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

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

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

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

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

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

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.

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:

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.”

Jenna Zeorian
September 20, 2012

 
 She typed the words “leading lymphoma treatment center” into the Google search box and pressed enter.

 It was September 2004 and Chris Pilcher-Huerter of Omaha, was now seeking treatment advice for her newly diagnosed Hodgkin’s lymphoma.

 The search results that appeared on her computer screen matched what she already knew — what everyone, including her family full of respected medical professionals, had told her. The best option was only a few miles from home— the University of Nebraska Medical Center.

 The home team

Pilcher-Huerter made an appointment with international lymphoma expert Julie Vose, M.D., chief of the UNMC Division of Oncology and Hematology and a 1984 UNMC graduate. Soon after, she met her medical team and began treatment.

 “I could’ve gone to one of the most well-known cancer centers in the country,” Pilcher-Huerter said. “But after my initial meeting with Dr. Vose, and the immediacy the team showed, I chose with confidence to stay right here at home.”

 Grateful volunteer

Now three years cancer-free, Pilcher- Huerter “strives to pay it back” to the place and the people that gave her life back. She is an active volunteer at UNMC where she serves in many capacities, including as a member of the Patient Family Advisory Council.

 It was through her work with the council that Pilcher-Huerter first became aware of the plans for a new cancer center on the UNMC and The Nebraska Medical Center campus in Omaha.

 Better for patients

The center, a $370 million project, will provide the entire scope of cancer treatment and therapy by a multi-disciplinary team, bringing together physicians, nurses, pharmacists, cancer researchers and others in an environment where research and patient care seamlessly integrate.

“From a patient’s point of view, going from one clinic to the next to the next can be very trying,” she said. “The whole idea of having physicians, scientists, clinics and treatment facilities in one place is going to be so much more convenient for patients, for loved ones, for family members. And to have that here in Nebraska is absolutely unbelievable.”

Better for discoveries and new treatments

Translational cancer medicine — taking research from bench to bedside — will increase dramatically.

“Laboratory researchers will literally be shoulder to shoulder with practicing physicians,” said Kenneth Cowan, M.D., Ph.D., director of the UNMC Eppley Cancer Center. “Their proximity will hasten the transfer of discoveries from the lab into new treatments that benefit patients.”

 Statewide impact

“Not that I plan on having cancer again,” she said with a laugh, “But this will elevate the superior care that’s right here in our backyard. And it’s going to impact all Nebraskans, not just the ones with cancer.”

 The center would create an estimated 1,200 highly skilled jobs and infuse $100 million into the state economy. And it will position UNMC and The Nebraska Medical Center to earn the National Cancer Institute’s top designation of Comprehensive Cancer Center.

 This achievement would place the medical center among the 40 best cancer centers in the country.

A little more than half of the people in Nebraska who should be getting colonoscopies actually do.

“There are things we know we can do something about early: prostate cancer, breast cancer, blood sugar control, and colon cancer,” said Grant Hutchins, MD, gastroenterologist at The Nebraska Medical Center. “These are things in which we know we can make a difference early and can prevent a lot of mortality down the road.”

Dr. Hutchins and Gary Volentine, MD will see patients at a new endoscopy center opening this week at Village Pointe Medical Center near 180th and West Dodge Road in Omaha. Both physicians will begin seeing patients Friday, Sept. 7.

The center’s opening comes at a time when there is a renewed push across Nebraska to educate people about the importance of colonoscopy screening and colon cancer prevention. Colonoscopy is very effective at finding polyps and pre-cancerous lesions in the colon.

“The cure rate for colon cancer is excellent – if it’s found early.” Dr. Hutchins said. “It’s the people who don’t get screened when they’re young or have symptoms that they ignore, that unfortunately present later with disease that has spread to a lot of places.”

Dr. Hutchins recommends most people begin regular screenings at age 50. He advises others, including African Americans and those with a family history of colorectal cancer to begin screening at age 40. If there is a family history of colorectal cancer, the first colonoscopy should be performed ten years before the age that a person’s first-degree relative (parent or sibling) was diagnosed.

Dr. Hutchins advises people to ask their family doctor when they should begin screenings and to tell their doctor about any colon cancer symptoms such as a change in bowel habits or blood in the stool.

“We know people aren’t exactly clamoring for colonoscopies,” Dr. Hutchins said. “But it’s not a painful procedure. It is uncomfortable, but it’s not painful. And it is very important and very effective. We hope this new center will give patients more options to have their screenings done closer to home.”

Patients often have questions about the need for colonoscopies and what it takes to prepare for the screening. Dr. Hutchins answers many of those questions in a short video posted on The Nebraska Medical Center’s YouTube channel.

Twitter helped connect donor and recipient

Kansas pastor Mike Bronson knew for years that a kidney transplant might be necessary. In 2009, it became a reality. His doctors said he was in end stage renal disease and needed a transplant.

“Once news became public, I was overwhelmed with the number of people offering to donate a kidney, Bronson says.

Family members, friends and members of his church all wanted to help.

-Transplant recipient Mike Bronson serves as pastor at West Haven Baptist Church in Kansas

“Another man in my church went through the entire battery of tests. At the very end, he was disqualified due to a ‘minor’ heart problem. It turns out that heart problem became major. He had two successful surgeries since but the problem may not have been uncovered in time without his desire to donate.”

