Intestinal failure, whether occurring as a sudden catastrophe or more insidiously over years of symptoms and surgeries, can be devastating for patients and difficult to manage for physicians. “For both adults and children with the diagnosis, treatment can be complex, often requiring intensive nutritional support, management of wounds and central lines, surgical intervention and assistance with psychological and addiction issues,” says David Mercer, MD, PhD, an intestinal transplant surgeon and director of the Intestinal Rehabilitation Program at The University of Nebraska Medical Center (UNMC).

Broadly defined, intestinal failure (IF) is the inability to maintain a reasonable state of nutrition and hydration using the gut alone. In children, this is often the result of a problem at birth such as gastroschisis, necrotizing enterocolitis or intestinal atresia. In adults, IF can develop suddenly from problem such as intestinal volvulus or ischemia or more insidiously after multiple operations for inflammatory bowel disease or adhesive obstructions. “In some cases, while the intestinal appears intact, there is significant functional impairment, either from pain or poor motility, which prevents normal intake or digestion,” says Dr. Mercer.

Patients with IF may require nutritional supplements or even parenteral nutrition. “Symptoms such as pain, diarrhea or constipation, vomiting or bloating can be incapacitating for IF patients and often prevents them from working, going to school or enjoying life,” says Dr. Mercer. “These patients can be very difficult and time-consuming to manage, especially with complex surgical problems such as enterocutaneous fistulas. Many patients develop significant pain issues and narcotic tolerance.”

The Intestinal Rehabilitation Program at UNMC is a multidisciplinary team that collaborates to treat patients with symptoms ranging from chronic abdominal pain and malnourishment to complete loss of the small intestine. “We can see any patient who is not receiving 100 percent of their calories and hydration by mouth,” says Dr. Mercer. “In serious cases, the earlier patients are referred, the better they do.”

Treatment for each patient is strictly individualized using advanced medical and surgical techniques to restore gastrointestinal function and encourage intestinal adaptation. “It is our goal to have every patient, adult or child to be able to take 100 percent of their food and water by mouth,” says Dr. Mercer. “While this is not always achievable in every patient, we believe our experience and resources allow us to provide the best overall care for this population.”

Patients seen by the Intestinal Rehabilitation Program will receive a thorough anatomic, functional and nutritional assessment. Based on these results, a comprehensive treatment and care management plan will be developed and shared with the primary care physician. Some patients may require surgical correction of anatomic problems, lengthening procedures, home TPN management and management of IF-related symptoms. “The majority of basic care issues can continue to be managed by the primary care doctor,” says Dr. Mercer. “However, patients with complex nutritional issues may need closer management by our Intestinal Rehabilitation team.”

Cardiac MRI is a very powerful diagnostic tool and one of the most valuable techniques available to image the heart, says Samer Sayyed, MD, cardiologist at The Nebraska Medical Center and assistant professor of Internal Medicine at the University of Nebraska Medical Center (UNMC).

“Cardiac MRI goes beyond just analyzing the structure of the heart, but can also provide accurate quantitative assessment of bi-ventricular and valvular function, shunt fraction, myocardial perfusion, viability and scarring, as well as angiography of the pulmonary and systemic vasculature, all while avoiding the use of ionizing radiation or contrast agents that are toxic to the kidney,” he says.

First line cardiac diagnostic studies generally involve an electrocardiogram and/or an echocardiogram. A cardiac MRI study is appropriate when other tests are inconclusive, or when additional information about a patient’s cardiac condition is required to develop a more accurate diagnosis or management plan, notes Dr. Sayyed.

To get the most value from an MRI, the exact indication for ordering the test needs to be provided so the study can be tailored to effectively answer the clinical questions at hand, says Dr. Sayyed. “The study itself can take anywhere from 30 minutes to over an hour sometimes,” he says, “therefore, time is of the essence, and it is not a test to be performed in emergency situations.”

