful for the body. The transfemoral approach usually requires about three hours to complete; the transapical about 30 minutes less.

Developed in 2000 by a French cardiologist, TAVR was approved for use in the United States in 2011, slightly ahead of schedule when clinical trials proved remarkably successful.

However, TAVR is still relatively new and not without risk. “Currently, this approach is limited to patients who must meet very specific criteria,” said Dr. Pruitt. “TAVR brings with it its own set of side effects and has as slightly higher rate of certain complications than traditional, open-heart surgery. The FDA has only approved its use for patients with severe, symptomatic aortic stenosis who are felt to be inoperable, or at very high risk for traditional surgery by two independent cardiac surgeons.”

In addition, potential candidates must undergo a series of test to determine if they meet the physical and medical parameters to accept the device safely. “We very carefully have to weigh risks versus benefits, and for those patients who cannot tolerate open-heart surgery, TAVR can be a life saver,” said Dr. Pruitt. “TAVR not only extends patients’ lives, it can significantly improve their quality of life.”

Cardiologists and cardiac surgeons at St. Joe underwent intensive training to learn this new surgical procedure. Based on the high volume of surgeries conducted here, the expertise of our physicians and staff, and the collaborative multidisciplinary heart team that evaluates all potential cases, patients who qualify for TAVR can feel confident in the skill level and experience of their heart team.

“The message to prospective patients and their referring physicians is this: Don’t give up hope. Even for the frailest patients with extremely advanced conditions, we can offer solutions and relief,” said Dr. Pruitt. “In cases where TAVR is an option, it literally can mean the difference between life and death.”

IHA Concludes 2014 by Welcoming Community Orthopedic Surgery, P.C. & Huron Valley Hand Surgery

News Release
December 23, 2014
For Immediate Release
For more information, contact:
Amy Middleton

IHA Concludes 2014 by Welcoming Community Orthopedic Surgery, P.C. & Huron Valley Hand Surgery

ANN ARBOR, MI – (December 23, 2014) – IHA is pleased to announce its planned integration with Community Orthopedic Surgery, P.C & Huron Valley Hand Surgery, effective December 31, 2014. With offices in the Michigan Orthopedic Center on the St. Joseph Mercy Ann Arbor campus and in Brighton, the practice, comprised of Michael S. Fitzsimmons, MD; Fred M. Hankin, MD; John V. Hogikyan, MD; James L. Telfer, MD; and Mark R. Wilson, MD; has provided compassionate, patient focused care to patients across Southeast Michigan and beyond since 1984.

Dr. Walter “Mac” Whitehouse, Jr., IHA Surgery Department Chair commented that “these are not only nationally-recognized surgeons, but also outstanding individuals whom we are thrilled to welcome to the IHA family as IHA Community Orthopedic Surgery.”

“Ready and efficient exchange of clinical services between primary, specialty, and subspecialty providers is vital to delivering the high-quality, cost-effective care that patients need and expect today,” says Michael S. Fitzsimmons, MD, President of Community Orthopedic Surgery, P.C. & Huron Valley Hand Surgery. “Joining the IHA team enables us to achieve this by integrating our expansive range of orthopedic services with a high-quality physician group.”

Dr. Whitehouse also adds, “the surgeons provide a broad range of orthopedic capabilities along with sub-specialty expertise which all of us at IHA are now thrilled to have on the same team.”

  • Dr. Fitzsimmons has been active in general orthopedic surgery with particular emphasis on hand and microvascular reconstruction. This has included management of carpel tunnel syndrome, wrist pain, and complex replantation of free flap transfers. He has been involved with resident education at a number of programs. Dr. Fitzsimmons will serve as the Site Medical Director.
  • Dr. Hankin has interests in a variety of hand problems including congenital deformities, cerebral palsy, acute and late tendon injuries, rheumatologic conditions, infections, and hand problems related to quadriplegia.
  • Dr. Hogikyan has been an active provider of care to individuals with a variety of hand afflictions. He has wide ranging experience in management techniques for trauma, compressive neuropathies, nerve and tendon injuries, arthritis and fractures. Common surgeries performed include carpal tunnel release, tendon repair and arthritis surgery.
  • Dr. Telfer is active in general orthopedic surgery with an emphasis on sports medicine. His practice includes surgery of the knee and shoulder as well as primary joint replacement.
  • Dr. Wilson emphasizes hand and microvascular related conditions in his practice. Various types of non-surgical as well as surgical management are utilized in the care of conditions such as arthritis, trauma, nerve compression and wrist pain. Microvascular reconstruction is used for wound problems such as open fractures and osteomyelitis. He treats avascular necrosis of the hip joint at this center with vascularized fibula grafting.