Bronson tweeted about his search for a donor. That’s how he re-connected with Tonya Blythe, whom he had baptized several years before.

“Mike was a pastor at my church in Jefferson City, MO, but he had moved away and we lost touch,” Blythe recalls. She was still following him on Twitter.  “By the time I became aware of his need, he’d been on the waiting list for a year.”

Blythe contacted Bronson and began the process of getting matched.

“I thought, ‘This won’t work,’” she said, “But I kept getting green lights.”

Blythe turned out to be a match, but there was one thing that still wasn’t right.

“We didn’t feel comfortable at our transplant center, so right before we were going to be approved for transplant, we started looking elsewhere,” Blythe said.
 
-Kidney donor Tonya Blythe says the transplant will teach her children the importance of giving selflessly

“I stumbled across The Nebraska Medical Center,” Bronson said. “I sent Sue Miller an email and our experience was tremendous. Sue gave my wife and me a tour and after speaking with Tonya and her husband Jon, we were convinced God was sending us to Omaha.”

“We went out on a limb and said, ‘Let’s go to Nebraska and start over,’” Blythe said.

As the donor, Blythe says she had no second thoughts when it came time to come to the medical center to give her former pastor one of her kidneys; especially when she learned it would not affect her ability to have another child.

“As it was happening, I had this overwhelming feeling of, ‘Why don’t more people do this?’” she said. “This is a legacy of giving. I want others to know that giving is important. I want my children to understand: this is who we are as a family.”

-Transplant recipient Mike Bronson stands with his family at his son’s recent wedding

Three years later, Bronson says he is still sometimes at a loss for words when he thinks about the gift he received.

“You would think that a pastor who writes sermons and Bible studies weekly would be able to express himself well, but I still struggle to express my gratitude with clarity,” he says. “I still cannot believe that she was willing to subject herself to numerous tests, pain, great inconvenience and surgery and to save my life.”

Kidney disease continues to challenge Bronson even after the transplant. Continued treatment here and in Kansas City has slowed the disease’s progress and he remains optimistic and thankful. Not only for his donor, but also for Sue Miller; transplant coordinators Lori Schmida and Kim McAnally as well as co-directors of the kidney transplant program Drs. Cliff Miles and Michael Morris.

-Kidney recipient Mike Bronson talks with his donor Tonya Blythe after the transplant at The Nebraska Medical Center in 2009

Marcia Shanahan’s regular mammogram didn’t show anything. But during a routine check-up, her doctor felt something.

“I really believed at the time it was going to be nothing,” Shanahan says. “But after the biopsy when they said the word ‘cancer,’ it got scary.”

Shanahan felt like she needed a second opinion. On the advice of a friend, she contacted James Edney, MD, a surgical oncologist at The Nebraska Medical Center.

“Women may have two surgical options when they have breast cancer,” Dr. Edney explains. “Mastectomy is one; and breast conservation, where we remove the lump and leave the breast behind is the other.”

Dr. Edney says lumpectomy is followed with a course of daily radiation that typically lasts six weeks.

“This can create a real problem for people depending on their schedule,” Dr. Edney says. “There are geographical barriers, especially when you’re in a place like Nebraska where a patient may have to drive 250 miles a day for treatment.”

He says of all women who get breast cancer, about 75-percent of them are candidates for breast conservation. However, he says only 35-40-percent of that group follows through with conservation because of the logistical barriers and time commitment. When Shanahan met with Dr. Edney to discuss her options, he explained to her a new procedure called Intrabeam, a type of interoperative radiation therapy (IORT). Instead of six weeks of treatment following surgery, Intrabeam patients have their surgery and radiation in one session lasting about 90 minutes.

“It sounded really good,” Shanahan remembers. “I said, ‘Sign me up.’”

After the surgeon removes the tumor, a special bulb-shaped applicator is inserted into the cavity where the tumor was before. The applicator is attached to a portable radiation machine through which a radiologist applies a low-dose of radiation to the affected area and its surrounding margins. The entire process typically takes between one and two hours. Dr. Edney describes it as a team effort between surgical oncologists and radiation oncologists. He also believes this approach will become much more common in the years to come.

“I think that it is our responsibility as an NCI-designated cancer center to provide those kinds of options that may not be available anywhere else.”

The Nebraska Medical Center and UNMC have played an important role in the development of Intrabeam therapy for breast cancer. Their involvement began early during clinical trials when the medical center was one of just four centers in the United States participating. With solid clinical data showing this approach to be effective, it’s now becoming more widely available, though still only available in this region here at the medical center.

“What we found with over five years of follow up, is that the results are equivalent to traditional treatment,” Dr. Edney says. “The cosmetic results were far superior with Intrabeam because we are not irradiating the entire breast and overlying skin.”

Women who undergo whole-breast radiation often deal with red, irritated skin and changes in breast density. Since Intrabeam patients only receive radiation in a small area inside the breast, those side effects are greatly reduced.

Six weeks after her Intrabeam procedure, Marcia Shanahan is back at work. She is undergoing chemotherapy to reduce the chances that the cancer will come back. As she looks back at all she’s been through in the last several months, she is very happy she asked about a second opinion.

“I wouldn’t have known if I had stayed in my original healthcare system,” she says. “I was so excited when I heard there was this option. It made a huge difference for me.”