Some of the primary indications for cardiac MRI include:

• Assessment of cardiac structure and function when other techniques are insufficient or ineffective
• Evaluation of valvular structure and function
• Cardiac stress testing
• Assessment of myocardial viability prior to revascularization
• Ischemic and non-ischemic cardiomyopathy such as hypertrophic cardiomyopathy, sarcoidosis, amyloidosis, and hemochromatosis.
• Cardiac masses or thrombi
• Complex congenital heart disease
• Aortic and pulmonary angiography for aneurysms/dissection even for those who can’t receive contrast
• Complex intra and extra cardiac shunts
• Arrhythmogenic right ventricular dysplasia
• Pericardial disease such as acute pericardial inflammation and pericardial constriction

A comprehensive list of appropriate, uncertain, and inappropriate indications for cardiac MRI has been published by the Journal of the American College of Cardiology in 2006, says Dr. Sayyed.

It should also be noted that the contrast agents used for cardiac MRI are very different from those used for CT scans, says Dr. Sayyed. A CT scan uses an iodine-based agent whereas a cardiac MRI uses a gadolinium-based agent. The iodine agent can be toxic to the kidneys. The gadolinium-based agent, on the other hand, is not nephrotoxic and can be given to a larger group of patients, even those with moderate kidney disease. However, it should not be used on those patients with severe kidney disease. Even in those with a contraindication for contrast, there are ways to perform non-contrast enhanced MRI angiography with high image quality, notes Dr. Sayyed.

Because cardiac MRI uses magnetic fields, patients with implanted ferromagnetic material such as pacemakers, nerve stimulators or have a history of welding may not be eligible for this test. Obese and claustrophobic patients may also be unable to fit within the magnet, or tolerate being confined within its bore for the duration of the study. Despite these few limitations, MRI remains the gold standard noninvasive method of evaluating a wide array of cardiovascular diseases.

Early diagnosis and evaluation is key for patients with kidney disease who are candidates for hemodialysis. “Our goal is to evaluate patients well before they need dialysis so we can provide them the proper access and determine if they are candidates for transplant,” says Michael Morris, MD, who heads the Vascular Access Clinic at The Nebraska Medical Center. Dr. Morris and his team specialize in vascular access surgery, laparoscopic procedures and kidney transplantation.

“One of the leading reasons for rehospitalization for these patients is complications related to their vascular access,” he says. Common complications include strictures, infections, aneurysms, clotting and poor blood flow. “Our team has been doing this for many years. We have the experience and expertise to ensure our patients are receiving the correct type of access, the procedure is performed properly and they are cared for and managed appropriately.” Dr. Morris and his team work very closely with nephrologists in the dialysis unit to determine the best solution for each patient and to minimize complications.

“This is a long-term relationship,” says Dr. Morris. “We are committed to the long-term care and health of our patients. “We understand that the loss of vascular access can mean the difference between life and death for our patients.”

Dr. Morris specializes in placing fistulas, which is the most difficult procedure to perform but it is also the most successful with the fewest problems over the long term, he says. Patients require four to six weeks of healing time after surgery before they can begin dialysis. He also performs catheter access procedures, which are intended for short-term use and should be avoided whenever possible as they tend to injure the veins.

Because the clinic is associated with the Transplant Program at The Nebraska Medical Center, patients have the benefit of being evaluated for kidney transplant at the same time they are evaluated for vascular access. “In some cases, we can delay dialysis, and at the very least, get the transplant process started while the patient is on dialysis instead of waiting until the patient is in a dire situation,” says Dr. Morris. This is important because unless the patient has a living donor, the transplant waiting time can be up to several years. Many patients qualify as transplant candidates.

The ultimate goal, notes Dr. Morris, is to avoid dialysis whenever possible and to get a patient on the transplant list. But for this to happen, “we need to see patients well before they need dialysis,” he says. “The risks associated with dialysis tend to be far greater than the risks associated with transplant and transplant patients have longer survival rates.”

Early symptoms of kidney disease include protein in the urine, uncontrollable high blood pressure and serum creatinine.

Dr. Morris is also co-director of the Kidney/Transplant program at The Nebraska Medical Center and associate professor of Surgery at the University of Nebraska Medical Center.

Doctors at The Nebraska Medical Center have added a new high-speed cardiac nuclear imaging camera that can improve doctors’ ability to evaluate a patient’s risk of having a heart attack to their arsenal of cardiac diagnostic tools.

Compared to older nuclear imaging cameras, the new technology offers a solid state technology that results in images of higher quality and can reduce imaging time from approximately 15 to 20 minutes per scan to as low as two to four minutes per scan. As a result, it has the potential to significantly reduce radiation exposure for patients. Additionally, the camera allows patients to be scanned in a much more comfortable, sitting position, than the standard supine position with the arms raised above the head.

“This provides us with another important non-invasive diagnostic tool to risk stratify our patients,” says Kiran Gangahar, MD , cardiologist at The Nebraska Medical Center. “Currently, it is the only high-speed, solid-state, cardiac nuclear imaging camera available in Omaha.”

Nuclear cardiac imaging offers an alternative to patients who are unable to undergo other forms of stress imaging, such as stress echo, because of the inability to image the heart by ultrasound, intolerance to some of the pharmaceutical agents used, physical limitations or body habitus. The test can be used for assessment of ischemia, ejection fraction and myocardial viability.

It is also an effective alternative when echo images are of poor quality. “The time period allowed for echo imaging is much shorter,” says Dr. Gangahar. “With nuclear imaging we have 15 to 30 minutes to take pictures compared to just a few minutes allowed with echo. This allows us to perform multiple pictures to ensure we get the right one.”

In addition, the pharmacological agent used has a shorter half life so it is eliminated from the body much faster so patient tolerance is much better. The testing area can also accommodate obese patients up to 550 pounds as long as the patient is mobile.

Typical candidates for the procedure are those at intermediate risk for coronary artery disease. “These are patients who have risk factors for coronary artery disease, but may have atypical symptoms,” says Dr. Gangahar.

To perform the procedure, the patient is injected with a nuclear tracer fluid based on their body mass index (BMI). The patient’s chest is then imaged in a comfortable sitting position. The patient will then have either an exercise or pharmaceutical stress test, as determined by their physician. This is followed by an imaging post stress in sitting and reclining positions.

“Nuclear stress tests are strong predictors of future cardiac events,” says Dr. Gangahar. “The goal is to identify patients who are at high risk for cardiac events so that further, invasive diagnostic testing such as cardiac catheterization, appropriate medications and aggressive risk factor modification can be implemented.”

by John Keenan, UNMC public relations

 
UNMC remains the sixth-ranked primary care medical program in the United States, according to the 2014 U.S. News & World Report rankings of the nation’s top graduate schools.

“To be recognized as a leader in primary care is a testament to the tremendous work of all our faculty, staff and students at UNMC,” Chancellor Harold M. Maurer, M.D., said. “Our expertise in primary care will be particularly beneficial to our state and region in the coming years, as more emphasis is placed on wellness and preventive care, and the need increases for more primary care providers.”

U.S. News surveyed 149 institutions while compiling the rankings, which were released Tuesday.

In addition to the primary care ranking, UNMC ranked 64th in research.

“To be recognized as a leader in primary care is a testament to the tremendous work of all of our faculty, staff and students at UNMC.”

Chancellor Harold M. Maurer, M.D.

“We’re pleased to see the rankings, which reflect the exceptionally talented faculty, staff and students we have here working on behalf of Nebraska,” said Dele Davies, M.D., vice chancellor for academic affairs. “Our educational mission is vital to everything we do here at UNMC. We strive to ensure our students receive an education that gives patients the best and most innovative care possible.”