According to Bill Fileti, IHA’s President & CEO, this integration with Community Orthopedic Surgery, P.C. & Huron Valley Hand Surgery represents another major development in a year full of successes and expansion. IHA celebrated its 20th anniversary in February 2014 and opened a new 44,000 square foot medical center at Domino’s Farms Office Park in May 2014. In June, IHA integrated with Michigan Heart and added 47 nationally recognized comprehensive cardiovascular physicians and practitioners. With an active and on-going physician recruitment program, IHA also strengthened its primary care and specialty capabilities with over 50 new physicians and practitioners.

“IHA continues to evolve into one of the largest and best multi-specialty group practices in Michigan,” notes Fileti. “With integrations, such as this upcoming partnership with Community Orthopedic Surgery, P.C. & Huron Valley Hand Surgery, IHA continues our commitment to expanding our capabilities in order to give our patients outstanding quality, easy access and cost effective care.”

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About IHA
IHA is one of the best and largest multi-specialty groups in Michigan. IHA employs more than 1,500 staff members, which includes 425 providers consisting of: physicians, nurse practitioners, physician assistants and midwives across 55 practices in Southeast Michigan. IHA provides high quality medical care and excellent service to more than 355,000 active patients. Recognized as one of Michigan’s top performing medical groups, IHA also ranks in the top quartile for patient satisfaction nationally. Offering extended office hours, Urgent Care, and access to clinical research studies, IHA demonstrates that it cares by bringing safe, high quality, comprehensive and affordable care to its patients. For more information about IHA, visit

About Community Orthopedic Surgery, P.C. & Huron Valley Hand Surgery
Community Orthopedics has been providing high quality, nationally-recognized orthopedic care to patients in Southeast Michigan for over 30 years. With five exceptional surgeons – four specializing in hand and microvascular surgery and one in general orthopedics with an emphasis on sports medicine – Community Orthopedics has consistently delivered efficient, compassionate, patient focused care with an emphasis on teamwork. Community Orthopedics has conveniently located clinics in the Michigan Orthopedic Center on the St. Joseph Mercy campus in Ann Arbor and in the St. Joseph Mercy Brighton building on Grand River in Brighton.

Treatment for Deep Vein Thrombosis

Deep vein thrombosis is the formation of a blood clot, primarily in deep veins of the lower legs or thighs, occurring when the vein is completely or partially blocked slowing or stopping blood flow. Patients can expect signs and symptoms of: pain or tenderness in the leg, swelling of the leg, discoloration, or no symptoms at all.

Blood clots can happen to anyone, at any age, and sometimes go undetected until the clot has dislodged and made its way to the lungs potentially causing a pulmonary embolism, which is the blockage of an artery in the lung. The risk, however, increases with a family history of clotting, or long periods of immobility.

Trellis Peripheral Infusion System is a unique and innovative treatment used to treat deep vein thrombosis (DVT). Before the Trellis procedure, previous techniques such as blood thinning medication were used along with compression stockings as to break up clots. Blood thinners, while effective in decreasing the blood clot and risk of a fatal pulmonary embolism, could lead to post thrombotic syndrome and don’t fully dissolve the clot.

The Trellis procedure, introduced in 2006, has proved to be safer and provided a quicker return to normal blood flow for the patient. Within 24 hours patients can go home and in a period of 1-2 days after the procedure they can return to normal activities.

Known as the clot buster, the Trellis procedure uses an oscillating catheter that is inserted into the problem vein. Two balloons are inflated isolating the clot within the vein. Clot dissolving medicine is infused through the catheter into the space between the balloons and takes 10 minutes of oscillation to dissolve the clot, at the end of the procedure the liquefied clot is aspired out of the catheter.

