Archive for the ‘Articles’ Category

Surgeon’s Legacy Continues, 45 Years after First Kidney Transplant in Nebraska

Richard Steenburg, MD was destined to be a physician from the time he was a child, following in the footsteps of both his father and his grandfather. “My grandfather was a horse and buggy doctor who provided health care for a 60-mile radius covering most of the middle of the state of Nebraska. My father was a Harvard-trained general surgeon,” he recalls.  “From an early age, all I ever thought about doing was becoming a surgeon. In fact, by 10 years of age, I would go after school and observe my father in surgery.”steenburg2

Richard Steenburg, MD (left) performed the first kidney transplant in the state of Nebraska. In his 17-year career at Clarkson Hospital, he performed more than 500 transplants.

 

A graduate of Aurora Public Schools, Dr. Steenburg attended Stanford University, Harvard Medical School and completed his surgical training at the Peter Bent Brigham Hospital. Early in his career, he served on the faculty at Johns Hopkins and became chief of surgery at Baltimore City Hospital, as the first transplant program in Maryland was developed. In 1970, he moved back home to Nebraska, where he built a transplant program from the ground up, and where his education, training and passion continue to have an impact on patients and families today.

“He trained with the best of the best. It was amazing he was willing to come back to the Midwest and get the program started,” says Tavi Baker, who worked for Dr. Steenburg in the 70s and 80s and continues to serve as a nephrology coordinator at Nebraska Medicine.

“He taught us everything. You watched and listened; he talked and explained,” remembers Mary Ellen Krobot, a kidney/pancreas transplant coordinator, who also worked with Dr. Steenburg throughout his 17-year career at Clarkson Hospital. “It’s how I learned the basics. He was a great teacher and wanted people to understand what’s going on.”

Much has changed since 1970, when Dr. Steenburg performed the first kidney transplant in Nebraska. “At the time local surgeons weren’t trained in the proper technique of recovering organs,” he says. “On many of the first transplants, I would fly or drive to hospitals in outlying areas and recover the organs.” Once the kidneys were tissue typed, the team would identify the most appropriate recipients and have them come to the hospital. Then, the patients would receive dialysis, a blood transfusion and be prepared for surgery. “The typical transplant usually took about three hours. Between recovering the organs, preparing the patients and then transplanting the kidneys into the recipients, it wasn’t uncommon to work 24-30 hours straight,” Dr. Steenburg says.

All the work was completed without modern electronic health records – or even computers. Baker and Krobot remember sorting through handwritten lab results and communicating with typed letters. Paper flow sheets were hanging on the walls outside patients’ rooms and Dr. Steenburg memorized many of each patient’s details. “All of the patient information, drug therapies and lab work was kept in paper copy in the patient’s chart,” he says. “But many subtleties of managing a patient were done using one’s head.”steenburg1

Richard Steenburg, MD with transplant coordinators Mary Ellen Krobot and Tavi Baker in 1989. Krobot and Baker continue to work at Nebraska Medicine, and describe Dr. Steenburg as a dedicated surgeon and teacher.

 

Before Dr. Steenburg retired in 1987, he performed 501 kidney transplants. Many of the transplant patients are still living, including some of the first patients from 1970 and his final transplant patient, who received a kidney in April 1987. “Historically, patients with renal failure requiring dialysis were kept on dialysis until their insurance ran out. We were able to provide these very needy patients a chance to live,” he says.  Because of Dr. Steenburg, teens were able to go to college, women were able to raise their families and older people were able to meet their grandchildren.

Dr. Steenburg’s impact continues to be strong today, as Nebraska Medicine treats more than 1,500 functioning kidney/pancreas patients following their transplants. Hundreds more are impacted by the Nebraska Organ Recovery System, which serves all of Nebraska and Pottawattamie County, Iowa. The basis of the nonprofit organization started in a closet of Dr. Steenburg’s operating room. Now, it handles the recovery, transportation and distribution of all organs and tissue for transplantation in the area.

Nearly 30 years have passed since Dr. Steenburg’s retirement, one thing that hasn’t changed – his patients adore him. “They looked at him as their lifeline,” says Baker. Children drew pictures of him, patients continue to ask about him and many participated in a card shower in honor of his 75th birthday fifteen years ago. “Patient satisfaction is probably the best indicator of performance. Hearing from so many patients so many years later led me to believe that we provided a high standard of patient care,” says Dr. Steenburg. That standard of care continues to be Dr. Steenburg’s legacy, more than four decades after his first, ground-breaking kidney transplant in Nebraska.

