September 2024

VA General- Physical Medicine and Rehabilitation

Judith B. Kosasih, MD. Professor, Department of Physical Medicine and Rehabilitation

There has been significant growth in amputation rehabilitation across the lifelong continuum of care at the Milwaukee VA. On the inpatient side; comprehensive post-operative consultations including PM&R, physical therapy, occupational therapy, prosthetics and rehab psychology are conducted on every veteran with a major limb amputation. The comprehensive PM&R consultation and inpatient amputation rehabilitation are provided through our CARF-accredited Comprehensive Integrated Inpatient Rehabilitation Program (CIIRP). The Amputation Clinic Team (ACT), part of VA’s nationwide Amputation System of Care, provides interdisciplinary clinic evaluations and prosthetic limb prescriptions to veterans with limb amputations across Wisconsin, northern Illinois and upper Michigan. In fact, Milwaukee ACT is the required provider for all prosthetic limb prescriptions for veterans receiving care within the VA system, as well as in the community. To improve access across the region, the Milwaukee ACT offers an array of clinic visit options. In addition to in-person appointments, veterans have access to a variety of virtual clinic options including; visits from home, skilled nursing facility/community nursing home, community vendor, or other VA facilities such as Madison VA, Tomah VA, Iron Mountain VA and surrounding VA community clinics. This ensures convenient access for veterans in diverse locations.

As part of the prosthetic clinic process, we utilize the national FLOW3 Electronic Workflow Management System to facilitate timely prosthetic limb ordering, tracking, and delivery to veterans. Other unique programs offered by Milwaukee VA ACT include an on-site prosthetic lab for in-house prosthetic fabrication by our ABC-certified Prosthetists and Orthotists, Driver Rehabilitation Training, an Amputation Clinical Specialist Physical Therapist, Amputation Exercise Group, Amputation Education/Discussion Group and Amputation Certified Peer Visitors (CPVs). CPVs are trained to meet fellow Veterans with new amputations, either in person or virtually, to help support them in their rehabilitation journey. CPV's provide supportive listening, encouragement, and resources/information. Through collaborative care and resources, the Milwaukee ACT supports the Whole Health of veterans in our care.

Dr. Ellie Farr to Join the PM&R Team on October 1st

Ellie Farr, MD, Brain Injury Specialist originally from Cincinnati, Ohio. She did her PM&R residency training at Northwestern Feinberg/Shirley Ryan AbilityLab in Chicago, Illinois and Brain Injury Fellowship at the Mayo Clinic in Rochester, Minnesota. Her career interests include; medical education, health systems management and of course, caring for all shapes and sizes of brain injury! Her husband is a pediatric ENT who will be working with the ENT team at Wisconsin Children’s Hospital. She has two cats who act more like dogs/stuffed animals and she will be more than willing to overwhelm you with cat pictures should you inquire. She also loves to read, play video games, work out and start various crafting projects that will sit partially completed for years. Please be sure to welcome her to the team on Tuesday, October 1st!

National Veterans Wheelchair Games in New Orleans, LA

This year's National Veterans Wheelchair Games was held in New Orleans, LA from July 25th to July 30th. Faculty members Dr. Kenneth Lee and Dr. Denis Castillo attended along with residents Drs. Will Bataller, Andrew Hua, Kristen Vaccaro, fellow Dr. Haley Willarson, medical students Nathan Rose and Jesse Isaacson. The medical team assisted with running the medical clinic for all veterans at the Wheelchair Games as well as providing sideline coverage during higher risk sports such as wheelchair rugby and swimming. Dr. White and the previous SCI fellow Dr. Paschall were also there to classify veterans. The MCW team worked collaboratively with faculty, residents, and students from the University of Minnesota, University of Michigan, the University of Miami, Stanford University, Louisiana State University, and VAs throughout the United States. For kid’s day (when kids with disabilities from the local community attend and are introduced to adaptive sports) Dr. Lee traditionally wears a costume and becomes the MC. This year he dressed as a jester to match the New Orleans theme! He always does a great job at bringing joy and enthusiasm to any event!