IHA Vascular & Endovascular Specialists like me, routinely preform this operation. We are all highly trained and board certified in our respective fields. These operations are routinely preformed and if you fit the right criteria the Trellis Procedure is a quick and easy procedure for DVT.

To decrease the risk of DVT, I recommend maintaining an active lifestyle. Also preforming leg exercises and stretching at least two times a day can help lower the risk. Along with exercising, choosing a healthy diet and getting regular check-ups for blood pressure can also help decrease the formation of blood clots.

It is also wise to get up and move around after long periods of immobility. For example, on long plane rides get up from your seat and walk the aisles. Similarly if you sit at a desk all day, get up and take breaks from your desk. The same is true for long car rides as well, pull over and take pit stops to stretch your legs.

If you are experiencing any of the signs or symptoms, or feel that you are at risk for DVT, call your primary care physician to set up an appointment.

Benefits of Nurse-Midwifery

When you find out you’re “expecting” there are so many decisions to make. Will you find out the gender before birth? What names do you like? What items do you have and what items do you need? And, perhaps most importantly, who will deliver the baby? For most women, this means choosing between an obstetrician-gynecologist and a midwife.

There’s no right or wrong answer. Every pregnancy is different, every woman is different and every woman has a different idea about their ideal birth experience and needs to make the decision that’s right for them.

An obstetrician-gynecologist (OBGYN) manages medical complications throughout pregnancy and birth. If you have certain complications that make your pregnancy high-risk, an OBGYN will be equipped to guide you through the pregnancy and delivery, and will be able to perform a cesarean section, if needed. IHA has many trusted OBGYNs in the greater Ann Arbor area.

An OBGYN isn’t your only option, though. A certified nurse midwife (CNM) is a registered nurse who has graduate-level training in midwifery and is certified by the American College of Nurse-Midwives. IHA Nurse Midwives, who have office hours at the new Domino’s Farms building and attend births at St. Joseph Mercy Hospital in Ann Arbor, are trained to handle all aspects of prenatal care, labor and delivery for low-risk pregnancies. CNMs are trained to recognize potential complications during pregnancy and birth, like the need for a cesarean section, for example. In this case, your CNM will consult with the IHA obstetrician that is readily available on the Labor and Delivery unit.

Additionally, CNMs provide care for the well-woman including family planning, contraception, annual exams and problem gynecological visits. CNMs favor a holistic, family-centered approach to pregnancy and birth with a focus on education, support and intervening in the process only when necessary.

While you’re interviewing and considering practitioners, don’t hesitate to ask specific questions about their approach to prenatal care, labor and birth, protocols for complications and anything else that may help you make your decision. The more information you gather, the better you’ll be able to choose the right provider for you and your family.

If you’re interested in learning more about IHA Nurse Midwives, please join us for a midwife-guided tour of the hospital birthing center on October 16, 2014 from 6:00-7:00pm at St. Joseph Mercy- Ann Arbor, 5301 McAuley Drive (the first floor lobby of the birthing center).

What is PEVAR?

PEVAR (Percutaneous Endovascular Aneurysm Repair) is an FDA-approved, minimally invasive procedure for patients with an abdominal aortic aneurysm. An aortic aneurysm is an abnormal enlargement in the wall of the aorta, which is the largest artery in the human body. The aorta supplies oxygen-rich blood from the heart, down through the chest and abdomen area before dividing into the vessels in the legs.

An aneurysm can happen to anyone, at any time, however, your risk increases with age, tobacco use and a family history of heart disease or aneurysms. In general, if you’re an older male, who smokes, has high blood pressure and a family history of hypertension, you’re at a higher risk.

Previously, the only surgical options to fix an abdominal aortic aneurysm were Open Surgical Repair (OPEN) and Endovascular Aneurysm Repair (EVAR). OPEN repair involves an incision in the abdomen directly over the aortic aneurysm, usually from below the breastbone to just below the navel. A long cylinder-like tube called a graft is used to repair the aneurysm. This operation is highly invasive, has a higher short-term and intermediate-term mortality rate, longer hospital stays, longer at-home recovery times, and is not suitable for high-risk patients.