How Breast Cancer Research Saved My Life

In September 2015, Janet Tinney was diagnosed with breast cancer.

In September 2015, Janet Tinney was diagnosed with breast cancer.

As you listen to the news, read the paper, check Facebook or talk to others, you’re frequently made aware of someone that’s been diagnosed with cancer. You think about them often, pray for them and their family, but then go on with your day-to-day life. Until that one day, when you’re the one receiving the devastating phone call. Where they ask you to come back in – because something doesn’t look right.

Janet at her chemotherapy treatment.

Janet at her chemotherapy treatment.

Over the years, due to very dense breast tissue, I’ve had many calls asking me to return for further testing following a mammogram. I’ve even had a couple biopsies and other procedures. Fortunately, each time the extra tests were performed, I received a phone call with good news that everything was benign – until September of 2015. That’s the year I received a phone call, informing me I had breast cancer.

For the first few minutes, I was stunned and speechless. Then the tears came. My emotions got the best of me. Until you’re the one getting that phone call, you never truly know what it’s like. My father passed away due to cancer. I spent nearly two years going to appointments and treatments, waiting through every surgery. Even though the experience with my dad was unpleasant in the end, I knew I had been given the knowledge and strength to deal with my own cancer battle.

As a caregiver, my first thoughts were about my husband and children. I knew this situation would be tremendously stressful for them. At the time, I felt helpless, but knew my family and friends would be my rock.

The day I was diagnosed with cancer, I was sent to a local surgeon in North Platte, Nebraska. He was incredible, but knew I needed to see the very best.

I was referred to Nebraska Medicine surgical oncologist Edibaldo Silva-Lopez, MD, PhD. During the first visit with Dr. Silva in Omaha, I barely let him speak before peppering him with questions about my future. Did I need to get my things in order? If so, how long did I have? He looked me straight in the face and said, “that is not even a concern for you.” He was certain I would survive. My heart danced!

Edibaldo Silva-Lopez, MD

Edibaldo Silva-Lopez, MD

Dr. Silva’s recommended treatment plan for me was newly approved, but research showed the results were very positive. Within the next couple weeks, we began treatment at the cancer center in North Platte. Everything started to happen just like Dr. Silva said it would. He anticipated my cancer journey would be about a year long, barring any complications.

But, after two rounds of chemotherapy, we were in for quite a surprise. During an ultrasound of my breast, the tumor was nowhere to be found. My radiologist was completely shocked. What a happy day!

I completed two more rounds of chemo, followed by a regimen of drugs. In January, Dr. Silva performed surgery, removing a margin of tissue where the tumor once was, along with 17 lymph nodes. About a week later, I received a phone call from Dr. Silva’s nurse, Carol, telling me all the tests performed on the removed tissue and lymph nodes were negative for the cancer! The treatment plan Dr. Silva gave me worked.

When this journey began, my husband and I both prayed for a miracle. That miracle was not for the cancer to just go away, but for me to be directed to the right physicians with the knowledge to cure my disease. In my opinion, my prayers were answered and my miracle was granted. Without cancer research and the dedication of physicians who put it to use, who knows where my journey would have led. But, because we are fortunate enough to have these services in Nebraska, I am able to look forward to a bright future.

I now pray for a financial miracle so that breast cancer research can continue to evolve at the Fred & Pamela Buffett Cancer Center for many, many years to come. I am living proof that this research does make a difference.

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Computer Aided Detection: New tools to help your doctor find cancer

Neil Hansen, MD

Neil Hansen, MD

Prostate and breast cancer are two of the most common cancers around. Unfortunately, most people know someone who has one of these. Many doctors have spent their careers trying to design screening tests to find these tumors at an early stage when they are still curable. This usually means finding them when they are really small. That sometimes means smaller than a pea.

So, how do we find these cancers? For breast cancer, the standard screening exam for years has been mammography – taking an x-ray of the breast and looking for cancer. Recently, Nebraska Medicine Radiology has adopted a fancier version of this – tomography—which is a 3D x-ray. On mammography, finding cancer can be tough. It can be seen as only a few tiny dot sized areas of calcium—little blips of white on the screen. To help find these doctors use computer aided detection (CAD). This is a computer program that takes the mammogram and identifies these calcifications. Studies have shown that these programs allow doctors to find earlier cancers better, especially younger and less experienced doctors.