Rankings are based on two types of data: expert opinions about program excellence and statistical indicators that measure the quality of a school’s faculty, research and students.

Primary care rankings included a series of indicators such as peer assessment, assessment by residency directors, student selectivity, mean Medical College Admission Test (MCAT) score and other factors.

Although new rankings aren’t available in all categories for 2014, UNMC continues to be rated in four other programs:

16th of 130 physician assistant programs;
32nd of 125 pharmacy programs;
34th of 201 physical therapy programs; and
36th of 467 for the master’s program in nursing.

Effective treatment of multiple sclerosis (MS) begins with early and proper diagnosis. However, the episodic nature of the disease as well as the fact that no two cases are alike can make it difficult to diagnose even in the best hands, notes Mac McLaughlin, MD , an MS-trained neurologist who works at the Multiple Sclerosis Clinic at The Nebraska Medical Center and an assistant professor of Neurological Sciences at the University of Nebraska Medical Center (UNMC).

“Getting the right diagnosis and starting the right medications early in the disease is important for the overall disease outcome,” says Dr. McLaughlin. “If we can get a patient started on medications very early in the disease course, we can maximize the ability to slow down the progression of the disease.”

The use of MRI has greatly improved diagnosis of the disease and has made it possible to diagnose the disease earlier in the disease process. “An MRI image can show areas of active inflammation, which indicates active involvement of MS,” says Dr. McLaughlin.

“Because of the multiple types of medications available in addition to keeping up with the changing symptoms, the disease can be difficult to manage,” says Dr. McLaughlin. “That’s where a multi-disciplinary clinic like ours can really help patients stay on top of the disease to control symptoms and slow the progression.”

The Multiple Sclerosis Clinic is one of the most comprehensive in the region. The clinic, which follows more than 1,500 MS patients, staffs the only two MS-trained medical specialists in the area and is supported by an experienced and dedicated MS staff of physical therapists, case managers and physician assistants. Patients also benefit from the expertise of specialists in areas such as physical and occupational therapy, psychiatry, neuro-ophthalmology, pain, urology and OB/GYN.

The Multiple Sclerosis Clinic provides a comprehensive approach to MS care that addresses the physical, psycho-social and economic situation of each patient. Because MS affects each person differently, treating the whole person and their individual symptoms can make a significant difference in their quality of life, says Dr. McLaughlin. Our clinic is a partner with the patient throughout their lifetime.

The Nebraska Medical Center is the first in the region to offer LARIAT

Marc Leger lived under the constant threat of having a stroke. His heart has atrial fibrillation, an irregular heartbeat. Because of another medical condition, the 62-year-old Plattsmouth, Neb man cannot take blood thinners, which is how doctors typically deal with the stroke risk that is present with atrial fibrillation patients.

-Dr. John Scherschel guides the Lariat into place during Marc Leger’s procedure

“It’s always in the back of your mind but you put your trust in your doctors and your prayers,” Leger said. Previously, the only way to deal with the risk was with open-heart surgery to close off the left atrial appendage; a small part of the heart where blood can pool and clots can form.

“With atrial fibrillation, blood doesn’t go in and out very well,” explained John Scherschel, MD, cardiologist at The Nebraska Medical Center. “The clots form in those nooks and crannies and can be carried out.”

Dr. Scherschel is the first physician in the region to bring a new alternative to surgery for patients like Leger. It’s called Lariat. “When I saw this technique described in scientific literature back in 2009, I said, ‘We need to be doing that,’“ Dr. Scherschel said. “That’s the right way to do this.”

The Lariat procedure involves two small incisions. It is done in a cardiac catheterization lab with the patient under general anesthetic.

Dr. Scherschel began Leger’s procedure by placing a needle and then a small tube into the pericardium, the space around the heart. Then, a catheter was placed in a vein in his leg. Guided by x-ray and ultrasound, Dr. Scherschel ran the catheter into Leger’s heart and into his left atrial appendage. That catheter is tipped with a small magnet which attached to another magnet on the probe on the outside of the heart.

“That creates a rail over which the Lariat loop can pass,” Dr. Scherschel explained.

“We place that loop over the neck of the appendage and close the loop.”

The cath lab team then uses ultrasound to make sure no more blood is flowing into the appendage. The stitch closing the appendage is then cut and the tiny instruments removed. The process typically takes less than an hour.

“I woke up afterwards and felt really good,” Leger said with a smile. “I’ve seen people have dental work that was more uncomfortable than this procedure.”

Dr. Scherschel said the biggest benefit of the Lariat procedure is the ability to provide the same outcome as open surgery without the lengthy hospital stay and risks of complication.

-Dr. John Scherschel watches x-ray and ultrasound images of Marc Leger’s heart during his Lariat procedure

“It really is an elegant solution,” Dr. Scherschel said The Nebraska Medical Center is one of a small number of hospitals in the U.S. and the only hospital in the region performing Lariat procedures.

“This is proof that the medical center is committed to bringing new cutting edge procedures here for the benefit of our patients,” said Jorge Parodi, executive director of cardiovascular services at The Nebraska Medical Center. “It also has the potential to reduce costs to the healthcare system because of the shorter hospital stay and recovery time.”

About a week after his Lariat procedure, Marc Leger was all smiles.

“I feel great; not quite ready to go out for the Olympics but I really feel good,” he said. “When you put down on your prayer request at church that you’re going to have a heart procedure done, everybody assumes they’re going to crack open your chest and you’re going to be weeks in recovery. Then they see you four days later and you’re running around a fish fry. They say, ‘Did you have your procedure?’ Oh, yeah it’s all done.”

He was one of the first Lariat patients in Nebraska, and Dr. Scherschel believes this will become the dominant way doctors deal with the condition in the future.

In his pocket, Leger carries a regular looking band aid taped to a business card as his souvenir of his Lariat procedure. It’s what covered the access point in his chest. Leger says it beats a big scar on his chest that would have resulted from open-heart surgery.

“I’ve cut my finger before and had to put bigger band aids on it than that,” he said. “They did a heart procedure and that’s it – one little band aid.”

New guidelines published in the Journal of National Comprehensive Cancer Network (NCCN) recommend that certain high-risk groups can benefit from lung cancer screening with low-dose CAT scan. The guidelines were developed after a study sponsored by the National Cancer Institute and published in the New England Journal of Medicine indicated that screening can reduce lung cancer mortality by 20 percent.

“This is good news because chest X-rays are inadequate at picking up lung cancer at an early stage,” says Rudy Lackner, MD , a thoracic surgical oncologist at The Nebraska Medical Center. “A CAT scan, on the other hand, can detect lung cancer nodules in stage 1a when the cure rate can be as high as 90 percent or more. However, currently only about 25 percent are found in the earliest stages. Approximately 75 percent of lung cancer cases are found in stages 3 and 4, when cure rates drop to 5 percent and lower.”

The guidelines recommend that individuals ages 55 to 74 that have smoked a 30-pack history should be screened. This is equivalent to a half pack a day for 60 years, one pack a day for 30 years or two packs a day for 15 years.

Because of these new recommendations, some of the major insurers are now covering this screening, says Dr. Lackner.

If a patient falls into this high-risk group, the pros and cons of lung cancer screening should be discussed between the patient and his or her primary care doctor. If a CAT is ordered and nodules are found, the patient should be referred to a lung specialist to determine whether they need to be biopsied or watched. About 50 percent of the population will have lung nodules from exposure to things like fungus or respiratory tract infections, but only 2 percent of these individuals will have cancerous nodules, says Dr. Lackner.

“Whether we biopsy the patient will depend on factors such as the size of the nodules and whether the nodules are increasing in size and multiplying,” says Dr. Lackner. “If the biopsy is negative, we will follow the patient for a minimum of three years.”