EVAR entails making small incisions in the groin area, above the femoral arteries, uses special endovascular instruments to insert a stent-graft through the femoral artery and into the aneurysm. EVAR is minimally invasive, with lower mortality rates, shorter hospital stays, shorter at-home recovery time, and is safer for high-risk patients.

PEVAR expands upon the minimally invasive concept of EVAR, requiring only small nicks in the skin, meaning there is less blood loss and less pain. It reduces groin complications, hospital time and recovery time, meaning the patient can return to their normal activities much quicker than they could with OPEN or EVAR. It also requires less operating time, making it a more cost effective and less invasive surgical option for patients.

IHA Vascular & Endovascular Specialists are the only certified physicians who can perform the PEVAR procedure at St. Joseph Mercy – Ann Arbor. Personally, I have been performing the surgery for the past year, and it is a routine procedure for me and the other providers here. If you’re a good candidate, PEVAR is a great option that allows the patient very quick recovery time and minimal pain, while still gaining the benefits of a fixed aneurysm.

For more information about PEVAR, please call 734.712.8150.

Travel Preparations and Travel Medicine

When preparing for vacation most people choose to focus on what to pack, their itinerary and what attractions they want to visit. But what about required and recommended vaccinations? Most people are aware of the need for Yellow Fever vaccines if you’re heading to Africa or South America, but do you know what you might need if you’re headed to Boreno or Mexico?

Travel medicine is a growing niche within healthcare. Meeting with a travel medicine provider allows you and your family to receive tailored immunizations and prescriptions based on current health, medical history, travel plans and past immunizations.

We understand the need for personalized consultations prior to your trip. At IHA Midwest Travel Care we have over 20 years of experience preparing people for their travels. During your appointment you can expect:

  • Counseling and written information about the effectiveness and possible side effect of vaccines received
  • Advice about consumption of water and food, and ways to avoid traveler’s diarrhea
  • Recommended preventative medications and packing a medical kit
  • Latest US government health advisories for your travel destination and current listings of US embassies and consulates
  • Tips for air travel and jet lag, and how to handle altitude related illnesses
  • Assessments for travelers with specific needs (pregnant women, young child, elderly, chronically ill)
  • How to locate English speaking physicians

IHA Midwest Travel Care is located in the new IHA Domino’s Farms Medical Center, 4200 Whitehall Drive, Suite 150, Ann Arbor.


Why Choose Breastfeeding?


Breastfeeding, or giving your infant expressed breast milk, is the most natural source of nourishment for your infant. When you choose to breastfeed your baby, you are providing him/her with the best possible infant food, and no product has ever been as time-tested as human milk.

Mother’s milk contains all the nutrients your baby needs and is more easily digested than any other baby food. Breastfeeding provides extra protection to infants against many common childhood infections such as: gastrointestinal, respiratory, ear, urinary tract, and dental caries. Breast milk has also proven to protect against more serious illness such as meningitis, juvenile diabetes, celiac disease, childhood cancer, acute appendicitis, and liver disease. There has even been research to support that breast milk helps to reduce the risk of SIDS (sudden infant death syndrome).

Not only does breastfeeding provide so many priceless benefits to your infant, but it also turns out to the best for a mother’s body as well. The lactation process causes changes in the mother’s body that benefit her directly. Some of these benefits include: helping the uterus get back in shape faster after delivery, changing metabolic rates thereby enabling most mothers to lose pregnancy weight gradually without dieting, protection against breast and ovarian cancer, urinary tract infections, and osteoporosis.

How Do I Prepare to Breastfeed My Infant?

Reading and taking a prenatal/breastfeeding class can be helpful. Many mothers find it most helpful to talk to experienced professionals such as a lactation consultant, nurse practitioner, pediatrician, nurse midwife, or obstetrician. There is no replacement for advice from your family members or friends who have breastfed; they often have many useful tips.

