Archive for the ‘Articles’ Category

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.7-19-Cancer-Center-picture-from-July-151-300x225

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’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.


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

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


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.

New service for sickle cell disease patients

by Vicky Cerino, UNMC public relations

Martin0531Jacinta Mwita and her son, Martin.

A patient’s story

Eleven-year-old Martin Mwita, of Omaha, has made more than 300 visits to health care facilities since he was a baby. Because of sickle cell disease, he’s suffered three strokes and countless other health episodes.

Jacinta Mwita, Martin’s mother, said the therapy improves the quality of the family’s life.

“The difference in his health since changing from transfusion to red blood exchange is incredible,” said Jacinta Mwita, a single mom who works full time. “The best they could get his sickled red cells down to before was to 50 percent. Now it’s 5 percent.

“The longer intervals in between treatment will be one of the biggest benefits of finding more life balance, so we don’t have to take much time away from everything else, especially school. It’s not just him, it’s everyone,” Jacinta said.

She is thankful to the blood donors who have improved not only Martin’s quality of life, but his family’s too. Though the family doesn’t know the identity of the donors who live in various states, the Red Cross contacts 20 who donate blood specifically to Martin because their blood matches Martin’s at a more complex level than just blood type.

“Isn’t that amazing? It’s incredible that someone we don’t even know would do this. I would love to meet them and say ‘thank you,'” she said. “I thank the staff and particularly those in the Lied Transplant Center. The nurses are incredible and the doctors care. Martin has practically grown up at the unit and they all know him by name.”

A therapy now available through Nebraska Medicine and UNMC will significantly reduce the risk of stroke for children with severe sickle cell disease.

The medical center recently began offering the state’s first pediatric chronic red cell blood exchange in conjunction with the American Red Cross.

Sickle cell disease can lead to many complications including stroke, chronic leg ulcers, frequent pain crises and blood clots. It can result in an increased susceptibility to infection. About 1 in 600 African-Americans has sickle cell disease.

Those who could benefit from the therapy are children and adults with a history of stroke or those whose imaging tests show a high risk of stroke. Newborns are screened for sickle cell disease and those found with the disease are screened yearly for potential strokes beginning at two years of age.

Physicians involved in the new service are Sara Shunkwiler, M.D., Scott Koepsell, M.D., Ph.D., and James Harper, M.D.

“Red cell exchange is not only an iron neutral procedure, it also can more quickly and more efficiently decrease the percentage of a patient’s red blood cells that are sickled,” said Dr. Shunkwiler, assistant professor, UNMC Department of Pathology and Microbiology and medical director of Blood Bank and Tissue Services at Nebraska Medicine. “This is the first time that chronic red cell exchanges for pediatric patients have been performed in this area.”

For sickle cell patients who have already had a stroke, frequent blood transfusions (chronic transfusion therapy) can decrease their risk of having a second stroke by as much as 90 percent. However, frequent transfusions can lead to a buildup of iron in the body which can lead to organ damage and eventually organ failure.

Shunk0531Sara Shunkwiler, M.D. 

Red blood cell exchange offers the risk lowering benefit of frequent blood transfusions without increasing the iron stored in the body. Patients are connected to an apheresis machine which removes sickled red cells and replaces them with normal red cells from donors.

Patients typically have red blood exchanges every three to four weeks that usually takes two to three hours.

This is in contrast to chronic transfusion therapy which is required as frequently as every other week, takes most of a day to complete and can cause scar tissue, making it difficult to get and maintain good vein access.

Dr. Shunkwiler collaborates with Dr. Harper to identify children who need the service. Dr. Harper is a UNMC associate professor and pediatric hematologist/oncologist at Nebraska Medicine and Children’s Hospital & Medical Center.

Three Heart Transplants in 34 Hours

When transplant surgeon John Um, MD, walked into Nebraska Medicine – Nebraska Medical Center the morning of April 11, little did he know, it was the start of two very long days. By the evening of April 12, Dr. Um had performed three heart transplants in 34 hours – a personal best for himself and the transplant team at Nebraska Medicine.

“The surgeries were pretty long. About six to eight hours each,” describes Dr. Um.
three heart transplant recipients in 34 hours and their doctor


From left to right: Harvey Brandy, Lucas Kollars, Curt Spethman and Dr. John Um

It all started with 24-year-old Lucas Kollars of Arlington, Neb., who was found unresponsive at home by his mother. After receiving a left ventricular assist device (LVAD) and a right ventricular assist device (RVAD), Kollars was on the heart transplant waiting list for 58 hours.

“Dr. Um said I had about two more days to live,” says Kollars.

Twelve hours after finishing Kollars’ heart transplant, Dr. Um started on the second one. The patient was 57-year-old Harvey Brandy of Omaha. Brandy’s heart problems began several years ago with a heart attack. After receiving a stent and pacemaker, Brandy’s name was placed on the transplant waiting list. It took three days to find a match.

“At the time, I was feeling really, really bad,” says Brandy. “My heart was only functioning at ten percent.”
heart transplant


While Dr. Um finished Brandy’s procedure, 60-year-old Curt Spethman of Omaha was being prepped for surgery. Spethman’s heart issues were fairly recent, but progressing quickly. His name was only on the transplant waiting list for five days.

“I was amazed at how fast it happened,” says Spethman. “You’re scared, but then you go – ‘I’m getting a heart. A second chance.'”

At 10:40 a.m. on April 12, Dr. Um began Spethman’s transplant. Even though it was his third in two days, Dr. Um was prepared and ready to go. He couldn’t let Spethman miss out on his second chance at life.

“I have a couch in my office where I can put my feet up, get some sleep and grab a coffee,” explains Dr. Um. “We also have multiple teams that are able to come in. They’re refreshed as well. This allowed everyone to be working at the best possible level. It’s a testament to the med center to invest in those resources and have the personnel to do those things.”

On May 11, all three patients met each other for the first time. They also thanked Dr. Um for his incredible work.

“I feel great. I’m walking around – about a mile or more a day,” says Kollars. “I want to thank Dr. Um and Dr. Aleem Siddique. They saved my life about nine different times.” “If it weren’t for the team at Nebraska Medicine, I wouldn’t be here. . It’s amazing what they do,” adds Spethman. “I’m now walking down the sidewalk and planting flowers again. It’s incredible.”

“One day, I’m going to come back and buy them a box of donuts,” laughs Brandy. “To show my appreciation.”

To learn more about the three heart transplants in 34 hours, watch this video: