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.

New Pancreas Disease Clinic Gives Patients New Hope The only clinic of its kind in the region.
Katie Eastman was afraid her pain was just part of living. For five years, the young mother suffered with crippling pain in her midsection. “Horrible pain, debilitating pain, severe nausea,” she says. “It was constant all day long. Eating made it worse, so that became a problem.”

Eastman saw doctors at another hospital. When removing her gallbladder didn’t solve the problem, they sent her to The Nebraska Medical Center where she was seen by the team in the newly-created Comprehensive Pancreatobiliary Disorders and Autologous Islet Cell Transplant Clinic. “The impetus behind starting this clinic was making sure we could offer specialized care for these individuals,” explains surgeon Luciano Vargas, MD.  “These patients have complex problems and often they get left behind.”

Doctors at the clinic diagnosed Eastman’s debilitating pain as chronic pancreatitis. They recommended a transplant, but not a kind Eastman was familiar with. She needed an auto-islet cell transplant, where surgeons remove the pancreas and relocate the islet cells, which release insulin. “We are able to infuse those islet cells into the liver where they retain their function,” Dr. Vargas explains. “It is just housing the islet cells. The islet cells have just changed zip codes if you will. They were in the pancreas, now they’re sitting in the liver.”

For Eastman, hearing the word “transplant” was daunting at first. “Anytime you hear transplant, you freak out a little, obviously,” she says. “But as soon as I walked in and met my surgeon it all subsided. I felt very comfortable, I was ready to get it done. I was tired of suffering. I was like, ‘how fast can we do it?’”
Since her transplant, Eastman has lived a pain-free life she had almost forgotten during her five-year struggle with pancreatitis. “My husband has his wife back, my kids have their mom back and I have my life back, so I couldn’t ask for anything more.”

While the clinic is new, the physicians behind it bring with them years of experience in a number of medical specialties. “Not only do you have a surgeon involved, you have a pancreatic specialist from a GI standpoint involved, you have an endocrinologist involved,” Dr. Vargas says. “So that’s the biggest thing we’ve done. Consolidated these individuals into one place.”

In addition to the specialist physicians in the clinic, there is also a nurse case manager who works directly with each patient. “Prior to coming to this clinic, many patients feel like they’re not being heard,” says Christina Sailors, clinical nurse coordinator at the clinic. “They can’t go to school, they’re missing work and sometimes they’re on disability. They’re really at the end of their rope when they contact us. So to give them hope is really exciting.”

Eastman says she has found that hope and happiness. “When I walked in here, they got to know me as a person, not just me as a patient. I’d recommend this place to anyone. I wouldn’t go anywhere else.”

Watch video:

-Rudy P. Lackner, MD,
thoracic surgical oncologist

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. Rudy P. Lackner, MD, thoracic surgical oncologist, is hopeful that a new screening will help turn those statistics around.

Until recently, about 75 percent of lung cancer cases were found at advanced stages of the disease. Lung cancer found at these stages have a cure rate of 5 percent or lower. “Lung cancers are difficult to diagnose early because most people who develop lung cancer initially lack symptoms that warrant medical attention. It’s not until the disease has progressed, do symptoms such as persistent cough, chest pain, shortness of breath or recurring infections begin to appear,” says Dr. Lackner. The most common diagnostic test had been X-rays, which are inadequate at picking up lung cancer at an early stage.

But new guidelines from the National Comprehensive Cancer Network® (NCCN®) recommend certain high-risk groups can benefit from lung cancer screening with low-dose Computed Tomography (CT) scan.  “A CT scan can detect lung cancer nodules in stage 1A when the cure rate can be as high as 90 percent or more,” says Dr. Lackner. “This is very good news because the five-year survival rate for lung cancer is highest when the disease is still localized, but few lung cancers are diagnosed at this early stage.”

With these new NCCN guidelines, current or former smokers aged 50 years or older with a 20 pack-history could benefit from a CT scan lung cancer screening.  A 20 pack-year history is defined as smoking one pack each day for 20 years or two packs each day for 10 years. This applies even to individuals who smoked in their earlier years and have not smoked for many years. “For those people who fall into this high-risk group, they should discuss the pros and cons of being screened with their primary care doctor,” notes Dr. Lackner.

The Nebraska Medical Center now offers CT scans for lung cancer screening at the Village Pointe Cancer Center. The $250 scan is available for those who meet the above criteria. All screenings are self-pay. Appointments can be made by calling 9-4389 from 8 a.m. to 4:30 p.m.

The chance for long-term survival improves when the medical team involved has a dedicated interest in treating patients with lung cancer. “Determining what should be done if nodules are found is one of the most challenging aspects of this screening,” says Dr. Lackner. “The new type of screening for lung cancer and our team of specialists are accessible to our employees. I am hopeful that both current and former smokers take advantage of the opportunity, which could be lifesaving.”

by Kalani Simpson, UNMC public relations

It seems we are in similar places. Like the U.S., China looks to enact some version of health care reform. It does so in part because, like the U.S., it faces a shortage of primary care providers in rural areas.

