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Archive for August, 2014

In the Bubble

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Curtis Ledbetter was a three-year starter at the University of Nebraska-Lincoln, earning first-team All-Big 12 honors. In 2005, he helped the Huskers win their first College World Series game in school history.

It started at the age of six. All he needed was a ball and glove. Baseball was life.

“Dad coached me, and my mom played catch with me in the backyard. It was a whole family deal.”

Growing up in Lawrence, Kan., Curtis Ledbetter’s passion for the game only increased with age, and started to shape his future.

“It’s what I wanted to do. The sport I wanted to pursue in college.”

After playing one season at Garden City Community College, Curtis transferred to the University of Nebraska-Lincoln. He was a three-year starter, earning first-team All-Big 12 honors. During his senior year in 2005, Curtis earned Big 12 Tournament MVP honors, and helped the Huskers win their first College World Series game in school history.

“I fell in love with Lincoln,” says Curtis. “I’m so thankful that I had the opportunity to play baseball there.”

After graduation, Curtis was drafted by the Seattle Mariners. He played three years of professional baseball before moving back to Lincoln. That’s when a once-in-a-lifetime opportunity came his way.

“I was offered the position of Director of Operations for Nebraska baseball. My first interview for the job was with Coach Tom Osborne. Pretty neat experience. Made for one heck of a story.”

In 2009, Curtis’ story got even better. He proposed to his girlfriend, Monica on April Fools Day.

“Gives you a good understanding of our relationship,” he laughs.

The two were married a short time later, and started trying to have a baby.

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Curtis proposed to his girlfriend, Monica on April Fools Day. The two were married a short time later. Monica gave birth to their daughter, Laney on January 12, 2013.

“After about six months, nothing was happening,” explains Monica. “We sought help, and found out that we have male factor infertility, which affects 40 percent of couples. But, we were determined to have a family.”

On January 12, 2013, the Ledbetters’ dreams of having a baby finally came true. Monica gave birth to their daughter, Laney at 12:27 p.m.

“There’s nothing like that feeling,” a teary-eyed Monica remembers. “You talk to people who have children, but there’s nothing like meeting that person you’ve been connected to for nine months. It’s joy. Absolute joy.”

Unfortunately, four months later, joy turned to panic. It was May 16, 2013. Monica and Curtis were both at work, when they received a call from Laney’s caregiver. Their daughter was having a hard time keeping liquids down, and had no energy. Something was wrong.

“The look on Laney’s face. I’ll never forget it,” says Monica. “She was only four months old, but she had a scared look in her eyes.”

The next morning, Laney wasn’t doing any better. Monica rushed her to a hospital in Lincoln. Doctors discovered Laney had a massive brain bleed. She was quickly hooked up to a ventilator and flown by helicopter to The Nebraska Medical Center.

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On May 17, 2013, doctors discovered Laney had a massive brain bleed. She underwent emergency surgery at The Nebraska Medical Center to stop the bleeding. Further testing showed, Laney had no Vitamin K in her blood.

“I was in shock. I didn’t know how to act,” admits Curtis. “Monica went in the helicopter with Laney, and I drove to Omaha not knowing if I’d ever see my daughter alive again.”

When Laney arrived at the med center, Kenneth Follett, MD, chief of neurosurgery, informed the couple that their daughter needed emergency brain surgery to stop the bleeding.

“A blood clot was placing pressure on Laney’s brain, and it caused one side to shift to the other side of the head,” says Dr. Follett. “We occasionally see children with this, but what was remarkable in Laney’s case, was the sheer size and effect it was having on the brain.”

Once they took Laney to the operating room, doctors also discovered her INR (the measure of the blood’s ability to clot) was above 7, the highest INR any surgeon in the room had ever seen.

“A normal INR is 1,” explains Dr. Follett. “People who have a stroke typically have an INR of 2 or 3. Laney’s was exceptionally high, especially for an infant.”

After surgery, the next 48 hours were critical. A large team of doctors and nurses worked together, trying to figure out what caused the brain bleed in the first place.

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Laney was diagnosed with Progressive Familial Intrahepatic Cholestasis Type 2. Her liver doesn’t produce and move bile the way it should, allowing Laney’s body to absorb all the nutrients it needs. In order to survive, Laney will need a liver transplant.

“With a patient like Laney, you can’t even take a minute off,” says Andrew MacFadyen, M.D., associate professor of pediatrics at the University of Nebraska Medical Center and pediatric intensivist with Children’s Specialty Physicians. “Figuring out what exactly was wrong with Laney was intriguing from an academic sense. We suspected she had either a genetic abnormality that kept her blood from clotting properly, or a severe Vitamin K deficiency.”

A blood test proved, Laney had no Vitamin K in her blood. It was the turning point that eventually led doctors to a rare diagnosis.