While CAD has been used in mammography for years, it is relatively new for looking at prostate cancer. Screening for prostate cancer has been controversial, but traditionally has relied on physical exam (the finger / glove test frequently dreaded by men) and a lab test called Prostate Specific Antigen (PSA). If one of these is abnormal, that leads to a biopsy. In the prostate, biopsies are often randomly aimed because we don’t know where the cancer is. If one of the biopsies is positive then you know there is prostate cancer, but not necessarily its stage. If the biopsy is negative, then the tumor might have just been missed. This is where prostate magnetic resonance imaging (MRI) comes into use.

Prostate MRI uses a powerful magnet to take pictures of the prostate. It is sometimes hard to differentiate cancer from an old infection on MRI. This is where CAD is used. We recently acquired DynaCAD at Nebraska Medicine Radiology. It is a new tool where a computer program helps us identify cancer based off of blood flow in the prostate and other imaging parameters. A similar program has been in use for breast MRI, and we just acquired the latest software package for this as well. Our use of these doesn’t cost patients anything extra. The goal in the future is to use this program to do targeted prostate biopsies of suspicious areas and avoid randomly missing tumors.

These exciting new products will help us find early stage curable cancers. They aren’t perfect though and still require an expert radiologist to interpret their findings. At Nebraska Medicine Radiology, our specialty trained radiologists are committed to apply our expertise and all tools available to provide extraordinary care to our patients.

Look How Far We’ve Come!

Cancer-Center-Nov.-20[1]Our skyline is changing! The photo to the left was taken Nov. 20, 2015 of the Fred & Pamela Buffett Cancer Center. It’s a dramatic comparison to the next photo, which was taken on July 15.

The new cancer facility, which is expected to open May 2017, will ensure Nebraskans and patients throughout the region will have convenient and quick access to the latest breakthroughs in cancer therapy.A joint project of Nebraska Medicine and UNMC, the Fred & Pamela Buffett Cancer Center will include three areas dedicated to cancer: a 10-story, 98-laboratory research tower named the Suzanne and Walter Scott Cancer Research Tower; an eight-story, 108-bed inpatient treatment center named the C.L. Werner Cancer Hospital; and a multidisciplinary outpatient center.

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After Losing My Husband to Cancer, Nursing Saved My Life

Sara-nurse-OHSCUSara Weging is a nurse on the Oncology Hematology Special Care Unit at Nebraska Medicine.

I always knew I was meant to help people, but it wasn’t until I met a very special person that I was able to recognize how I was supposed to achieve that goal.

As a new undergrad, fresh out of high school, I felt that the world was completely open to me. I could do anything I set my mind to – what I wanted to do was nursing.

Luckily, my university had a week immersion program for perspective nursing students to make sure that nursing was the correct fit. By the end of the week, all twenty students were sitting around a large oak table going on and on about how nursing was the career for them. When it got to be my turn to speak, all I could muster was an emphatic, “No way!” I could not fathom the thought that I would be responsible for another human life. I had just graduated high school, moved out on my own and was expected to take care of myself for the first time. I was in NO WAY ready for the huge responsibility that is nursing.

So, I pushed nursing to the back of my mind and moved on to other pursuits. Fast forward fours years later, I was a new graduate moving to Chicago and ready to take on the world. Life in Chicago was not easy, but it was new and exciting. I craved adventure. Adventure found me in many ways, but the best way by far was in the form of my amazing husband, James. It didn’t take long for James and I to find adventures of our own and for both of us to enjoy the city in new and exciting ways. Whether it was touring the different neighborhood festivals, taking in a White Sox game or simply sitting on the great lawn in Millennium Park, life was great and neither one of us wanted it to change.

Right before Thanksgiving 2011, we received a phone call that forever changed our lives. James, when he was sixteen, was diagnosed with Acute Lymphoblastic Leukemia (ALL). He underwent treatment with chemotherapy and by the time we met, he was five years into remission. Unfortunately for us, that Thanksgiving would not be a day of thanks, but a day of worry and dread.

After a routine clinic visit, James received the call that his cancer had returned. Together, we returned to the life that he thought he was done with. This new world of clinics and hospitals was completely foreign to me. To turn and run would have been all too easy and honestly, expected. But, James handled everything with such courage. Every time he would look at me with his big blue eyes, all I could feel was the enormous amount of love I had for him. He was my sun in a sky full of dark clouds.

So, I charged forward and did everything in my power to help James. I didn’t want him to feel like he was “the man with cancer,” yet again. At first, it was the small things – taking him to clinic visits, making sure we had food in the apartment that he had an appetite for, keeping the apartment clean and just trying to keep our lives as normal as possible. Making cancer something that was a part of our lives – but not the thing that defined it.

Sara-and-James

Sara’s husband, James, lost his battle with leukemia in 2012.

As time when on and treatment continued, James grew increasing sick. I decided to take time away from my day job and become his full time caregiver. This was not an easy decision to make, but it was killing me to be away from him. James would have to stay in the hospital for multiple days and he would never say it, but I could always see it in his eyes – he hated to see me leave.

Soon, I was learning how to clean and dress any wounds that he may acquire, how to hook him up to hydration when he was getting to dehydrated, mix medications together, keeping track of more pills than I had ever seen and how to give shots. This was a world that I had once envisioned for myself, but in a very different setting. It alarmed me at how comfortable I had become in such a short amount of time. I felt myself watching the nurses to see how they interacted with patients and how they performed certain tasks. The nursing staff quickly became more like friends than anything else. They were people that I could openly share my fears, share plans for our future and truly anything that was on my mind. They were the ones that were there during the hard nights, holding my hand and giving me words of encouragement.

The nursing staff was with James and me until the every end. At 8:52 a.m. on August 12, 2012, James took his final breath. After only two and a half years together, I had to tell the love of my life goodbye.

After James died, I was a wreck. I couldn’t eat or sleep. All I could do was sit and cry. Cry over not only losing the love of my life, but also losing my future – a future I desperately wanted. I felt like I was drowning and everyone around me was just watching me struggle as they continued on with their lives. Life for me continued in this fashion for about two years. Once I started to come out of the fog that was now my life, I couldn’t figure out what to do. What next? Surely, I couldn’t live in my mother’s basement for the rest of my life, curled up in blankets that were saturated with tissues and stained from tears.

It was at this time that I remembered nursing. I remembered taking care of James for all those months and not only loving the fact that I got to take care of him, but knowing that I wanted to do that for others as well. I vowed that I would give anything I had left to other families going through exactly what I had gone through – hopefully making James proud along the way.

I applied for the accelerated nursing program at Creighton University and within a year’s time, I was Sara Weging, BSN, RN. I started working in the Oncology Hematology Special Care Unit (OHSCU) at Nebraska Medicine – Nebraska Medical Center. I could not ask for a more perfect job.

Being in the OHSCU is oddly comforting and feels a little like home. Not only being able to take care patients at the most vulnerable points in their lives, but being able to bond with the families. I love it when my experiences are able to be shared and help others that are in similar situations as I was. I truly believe the patients and families on OHSCU are a very special group of people. It’s a gift when I can tell them I know exactly how you feel. They are not alone.

There are still days when I feel very lost. When something funny is on TV, or a special song plays on the radio, I find myself turning to talk to James about it. Then there are days that I wake up and pray it was all a bad dream. When I realize it’s not, I feel like I have lost him all over again.

It has been really hard to live each day like I know James would want me to. He wouldn’t want me to cry over him. He would want me to go on living and he most definitely wouldn’t want me to give up on my dreams. Nursing is slowly bringing me back to life and helping me realize that it is okay to move forward. Life doesn’t stop moving just because I fell off the ride

Mother Hears Son’s Heart Beating for First Time in Three Years


April is National Donate Life Month, a time to raise awareness about organ donation and celebrate those who have given the ultimate gift of life. On April 1, a unique event took place at Nebraska Medicine – Nebraska Medical Center involving heart transplant patient Terry Hooper and his donor’s family.

In June 2003, Hooper was diagnosed with cardiomyopathy, a disease of the heart muscle in which the heart loses its ability to pump blood effectively. In April 2005, doctors at Nebraska Medicine discovered Hooper’s aortic valve was leaking – something that had probably gone undetected since birth. He underwent an aortic valve replacement, but his heart was still only functioning at 30 percent. By August 2012, his heart function had declined to 5 percent and he was placed on the transplant waiting list in October of that year. After being on the list for 52 days, Hooper received a heart transplant on Dec. 10, 2012.

Lisa and Terry Meet
On April 1, Lisa Swanson met Terry Hooper, the Nebraska Medicine patient who received her son’s heart.

At the time, Hooper had no idea his donor was 18-year-old Levi Schulz of Horace, N.D. Levi was killed in an automobile accident Dec. 7, 2012. His body was kept on life support so that his organs could save others.

In the spring of 2013, Hooper wrote a letter to his donor family. That May, he received a letter from Levi’s mom, Lisa Swanson. Over the years, they continued to correspond, but never spoke on the phone or met face to face.

Lisa-and-Terry-meet

On Friday, April 1, Hooper met Levi’s mom and twin brother, Shelby Schulz, for the first time.

The family got to see and hear Hooper’s heart beating through an echocardiogram. At the end of the meeting, Hooper surprised Swanson with a HeartBeat Bear that had a recording of his heartbeat.

Nebraska Medicine is home to one of the most reputable and well-known organ transplant programs in the country. It’s one of a few institutions nationwide to offer all solid organ transplants under one roof.

Nature study suggests pathway to possible HIV-1 cure

Kalani Simpson

Fletcher011Courtney Fletcher, Pharm.D.

An international team of scientists – among them Courtney Fletcher, Pharm.D., dean of the University of Nebraska Medical Center College of Pharmacy – this week published a study in the journal Nature, which shows findings that suggest a pathway to a possible cure for HIV-1 infection. The print edition of the journal hits newsstands today (Thursday).

The work builds upon a 2014 publication in the Proceedings of the National Academy of Sciences, of which Dr. Fletcher was first author, which investigated the question of why, despite being driven to undetectable levels in blood by powerful antiretroviral drugs, HIV is never fully wiped out in patients with the disease.

In that study, Dr. Fletcher and colleagues found that a much lower concentration of the drugs made it to lymph node and lymphoid tissues, allowing viral replication – and persistence – of reservoirs of HIV in those tissues.

Finding out why low levels of HIV were hanging on, “for the first time allowed us to have a scientific-based conversation about a cure – is it possible?” Dr. Fletcher said.

This latest study takes it a step further – and finds that while the levels of drug concentration that make it to those tissues are too low to wipe out HIV, the virus also has not developed a resistance to those drugs, as might usually be expected. In the current paper, the authors suggested this is likely because the levels of the drugs are so low, there was no reason for the virus to develop resistance.

“In simple terms, we think there is no evolutionary advantage to have developed a resistance,” Dr. Fletcher said.

And if it has no drug resistance, the scientists may have found a pathway to a possible cure.

“Can we deliver more drug to these tissues and see if we can shut down replication?” Dr. Fletcher said. That’s the next problem to solve.

“Will this cure HIV? No one knows,” Dr. Fletcher said. “But it is a very rational, evidence-based approach.

“This is a problem that we are extremely well positioned here at Nebraska to address. We think this problem of ongoing viral replication in lymphoid tissues may be solved by enhanced drug delivery, and that’s something that we here at UNMC are really good at.”

Already, Dr. Fletcher has a significant grant application in with the National Institutes of Health, and he is optimistic that UNMC will be tasked with finding a way to deliver enough drugs to the hard-to-reach places where the last remaining bits of HIV hide out.

“We believe we are one of the few places in the country – with some help from experts in virology around the country,” he emphasized – “to do this work.”

An international collaboration

Dr. Fletcher stressed that it took an international collaboration of top-notch academic medical centers, each bringing its own world-class expertise, to take on a project like this.

For example:
• Investigators at the University of Minnesota, with which Dr. Fletcher has long collaborated, recruited the patients into the original study, obtained the plasma and tissue samples, and measured the amount of virus in the tissues;
• Northwestern University researchers explored the evolution of the HIV virus;
• University of Oxford scientists took the lead on the mathematical side; and
• Researchers at the University of Edinburgh, in Scotland, brought to life the story of how the virus changes its genetic makeup.

Investigators at the Fred Hutchinson Cancer Research Center, in Seattle, the University of Porto, in Portugal, the University of California, San Diego, Korea National Institutes of Health, and King’s College London also made crucial contributions.

Dr. Grant elected councilor-at-large for ASTS

By Tom O’Connor, UNMC public relations

Grant0609Wendy Grant, M.D.

Wendy Grant, M.D., a transplant surgeon for UNMC/Nebraska Medicine, has been elected councilor-at-large for the American Society of Transplant Surgeons, an organization that includes more than 2,000 transplant surgeons, physicians, scientists and allied health professionals from around the globe.

Dr. Grant has been active in ASTS since 2005. She is currently chair of the Fellowship Training Committee, which is responsible for overseeing the accreditation of all transplant surgery fellowship training in the U.S. She also serves as co-leader of the Exam Development Group and as a member of the Certification Task Force.

“I am just delighted for Dr. Grant,” said David W. Mercer, M.D., professor and chair of the UNMC Department of Surgery. “This signifies a logical extension of her recognition by the ASTS and is richly deserved. It also represents continued recognition by the ASTS for our transplant team at UNMC/Nebraska Medicine, as our faculty have held many prestigious officer positions within the organization. I would anticipate Wendy climbing the ladder too as her star continues to shine brighter and brighter in academic surgery.”

Alan Langnas, D.O., professor of surgery-transplant at UNMC and chief of the Transplant Center at Nebraska Medicine, served as president of ASTS in 2014.

“Dr. Grant has been a national leader in transplantation for many years and is so deserving of being elected by the membership of the ASTS to its council,” Dr. Langnas said. “The ASTS and UNMC/Nebraska Medicine are fortunate to have an individual of her skills and vision help move the field into the future.”

Dr. Grant, who is professor, surgery-transplant, at UNMC, also serves as assistant dean for student affairs and chair of the curriculum committee for the College of Medicine. She was one of the leaders in the College of Medicine’s recent reaccreditation by the Liaison Committee for Graduate Medical Education. She also has been one of the individuals tasked with pushing forward a curriculum redesign for the medical school.

The ASTS is dedicated to excellence in transplantation surgery. Its mission is to advance the art and science of transplant surgery through leadership, advocacy, education, and training.

Nebraska Medicine Offers Cure for Hepatitis C that is 95 Percent Effective

Mark-Mailliard-Gastroenterology-2014-300x268

Mark Mailliard

Mark Mailliard, MD, chief of Gastroenterology and Hepatology at Nebraska Medicine and director of the Hepatitis C Clinic, discusses exciting new treatments for Hepatitis C.

Is there an actual cure for hepatitis C? How effective is this drug cocktail?

Instead of “cure,” I like to use the word “eradicate.” With the drugs we have now, we can eradicate the hepatitis C virus without risk of recurrence or reactivation. You would have to be infected again to acquire the virus.

With hepatitis C, your body does not build immunity – unlike with other viruses. So our goal is to kill the virus in your system. That might be considered a cure, but because you can acquire the infection again, it’s a little different than mumps, for example. Once you’ve had mumps, you are immune – in essence, “cured.”

But, the good news is – with these new medications, we estimate that up to 95 percent of hepatitis C patients can get rid of the virus. Not everyone, because of certain factors. But just about everyone. That’s amazing news!

What drugs are part of this new treatment?

The new drugs are Sovaldi, Harvoni, Olysio, Viekira, Daklinza, Technivie. Sovaldi (sofosbuvir) is the big wonder drug – and it is quite an advancement. This drug has a unique mechanism that prevents the hepatitis C virus from replicating. That’s medical-speak for “stops the virus in its tracks.” If the virus can’t produce new strands of virus, it’s dead in the water. Production halted. The virus goes away. This drug is incredibly effective and amazingly safe. People have little to no side effects. It’s a walk in the park compared to previous hepatitis C drugs. My patients love it!

How it works is interesting, as this drug blocks a “gate” we haven’t used before, similar to a gate to your backyard. These gates are composed of molecules called nucleotides. This drug blocks a “gate” called the NS5B nucleotide – which prevents the virus from multiplying in the body.

This time, the drug developers nailed it. The patients who have taken this new drug — Sovaldi – can’t believe the difference. They are absolutely delighted! Further good news, this drug works for most people.

For patients with the genotype 1 strain of hepatitis C, we prescribe Harvoni (ledipasvir/sofosbuvir) which is a combination drug that includes Solvadi, and is the preferred option with practically no side effects.

Another option – the Viekira Pak – is four medicines combined which patients take twice daily. Some patients will add a Ribavirin pill with this Pak, which adds up to 9 to 10 total pills per day.

That may sound like a lot of pills, but it’s still far fewer than in the past. And with virtually no side effects — this really is a critical improvement.

How long have these drugs been available?

Solvadi became available in December 2013; Harvoni in November 2014; Daklinza in July 2015 (yes, very recently); the Viekira Pak since January 2015. As you can see, these are indeed very new medications. We’re intent on getting them to our patients ASAP.

Do I have to make several trips to Nebraska Medicine for treatment?

Actually, there are only two or three times when you need to come to the clinic.

If you’re just getting tested for hepatitis C infection, you will come for an initial blood test. Some patients have had this initial testing elsewhere and come to us for confirmation and treatment.

If there is evidence of infection, you’ll come in for a second test to confirm the diagnosis – and to determine the virus count in your blood. That tells us how aggressive your infection is. You will also get an ultrasound of your liver at that appointment.

After those initial two visits for testing, you’ll come back to talk about treatment. You’ll get your prescription at that third visit.

Once you’ve got your prescription, you’re on your own! There’s no need to return for check-ups, or anything like that. We’ll stay in touch with you via phone calls, to make sure everything is going smoothly. And, of course, you can always call us with questions. Our goal is to help you get rid of this virus, and to make your treatment as smooth as possible. Whatever we can do to help with that, we are happy to do.

Who should get tested for hepatitis C virus? Why is it necessary to get treated?

People born between 1945 and 1965 are encouraged to get tested since many don’t recognize they are at risk for the disease. A simple blood test can diagnose the disease.

Not only will treatment reduce the chance for liver failure and liver cancer, the diagnosis reminds patients of the danger of alcohol use and obesity, which increase the risk of getting cirrhosis and cancer.

New Solutions for Congestive Heart Failure

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As one of the largest heart failure centers in the U.S., Nebraska Medicine is participating in a nationwide clinical research trial of an investigational LVAD called HeartMate 3.

For patients with advanced congestive heart failure, the heart is weak and unable to keep adequate blood circulating in the body, resulting in symptoms such as fatigue, shortness of breath and weight gain.

If that describes you, or someone in your family, you know that medications can help. A heart transplant is another possibility. Also, a Left Ventricular Assist Device (LVAD) can assist the heart, either long-term, or until a heart is available for transplantation.

As one of the largest heart failure centers in the U.S., Nebraska Medicine, is participating in a nationwide clinical research trial of an investigational LVAD called HeartMate 3, IRB#344-15-FB.

Nebraska Medicine began enrolling patients in July 2015, and is still enrolling patients. Nationwide, 59 hospitals are participating in this trial – and will enroll 1,028 patients total, who will be followed for up to two years.

Details about the device

The first LVAD device was developed originally in the 1980s. The device circulates blood throughout the body when the heart is too weak to pump blood on its own. It is sometimes called a “heart pump” or “VAD.”

HeartMate II® is the second version of this device — a smaller version of the LVAD that is implanted in the chest, and has been a real breakthrough in medical technology. This device has rapidly become the most widely used device of its kind in the world.

The HeartMate 3 is the newest generation of LVAD – designed to work at slower speeds and hopefully prevent blood cell breakage. The MOMENTUM 3 trial is designed to evaluate the safety and effectiveness of the HeartMate 3 by determining whether the HeartMate 3 has similar outcomes to what we have seen with the HeartMate II. While the HeartMate 3 was designed in an attempt to negate some of the side effects that are seen with the HeartMate II, this is not the primary intent of the trial; however, it is something that will be evaluated.

The design of the Heartmate 3 pump will theoretically allow the pump to “wash itself out,” potentially reducing the risk of clot formation within the pump. Also, because the pump is designed to prevent blood cell breakage, it is theorized that the patient may have a lower risk of complications of blood cell breakage.

Nebraska Medicine is very excited about participating in the MOMENTUM 3 trial and expects that all patients will be enrolled nationwide by this summer.

Who participates in the trial?

Patients with severe congestive heart failure, who are either candidates for heart transplantation or need the device for long-term therapy, may be eligible for the research study.

In this research study, eligible patients will receive either a HeartMate 3 or HeartMate II pump. The research study team will monitor participants’ quality of life, heart function, device function, need for hospitalization or another surgery – as well as survival and other factors. Collecting outcomes data such as this will help assess the device’s safety and effectiveness.

Results of this research study are not expected to be released until enrollment is complete and all the data is collected and submitted to the U.S. Food and Drug Administration (FDA). Certainly, the HeartMate II has been a great success – so we are excited to see what the data from the MOMENTUM 3 trial will show.

Is it time to speak with a cardiologist about your heart disease risks? To make an appointment with one of our advanced heart failure specialists, please call 1-800-922-0000.

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