And so, nearly 20 physicians from China are in Omaha to take part in a family medicine “training camp” at UNMC.
 

 
-Chinese physicians conduct a simulated child birth in the Sorrell Center’s Clinical Skills Lab as part of a family medicine training camp underway this week at UNMC. 

These doctors already know medicine, said Jeff Harrison, M.D., professor and program director of the Department of Family Medicine, but here, they’ll learn how UNMC teaches physicians how to interact with patients in family medicine settings.

Rural exodus
Qing Yong Ma, M.D., Ph.D., is a surgeon and dean of education at Xi’an Jiaotong University. In China, after eight years of training, many physicians opt to practice in big cities, he said.

It is hoped that perhaps by offering an alternate five-year program, and government support, more might return to their hometowns to practice rural family medicine.

Mindset shift needed
But providers aren’t the only ones who need to change to enact reform. The Chinese countryside has an historic tradition of “barefoot doctors.” Many rural people have the mindset that city physicians are superior when it comes to modern, educated care. This leads to travel, back-ups, long waits.

New rural family practice docs must win the trust of their potential patients, Dr. Ma said.

A place to practice
They practice those skills here, thanks in part to Problem Based Learning exercises. Paul Paulman, M.D., assistant dean for clinical skills and quality in the UNMC College of Medicine, praised the doctors’ ingenuity: “You took over the teaching,” he said.

They are hoped to be the seeds in a project that would eventually train 10,000 doctors in family practice techniques.

How would you deal with that?

One role-playing exercise had a physician visit an angry “patient” who insisted she be given antibiotics. The young woman to portray the patient seemed a friendly, effervescent, girl-next-door type. How could she do angry?

But at “go,” she started to berate the doctor in a Chinese dialect. The assembled class roared with laughter and a spirited discussion soon followed. How would you handle that? What should have been done?

It was clear in any language: The adjustment to a new future in primary care won’t be easy, in either country. But at UNMC, both countries will do everything possible to be ready for anything that comes.

Clinic is the only one of its kind in the Midwest

Charlene Stehlik had accepted the pain as part of her life. For more than 20 years, the pain was a constant, daily fight.

“I had a bleeding ulcer 26 years ago,” Stehlik says. “I just figured it was part of that.”

She describes it as feeling morning sickness every hour of every day. It grew progressively worse. She says her gastroenterologist couldn’t understand why it kept getting worse. He sent her to The Nebraska Medical Center where she was diagnosed with chronic pancreatitis.

Patients with disorders like hers can now be treated by the team in the newly created Comprehensive Pancreatobiliary Disorders and Autologous Islet Cell Transplant Clinic.

“The impetus behind starting this clinic was making sure we could offer specialized care for these individuals,” explains Luciano Vargas, MD, surgeon at The Nebraska Medical Center. “These patients have complex problems and often they get left behind.” That’s how Stehlik felt. She couldn’t play with her five grandchildren. Some days were spent curled up writhing in pain. She knew nothing but constant pain.

After finding the source of her pain, she learned the treatment was something she never imagined: an autologous islet cell transplant.

“He said, ‘I think we can fix this,’” Stehlik remembers. “If it would give me back my life that’s what I wanted. That’s why we opted for it.”

Islet cells produce insulin from inside the pancreas. During a transplant, the patient’s pancreas is removed, and its islet cells are relocated.

“We are able to infuse those islet cells into the liver where they retain their function,” Dr. Vargas explains. “It is just housing the islet cells. The islet cells have just changed zip codes if you will. They were in the pancreas, now they’re sitting in the liver.”

Since her transplant, Stehlik has rediscovered “normal;” living pain-free in a way she had not done in more than 20 years.

“I no longer get up worrying about how I’m going to feel this morning,” she says. “I no longer wonder, ‘Can I have a cup of coffee or is it going to make me sick?’”

While the medical center’s clinic is new, the physicians behind it bring with them years of experience in a number of medical specialties.

“Not only do you have a surgeon involved, you have a pancreatic specialist from a GI standpoint, and you have an endocrinologist involved.” Dr. Vargas says. “We have consolidated these individuals into one place.”

In addition to the specialist physicians in the clinic, there is also a nurse case manager who works directly with each patient throughout his or her treatment.

“Prior to coming to this clinic, many patients they feel like they’re not being heard,” says Christina Sailors, RN, clinical nurse coordinator at the clinic. “They can’t go to school, they’re missing work, and sometimes they’re on disability. They’re really at the end of their rope when they contact us. So to give them hope is really exciting.”

Charlene Stehlik says she has found that hope and happiness.

“All the doctors here at the med center, all the nurses; I’ve told them so many times; thank you thank you thank you.”