“Laney was diagnosed with Progressive Familial Intrahepatic Cholestasis Type 2,” explains Monica. “Her liver doesn’t produce bile and move bile the way it should, allowing Laney’s body to absorb all the nutrients it needs. Unfortunately, the lack or build-up of bile means, her liver cells are choked off and eventually start to die. In order to survive, Laney will need a liver transplant.”

While doctors still aren’t sure when Laney will need a transplant, the Ledbetters are relieved to know, a plan and team of doctors are in place.

“We’re able to live our lives each day,” says Curtis. “Right now, Laney is doing so well. Her blood tests have been great, and she keeps progressing as a little person. The doctors at the med center gave Laney a second chance. I can’t thank them enough. They kept our family together.”

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“The doctors at the med center gave Laney a second chance,” says Curtis. “I can’t thank them enough. They kept our family together.”

A family that now includes a few more faces.

“Our head baseball coach, Darin Erstad, has a saying, ‘You’re either in the bubble or you’re not,'” smiles Monica. “Baseball life is a different life. You have people that you know you can open your life to. Now that bubble includes our nurses, doctors and surgeons at the med center. They helped us heal emotionally, mentally and physically for our daughter. I don’t know if we would have had that experience anywhere else… they’re in our bubble now.”

Neck manipulation may be associated with strokes

August 11, 2014

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Pierre Fayad, M.D.

Pierre Fayad, M.D. Treatments involving neck manipulation may be associated with stroke, though it cannot be said with certainty that neck manipulation causes strokes, according to a new scientific statement published in the American Heart Association’s journal Stroke.

Pierre Fayad, M.D., professor in the UNMC Department of Neurological Sciences and director of The Nebraska Medical Center Stroke Center, was part of the 13-member team that co-authored the statement.

Stroke symptoms

You should seek emergency medical evaluation if you develop neurological symptoms after neck manipulation or trauma, such as:

  • Pain in the back of your neck or in your head.
  • Dizziness/vertigo.
  • Double vision.
  • Unsteadiness when walking.
  • Slurred speech.
  • Nausea and vomiting.
  • Jerky eye movements.

The group was headed by Jose Biller, M.D., of the Loyola University Health System in Chicago, and Ralph Sacco, M.D., of the University of Miami Hospital, with other members representing the Mayo Clinic, Washington University in St. Louis, the University of Connecticut, Tufts University, and the University of Kansas, among others.

Cervical artery dissection (CD) is a small tear in the layers of artery walls in the neck. It can result in ischemic stroke if a blood clot forms after a trivial or major trauma in the neck and later causes blockage of a blood vessel in the brain.

“Cervical artery dissection is an important cause of stroke in young and middle-aged adults, and it is often unrecognized,” Dr. Fayad said.

“Most dissections involve some trauma, stretch or mechanical stress,” Dr. Biller said. “Sudden movements that can hyperextend or rotate the neck – such as whiplash, certain sports movements, or even violent coughing or vomiting – can result in CD, even if they are deemed inconsequential by the patient.”

Although techniques for cervical manipulative therapy vary, some maneuvers used as therapy by health practitioners also extend and rotate the neck and sometimes involve a forceful thrust.

There are four arteries that supply blood to the brain: the two carotid arteries on each side of the neck, and the two vertebral arteries on the back of the neck. The influence of neck manipulation seems more important in vertebral artery dissection than in internal carotid artery dissection.

“Although a cause-and-effect relationship between these therapies and CD has not been established and the risk is probably low, CD can result in serious neurological injury,” Dr. Biller said. “Patients should be informed of this association before undergoing neck manipulation.”

The scientific statement is endorsed by the American Association of Neurological Surgeons and the Congress of Neurological Surgeons

A decade of success

by John Keenan, UNMC public relations

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Jialin Zheng, M.D., speaks at a gathering of Asia Pacific Rim Development Program colleagues during a recent visit to China by UNMC faculty and leadership. For Jialin Zheng, M.D., it’s all about friendships.

This week, Dr. Zheng will see the Asia Pacific Rim Development Program, the institutional collaboration he helped develop in 2004 between UNMC and universities in China, celebrate its 10th anniversary.

For a program timeline, click here.

“Time really flies,” said Dr. Zheng. “When you reach the 10-year mark, it gives you the opportunity to look back at what’s been achieved and look ahead to how you can achieve more.”

Program architects

Three people Dr. Zheng credits as being among the program’s architects offered their congratulations on the 10th anniversary:

“The partnership between UNMC and its sister universities in China is an excellent example of international cooperation at its best. From the first exploratory visit, UNMC has stood by its claim of always doing what it says it will do, and our friends in China have reciprocated in kind. I look forward to seeing what the next 10 years will bring.” – Thomas Rosenquist, Ph.D., former vice chancellor for research

“The strong ties that have developed over the years through these exchanges has been of mutual benefit for students, faculty, patient care and community engagement. In addition, it has fostered enduring friendships between and among institutions, and mutual respect and admiration between the peoples. Although cultures may be different and distances are great, our human needs are the same and overcome all obstacles to collaboration.” – Harold M. Maurer, M.D., chancellor emeritus

“I doubt any of us making our first visit to China in 2004 would have forecast the close relationships that have developed between UNMC faculty, staff and students and our Chinese counterparts. . . . Today, our relationship with China goes beyond education and includes research, clinical care and business relations. Nothing could be more satisfying than to have had the opportunity to witness the growing strength of these many relationships. I am confident that the next 10 years will deepen these relations, and the 20-year anniversary in 2024 will have even more to celebrate.” – Don Leuenbeger, vice chancellor, business & finance

UNMC Chancellor Jeffrey P. Gold, M.D., said UNMC is committed to continuing to strengthen the collaboration. Dr. Gold said goals going forward will include a focus on joint education, particularly enhancing the new joint family medicine program and the soon-to-be-established physical therapy program.

“We also look forward to potentially advancing our collaborations in dentistry, nursing, pharmacy and public health, strengthening the global impact of our health professions programs,” Dr. Gold said.

Joint research in translational research program development will remain a focus as well, he said — promoting joint research proposal applications and facilitating technology development.

For information on the fifth annual APRDC Joint Research Symposium, to be held Thursday, click here.

In an era when it is increasingly important to be global thinkers, the collaboration has been and will continue to be very important to UNMC, said Dele Davies, M.D., vice chancellor of academic affairs.

“The full value of the economic, sociologic and other intangible benefits of these ties cannot be easily quantified and may not be totally evident until a much later date,” he said.

As Vice Chancellor of Research Jennifer Larsen, M.D., noted, decade-long relationships are not built overnight.

“The growth of our programs and interactions with multiple institutions and leaders in China are a testament to our commitment as well as our vision and desire for this relationship to grow,” she said.

The relationships are the key to the program’s success, Dr. Zheng agreed.

“If there’s one thing I value, it’s the friendships which have been built among the leaders, students and faculty of the Chinese institutions and the leaders, students and faculty of UNMC as a whole,” Dr. Zheng said.

Those friendships, he said, are the foundation of 10 years of achievement, as well as the foundation “for what we can achieve many years beyond.

“We have so many people who really provide support, from the leadership side, from the faculty perspective, from the student perspective,” he said. “This is truly a team effort.”

Book examines cutting-edge robotic surgery

by John Keenan, UNMC public relations

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From left, Nathan Bills, Ph.D., and Dmitry Oleynikov, M.D., have edited “Robotic Surgery for the General Surgeon.” It’s official — Dmitry Oleynikov, M.D., wrote the book on robotic surgery.

Dr. Oleynikov and his Center for Advanced Surgery Technology colleague, Nathan Bills, Ph.D., edited and contributed chapters to “Robotic Surgery for the General Surgeon,” a new textbook that was released earlier this year.

Dr. Oleynikov, director of CAST, said the book focuses on surgical applications of the DaVinci Surgical Robot, which Dr. Bills called the only FDA-approved robot for the general surgeon.

From outline to publication, the project took two years. Dr. Oleynikov created a list of chapters and he and Dr. Bills contacted national and international leaders in the field to contribute.

“It’s an interesting process, writing an academic textbook,” Dr. Oleynikov said. “Science is always moving, so many textbooks on new technology or new techniques become quickly out of date. My goal was to have this book be the foundation for anybody using surgical robotics for at least the next three to five years.”

The goal, he said, was to provide the general surgeon necessary information on performing robotic surgery procedures by getting contributors to lay out the science behind each procedure — hernia repair, gastric bypass, liver resection, etc. — with the established methods for using the technology.

“This is not just a how-to or a cookbook, but a book that looks at each particular application of the robot as it pertains to that surgeon’s practice,” Dr. Oleynikov said. “So while the robot may change a little bit as they come up with newer models, the disease process, the human body and the approach do not change. You still have to fix that hernia or cut out that cancer.”

The book captures a revolution in approaches to surgery.

“We’re moving from open and laparoscopic surgery now to robotic surgery, and how the robot is used — both properly and sometimes not so properly — is going to define the technology in many ways. So I’m hoping that this book, with chapters from some of the brightest and most inventive experts in the field today and likely into tomorrow, will guide those individuals who are starting to do this kind of surgery, use this type of technology.”

Drs. Oleynikov and Bills are pleased with the final product.

“The book distills the state of the art for every specific kind of surgery, with information from a world expert in that particular surgery,” Dr. Bills said.

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