However, because every mother and baby is different, the real experience will come after the baby is born. It will be a learning process for both of you, and patience is key. A supportive team of family, friends, and professionals will be valuable to you. Also, it would be helpful to check with your insurance policy before your baby is born to see if they will help cover the price of a breast pump. Most nursing moms find it beneficial for many reasons to have their own pump. Optimally, you might want a support pillow such as a Boppy, a nursing bra, breastpads, Soothies gel pads, and PureLan cream.

Who Will Help Me With Breastfeeding/Pumping After Delivery?

Your labor and delivery nurse or midwife will likely be the first person to help with breastfeeding and/or pumping after the delivery of your infant. Next, the nursing staff and lactation consultants at the mother-baby unit will be happy to assist you with breastfeeding. Once discharged home, you will have access to help through your pediatric office. IHA has many experienced pediatricians, nurse practitioners, PAs, and lactation consultants who would love to help with this life changing experience. If you have questions or concerns, or would like to schedule an appointment, please call 734.995.2950.

Back to School Physicals and Immunizations

With the kids going back to school soon, now is a great time to get their annual checkup by their physician or health care provider. This visit is also the best time to make sure their immunizations are up-to-date with the current recommendations and school requirements.

Most school-aged children receive several vaccines at their 4, 5, or 6-year-old checkup, and then the next set of vaccination occurs at 11 or 12 years of age. However, each year the physician will assess the child’s status of vaccines to make sure he or she is up-to-date.

Some important vaccine highlights this year include:

The meningitis vaccine: One of the newest recommendations is a second dose of the meningitis vaccine for high school students, usually at the age of 16; the first dose has been routinely given at 11 or 12 years of age. Meningitis is an infection of the lining of the brain and spinal cord that can be more easily transmitted when students are in close contact with each other. The HPV vaccine: This vaccine—which prevents genital warts in boys and girls and cervical cancer in girls—is now approved for boys ages 9 to 26 and has been approved for girls of the same age since 2006. It is a series of three vaccines, and the first dose is usually given at 11 or 12 years of age. Because the vaccine is to prevent a sexually transmitted infection from occurring, it is important that children get this vaccine before they become sexually active.

The tetanus-diptheria booster: Your child’s tetanus boosters should be up to date, especially because the booster contains the vaccine for pertussis, also known as whooping cough. Pertussis has been on the rise in Michigan recently, but the risk of this respiratory illness can be greatly reduced with the vaccine. Although immunizations are an important part of the annual checkup, the visit to the office is also an opportunity for the physician to review the child’s growth, eating habits, school performance, social interactions, and safety. The health care provider will do a complete physical exam and assess the child’s need for any testing. Additionally, he or she will be able to provide recommendations to the parent and child about topics such as healthy eating, exercise, risk reduction, and any other areas of concern that have come up during the visit.

IHA Domino’s Farms Medical Center Now Open!

We’re excited to announce the opening of the brand new IHA Domino’s Farms Medical Center. The state-of-the-art 42,000 square-foot building, located on Whitehall Rd. near Earhart Rd., is the new home to a variety of IHA practices, including a new Urgent Care location, open 14 hours a day Monday-Friday, and 10 hours Saturday and Sunday. Other patient-centered programs and services being offered are: pediatrics, internal medicine, obstetrics and gynecology, certified nurse midwives, dermatology, pediatric neurology, imaging and ultrasound, travel medicine, physical therapy and lab services. We look forward to welcoming you to this new kind of medical center – one that is centered on you!



First Floor

IHA Imaging & Ultrasound – Domino’s Farms

IHA Internal Medicine – Domino’s Farms

IHA Midwest Travel Care

St. Joseph Mercy Clinical Laboratory

IHA Urgent Care –Domino’s Farms
Open 7 days a week, including holidays
Monday-Friday 8:00am-10:00pm
Saturday-Sunday 9:00am-7:00pm

Second Floor

IHA Primary Pediatrics – Domino’s Farms
734.677 DERM (3376)

IHA Pediatric Neurology Consultants

IHA Dermatology– Domino’s Farms

St. Joseph Mercy Physical Therapy

Third Floor

IHA Ann Arbor OB/GYN– Domino’s Farms

IHA Nurse Midwives