If no nodules are found, a CAT scan is recommended every year until age 74, says Dr. Lackner.

“The most challenging aspect of this screening is determining what should be done if nodules are found,” says Dr. Lackner. “This is where our expertise comes into play. We have a long track record of performing lung cancer screenings and treating lung cancer patients.”

Current data indicates that the chance for long-term survival improves when the medical team involved is dedicated to lung cancer treatment. The Nebraska Medical Center is unique in the region in that it has the only team of surgeons, medical oncologists, radiation oncologists, radiologists, pathologists, case managers and nurses dedicated to the treatment of lung cancer. Dr. Lackner works side-by-side with Apar Kishor Ganti, MD , a hematologist/oncologist specializing in lung, head and neck cancers, Karen Trujillo, MD , who with Dr. Lackner, are the only thoracic surgical oncologists in Nebraska with practices limited to cancers of the chest. The other members of his team dedicated to the care of lung cancer patients include oncologists Anne Kessinger, MD , and Alissa Marr, MD , radiation oncologist Weining (Ken) Zhen, MD , pathologist William West, MD , and radiologist Matthew DeVries, MD .

The Nebraska Medical Center is also a member of the NCCN and Dr. Lackner serves on the committee that developed the lung cancer screening guidelines.

Lung cancer is the most common cause of cancer deaths in both men and women in the United States and is the most preventable. It causes more deaths in women than breast, cervical, uterine and ovarian cancers combined.

Carcinoid tumors are rare and can be difficult to diagnose. Getting proper treatment for patients with these types of tumors can be even more challenging. The Nebraska Medical Center offers a Neuroendocrine Tumor Clinic to treat these difficult cases – one of a few in the country.

Luciano Vargas, MD , an abdominal transplant surgeon that specializes in the surgical management of neuroendocrine tumors at The Nebraska Medical Center, says the clinic sees patients from across the country for evaluation and treatment. “We have several types of surgical techniques that we use to remove the tumor: primary surgical resection, staged hepatectomy resection or liver transplantation.”

Dr. Vargas joined the staff at The Nebraska Medical Center in July 2012. He attended medical school at the University of Texas Health Sciences Center in San Antonio; completed two years of general surgery residency at the University of Nebraska Medical Center (UNMC) in Omaha; followed by two years of research in intestinal transplantation and a fellowship in liver transplantation. He is also an assistant professor of Surgery at UNMC.

The Neuroendocrine Tumor Clinic meets twice monthly and has a growing patient base. Dr. Vargas works in collaboration with a neuroendocrine oncologist, Jean Grem, MD  and a dedicated nurse, Lucie Case.

Patients with carcinoid tumors typically present in the fifth and sixth decade of life and have various presentations, notes Dr. Vargas. Some are asymptomatic while others experience vague symptoms such as abdominal pain and bloating. If individuals have excess hormone production, they can experience diarrhea, flushing spells, heart palpitations and wheezing.

A physical examination may show heart valve lesions and signs of niacin-deficiency. “To confirm the presence of a carcinoid cancer will ultimately require a tissue diagnosis,” says Dr. Vargas. “Additional studies that are used to follow individuals with carcinoid cancer include 5-HIAA levels in the urine, CT and MRI scans, chromogranin A and an octreotide radiolabelled scan.”

Surgery to remove the tumor is the first line of treatment. The staged hepatectomy procedure involves removing a portion of the tumor from the liver. A port-vein embolism to block the blood supply to the affected part of the liver is then performed to stimulate growth to the unaffected portion. If the carcinoid tumor is unresectable and localized to the liver, the patient may be a possible liver transplant candidate. Liver transplant patients can expect one-, three- and five-year survival rates of 81 percent, 65 percent and 49 percent respectively.