WASA – WLUSA Lacrosse Nationals at the Ozaukee Ice Center

Wisconsin Adaptive Sports Association (WASA) was awarded the chance to host the 2024 Nationals Tournament by Wheelchair Lacrosse USA from August 16^th to August 18^th. The Ozaukee Ice Center in Cedarburg was the venue. Ten teams from all over the country competed. There were many upsets during this tournament. The Milwaukee Eagles, with Marquette University Men’s Lacrosse team coaching, made a 2peat and won the championship two years in a row! Yes, our very own Milwaukee Eagles are the National Champions, AGAIN!! We had many sponsors step up and provide support for this. One of the sponsors was MCW-PM&R. Dr. Lauren Shuda organized the medical support for the event. Drs. Christopher White, Vaishnavi Muqeet, Charlotte Ball, Andrew Hua, Cody Diehl, Haley Willarson and Colton Sauer along with many medical students attended and provided the support. They treated everything from minor bruises, finger fractures, dislocations, concussions and autonomic dysreflexia. Dr. Lee was also the cow mascot!

New Updates and Accomplishments in Research

New Featured Study

Research's new featured study is the NIH-funded clinical trial Ischemic Conditioning Improves Walking Function Post-Stroke (NCT04038697, R01HD099340). This study is in the final year of recruitment and will demonstrate the benefit of combined ischemic conditioning (IC), a stimulus which involves 5x5-minute bouts of leg blood flow occlusion/reperfusion, and treadmill training on motor function and cardiovascular health post-stroke. This randomized, controlled, double-blinded clinical trial is a collaboration between the laboratories of Dr. Matt Durand, Associate Professor and MCW’s Research Director for PM&R and Dr. Allison Hyngstrom, Professor and Chair of the Department of Physical Therapy at Marquette University. Through the hard work of our study teams, including PM&R Clinical Research Coordinators Jennifer Nguyen and Gabe Merkow, this study has enrolled >100 participants and the study teams have performed >1,100 testing and treatment sessions over 5 years. The study was also highlighted at this year’s Imagine More Dinner, a philanthropic event for pioneering advancements in neuroscience research, which featured a video including Drs. Durand and Hyngstrom and a testimonial from one of the research participants (https://www.mcw.edu/giving/events/imagine-more). This study is projected to finish June 2025. Congrats Team!!

Shout outs:

Dr. Alicen Whitaker-Hilbig, a postdoctoral fellow in Dr. Matt Durand's laboratory, was nominated to serve on the American Heart Association's Stroke Council Rehabilitation and Recovery Committee from July 2024 to June 2026. Alicen's expertise in clinical neurorehabilitation and stroke exercise research will help contribute to the committee's scope to "address complications that occur after stroke within the rehabilitation and chronic phase of care". Alicen will represent MCW at the committee meeting held during the International Stroke Conference as well as contribute to written educational and scientific material.

Dr. Whitaker-Hilbig also received a Clinical Research Loan Repayment Program (LRP) award from the NIH Eunice Kennedy Shriver National Institute of Child Health and Human Development (2024 - 2026). The LRP award was established " to recruit and retain highly qualified health professionals into biomedical or biobehavioral research careers" by financially assisting with educational debt.

Research Brings Awareness to the ADA with Trivia!

On July 26^th in 1990, the American with Disabilities Act was passed. The research team created a fun trivia game to spread awareness of the act and the different concepts it entails. Pictured below are Alan Young (Clinical Research Coordinator III) and Sarah Golus (Clinical Research Coordinator II).

Happy Birthday Alan Young!

Our department recently celebrated Alan Young's birthday with a lemon cake and good company!

Goat Yoga

This year's Froedtert & MCW Well-Being Fair held a Goat Yoga event at the Sargeant Health Center green space. Members of our research team Sarah Golus, Alan Young and Morgan McIlwee attended this exciting and fun event and got to interact with adorable goats!

PM&R Staff Share Scenic Photos from their Favorite Travels

Dr. Mitchell O'Neill shares a photo with his wife Nancy and their son Jonah in Puerto Vallarta, Mexico from this past April.

Dr. Kimberley Zvara shares scenic photo from her trip to Koko Crater, Honolulu, HI.