The liver transplant program at The Nebraska Medical Center was formed in 1985. With more than 2,500 liver transplants and more than 500 pediatric liver transplants under its belt, it is now one of the most active and advanced centers in the world.

If the entire tumor is resected, the patient will continue to be monitored for the rest of his or her life. “These types of tumors tend to recur so we like to see them twice a year with repeat imaging to confirm tumor remission,” says Dr. Vargas.

He says his clinic works closely with the primary care doctor to follow up with these patients. “We believe that a good communicative relationship is vital to patient outcomes,” says Dr. Vargas. “Often our patients are not local or our interaction with them comes down to once or twice a year. So we rely on the primary care physician to be the first responders to any changes in the condition of our neuroendocrine patients. To foster this relationship, we make ourselves easily available by email and phone.”

by Nicole Lindquist

The lime-green one is for Bailey, a 16-year-old girl. The light-purple one is for Diane, a go-getter from Seattle. And the orange one is for her, Lenice Hogan, a 47-year-old from Omaha. It simply reads “Hope After Stroke.”

The bracelets that take up most of Hogan’s left forearm each carry a special meaning, and represent someone, or something, from the stroke community.

Hogan has suffered three strokes. Coincidentally, that’s also the number of marathons she’s run SINCE her third and biggest stroke robbed her of full function in her left foot.

The mother of three boys and inspirational speaker was on campus recently as part of www.triexercise.org, a free monthly program sponsored by the Olson Center for Women’s Health to help individuals accomplish their exercise goals.

As a runner, I went for the inspiration. And to hear Hogan’s story. For a stroke survivor to run one marathon, let alone three, boggled my mind. I tried to train for a marathon once. This was before kids. When I was 100 percent healthy. And 23 years old.

Hogan was 26 when she had her first stroke and seven months pregnant when she had her second at 38. She compares the feeling to a light bulb that isn’t quite screwed into the socket.

After numerous doctor visits (at another hospital system) it was finally determined she had a hole in her heart. Surgery closed it up, and she thought her health issues were behind her. Two months later, her third stroke caused her to collapse and lose the use of her left leg.

It was Dr. Pierre Fayad, who Hogan calls her “angel in life,” at The Nebraska Medical Center’s Stroke Center who finally diagnosed her with a venous angioma that bled. There is no known cause and no known cure.

While Hogan walked out of the hospital of her own accord shortly after her third stroke, she spent the next two years in denial. Thirty-nine-year-olds shouldn’t have strokes. It wasn’t until she met a fellow stroke survivor that her life took a turn for the open road.

He, too, seemed too young to have suffered a stroke. He, too, was just trying to enjoy the sun on a Florida vacation. But the similarities ended there. Just as Lenice was relearning to run, he was struggling to walk. Her left foot was finally feeling good. His left side wouldn’t move and hadn’t in seven years.

She struck up a conversation with him. Hogan remembers eight words of it verbatim.

“You have no idea how lucky you are,” he said.

And that was it. After a few slow jogs on the beach in Florida, Hogan coincidentally received an e-mail from the National Stroke Association seeking runners for its first-ever New York City Marathon team. It seemed serendipitous. But everywhere Hogan turned, she hoped to find a roadblock. Sure, she’d run a mile on the beach, but 26.2 of them was unfathomable. After a green light from her physician and just as importantly, her mother, she called NSA, half-hoping the team was already full. No luck. She signed up.

She only had a few months to train, and was worried it wasn’t enough. But when Hogan stepped off the plane in New York, an overwhelming sense of peace came over her. She knew she could do it. And she did. She ran the whole thing and finished in just over five hours.

“Crossing the finish line was an amazing sense of accomplishment,” she said. “I wanted to sign up for the next one right then.”

She ran her second NYC marathon on behalf of NSA the next year and her third the year after that, bettering her time each year. She planned to run her fourth last fall, but Hurricane Sandy had other plans. So Hogan is signed up to run her fourth marathon in five years this Nov. 4.