Dr. Jennifer Yacub Martin shares a stunning scenic photo from her recent visit to Draper, Utah to see her twin sister!

Dr. Kenneth Lee shares a photo of himself alongside his wife from a trip to Potawatomi State Park, a hidden gem in Wisconsin.

Rhiannon Shewczyk shares a photo of herself in the middle of the Arc de Triomphe and a scenic photo of the Eiffel Tower from her solo trip to Paris France from 2018.

Dr. Christopher White shares a beautiful scenic photo from his travel to Jardin, Colombia (coffee country!)

In her most recent trip to Poland and Slovakia, Monika Szczerba visited the Treetop walk in Zdiar, Slovakia. In the background, you can spot the Tatra Mountains, being a part of Carpathian Mountain chain, which create a natural border between Slovakia and Poland.

In her recent vacation to Conover, WI Megan Hughes and her husband spent the day riding a UTV in upper Michigan, horseback riding and boating. She also shares a scenic photo of the sunset on the lake from her trip!

PM&R PGY2 Residents and Fellows that Started on July 1st

PM&R Residency

PM&R Fellowship

PM&R Philanthropy Case

Please contact Meg Bilicki, Senior Director of Development mbilicki@mcw.edu for more information.

To support Physical Medicine and Rehabilitation click on this link!

Department Mascot's Outfit for this Quarter

For this quarter's newsletter our department mascot 'Randy the Rhino' shares a recent photo of himself apple picking at a local farm.

The answer to the riddle below will be provided in our next newsletter. This riddle is courtesy of Alan Young, Clinical Research Coordinator:

"A man and his boss have the same parents but are not siblings. How is this possible?"

Answer to our last newsletter's riddle: " hydrogen peroxide "

Wellness Feature: The Importance of a Post-Summer Skin Check

Facts About Sun Exposure and it's Link to Skin Cancer

The unfortunate truth is that anyone can get skin cancer. It’s the most common type of cancer diagnosed in the United States, but there’s good news in the fact that it’s also one of the most survivable, especially when detected early. Exposure to sunlight is often the biggest reason behind visible changes to your skin, such as new moles or age spots. While the presence of these doesn’t mean you’re going to have skin cancer, most new cancers do emerge from new spots. An Italian study of over 20,000 incidents of skin cancer revealed that 71% of these developed from new spots on the patients’ skin.

Periodic self-checks can keep you on top of changes that might indicate the move toward cancer, and an appointment with a dermatologist adds another layer of protection in your quest for early detection, the best time to treat melanomas. As essential as the sun is to our bodies, too much of a good thing is also an issue. The ultraviolet (UV) components of light are responsible for many of the visible changes to your skin, and if you’re coming off a sunburn from enjoying the summer sun, you may have enough exposure to make skin cancer a concern. Recent sunburn can take between 5 and 20 years for visible changes to occur. However, it’s quite likely it’s not your first sunburn, and the effects of each are cumulative.

New Spot Suspicion

Newly emerging spots account for more than two-thirds of new melanoma cases. Spots you’ve had your entire life can become cancerous, but you likely have many more of those than new spots, and they’re responsible for melanoma less than one-third of the time. If you notice a new spot, it’s probably a good time to visit Dr. Banda for a quick check no matter what time of year it is. There are also skin changes that only a trained dermatologist can detect, so a new spot you recognize could be accompanied by more subtle changes you can’t.

The Summertime Sun Load

When you think of the end of the year, December 31 likely jumps to mind naturally, as the calendar changes. When it comes to the sun, the summer months account for 80% of your exposure. You typically get 20% from the fall, winter, and spring, so the end of summer could represent the end of your yearly dose of sunshine.

You can find more information on prevention and treatment here.

Featured Healthy Recipe - Low Calorie Chicken Salad Wraps

Ingredients:

• 2 cups of chopped cooked chicken

• 2/3 cup celery

• 1/4 cup dried cranberries

• 3 loosely packed cups of lettuce

• 1/2 tsp dried tarragon

• 2 tsp Dijon mustard

• 1/4 cup mayonnaise

• 1 tsp of sugar or honey

• 1 generous pinch of celery salt

• 1 tsp pepper

• 1/4 tsp salt

• 1 tsp rice vinegar

• 1/4 cup toasted pecans

• 1/2 cup plain Greek yogurt

• 6 large wraps - soft tortillas

Directions:

Whisk yogurt, mayonnaise, mustard, vinegar, sugar, tarragon, salt, celery salt and pepper in a medium bowl.
Add chicken, celery, cranberries and pecans into the same bowl and stir until completely coated.
Lay wraps on the work surface. Divide lettuce among the wraps. Top with chicken salad, about ½ cup salad per wrap. Wrap up into rolls and cut in half. Serve immediately or chill.

*If you would like to share a favorite healthy recipe in next quarter's newsletter please email Rhiannon Shewczyk at Rshewczyk@mcw.edu

‍August is National Civility Month

August is National Civility Month. This month emphasizes the importance of treating others with kindness, empathy, and respect. It's an opportunity to reflect on how our actions affect those around us and find ways to improve ourselves in this regard. By fostering professional communication and conduct, we can create a safe space for difficult conversations, helping employees feel acknowledged, appreciated, and more receptive to feedback.

Civility goes beyond surface-level politeness; it profoundly impacts employee mental health. When people are consistently treated with respect, they experience lower levels of stress and anxiety. NIH offers several resources to enhance and maintain well-being, including the Employee Assistance Program (EAP) and the Office of the Ombudsman. If you observe inappropriate behavior, contact the Civil Program for support in ensuring a safe work environment for everyone.

Important August DE&I calendar dates:

August 7 – Purple Heart Day
August 9 – International Day of the World’s Indigenous People
August 13 – Left-Handers Day
August 17 – Marcus Garvey Day (Jamaican)
August 19 – World Humanitarian Day
August 21 – Senior Citizens Day
August 26 – Women’s Equality Day
August 26 – Krishna Janmashtami (Hindu)

September is Hispanic Heritage Month

During National Hispanic Heritage Month, from September 15th – October 15th, the U.S. government celebrates the countless contributions of more than 60 million Hispanic Americans, Latinos, Latinas, and Latinx-identifying people to our culture and society. Hispanic Americans are the largest minority group in the United States today, and generations of Hispanic Americans have consistently helped make our country strong and prosperous. They contribute to our Nation beyond description. Hispanic Americans embody the best of our American values, including commitment to faith, family, and country. The Hispanic-American community has left an indelible mark on our government, culture, and economy.

September Month-long Observations:

National Guide Dog Month
Suicide Prevention Month

Important September DE&I calendar dates:

September 2 – Labor Day
September 5 – International Day of Charity
September 10 – World Suicide Prevention Day
September 10 – Grandparents’ Day
September 11 – Patriot Day (U.S.A.)
September 15 – International Day of Democracy
September 16 – Mexican Independence Day
September 18 – International Equal Pay Day
September 21 – International Day of Peace
September 21 – World Gratitude Day
September 22 – American Business Women’s Day
September 26 – HR Appreciation Day
September 27 – National Native American Day

COVID-19 Guidelines

Both Froedtert and MCW employees with an approved COVID-19 vaccination exemption are no longer required to wear masks at Froedtert & MCW facilities except when and where masks are required for all. To remain consistent within all adult clinical spaces, MCW clinics will follow this same guidance. Masks have not been required for unvaccinated individuals in MCW non-clinical spaces since October 2022.

The COVID-19 vaccine requirement was discontinued for employees effective on June 13, due to recent guidance from the CDC and Centers for Medicare and Medicaid Services (CMS). COVID-19 vaccinations and boosters will continue to be strongly recommended, but not required as a condition of employment with MCW. Vaccination will continue to be required for students and learners who participate in clinical care due to many healthcare partners who have not yet lifted their COVID-19 vaccine requirement. This requirement is being actively re-evaluated as a high priority, and we will provide follow-up information as soon as feasible. Individuals who work in partner healthcare facilities that require vaccination must also continue to follow the guidance and requirements of those facilities.

For additional information visit the COVID-19 page on infoscope.

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